Paul Farmer (1) (1959–2022)

Paul Farmer writes about the Ebola epidemic in Western Africa in 1014. His emphasis is on the fact that epidemics of contagious diseases do not occur in a vacuum, but instead are result of social, medical, and economic deficits that provide opportunities for a disease to rage out of control.

After an description of the clinical desert that existed in West Africa at the time of the outbreak, he describes the sequences of events, almost as if in real time. Then he turns to the history of the show more area, including the extractive colonialism by European countries and slave trading. Colonial rule meant that these areas were raided for people and natural resources, often heavily taxed and with forced labor, with little to no investment in infrastructure such as health care, education, or basic sanitation. Even while expat colonials living in the colony might enjoy these things within their own compounds. Upon gaining freedom, these countries were left destitute and vulnerable to any factions that hungered to rob them of any remaining natural resources.

The theme through the book is the lack of: staff, supplies, space, and systems to provide basic health care. And the hold over of a philosophy of containment of disease over one of providing medical care that arose in the colonial era. This goal of containment of ebola was the dominant approach during the 2014 epidemic, resulting in many needless deaths. Yet, western medical providers who were airlifted out of the region and provided with 21st century medical care survived their ordeal with the disease. The result is a deep distrust of medical authorities within the region.

Farmer also emphasizes the understanding of social medicine in the context of local cultures for the successful delivery of medical care, citing the work of social psychologists and anthropologists.

Finally, it becomes clear that these clinical deserts are likely to contribute to further epidemics and pandemics in the future, unless we as a society work to equalize the availability of staff, stuff, space, and systems to provide medical care through out the world.

The writing reminds me of Sebastian Junger and Frank Snowden, whose works are both cited in this book. There are segments where the author's anger clearly comes through...but it is a righteous anger formed from his life's work of dealing with difficult contagious diseases. show less

Paul Farmer is a genius and is worthy of reading by anyone interested in his field of medical anthropology. An MD/PhD professor of Harvard and founder of Partners in Health, Farmer, perhaps better than anyone else alive, embodies the ethic that health care is a human right.

In this book, he writes on his experiences in Haiti. He writes of fighting AIDS and Tuberculosis. He points out that poverty is not only correlated with these diseases but is perhaps a cause. By his broad training, he show more spans two schools of thought about how to fight these diseases. Poverty must be fought, but so too must the diseases. That is, the diseases synergistically amplify the poverty, and poverty, in turn, amplifies the diseases.

Unfortunately, AIDS (sida in Haiti's Creole language) and TB form a synergy amongst each other that haunts the public health of this island-nation. Farmer's work is laudable as always, and the needless expense of human capital in Haiti at the hands of disease and poverty - yes, infections and inequalities - is an immense tragedy. One wonders how Haiti can prosper. Certainly more Paul Farmers would help. show less

Global health is a field known, in the past, as international health and colonial health. It has recently sought to center itself around health equity - that every person deserves decent healthcare to have a decent life. Thus, it has tried to remove any shackles of Western imperialism from its conceptualization. Also recently, Paul Farmer and Partners in Health have brought attention to the field, especially in Haiti and Rwanda. A large braintrust centered around Harvard University has show more worked with them. Out of such hard work with thoughtful reflection comes books like these. It not only can serve as a global health textbook for the next generation, it can map out a future world of work.

This work offers twelve scholarly examinations of issues in the field of global health. Expect to have a few braincells strengthened. It incorporates much anthropology, philosophy, medicine (of course), and international politics to paint a rich, three-dimensional picture of what's going on globally in healthcare. I doubt there's any better one-volume introduction to the field.

Of course, things have changed in the dozen-or-so years since this text was penned. The American government, a large funder, has mercurially and blindly chosen to become hostile to global health initiatives. Yet efforts continue to help the "lowest billion" in Africa and Asia. The authors reiterate that such aid has to take a holistic approach to healthcare system reform by placing poverty, infectious disease, maternal care, children's education, and women's rights on equal footing. An entire system must be build with partnership from all interested parties, with priority given to the perspectives of those on the ground.

If you are at all interested in global healthcare from an academic perspective, this is a book for you to read in depth. It offers insightful analyses, interesting stories, and a wide-ranging vision that simply cannot be garnered elsewhere. I'd argue that, at nearly 500 pages, this book offers a bit more than an introduction to an intriguing field. Instead, it offers a comprehensive vision for a better world if we're willing to take some of its inspirations and enact them, each in our own way. show less

I received this book as an audiobook through the Early Reviewers Program. I don't usually listen to audiobooks, but this particular book lent itself well to the format because I just felt like I was listening to a lengthy NPR piece. It begins with Paul Farmer's account of the aftermath of the earthquake in Haiti. He describes the devastation to both physical structures, such as the hospital, and public systems, mainly due to loss of life. He also details efforts to assist the Haitians in the show more direct aftermath and in the months following the earthquake. One of the most interesting sections deals with a cholera outbreak that occurred several months after the initial disaster. This led to a debate in the international community over whether cholera vaccine administration would be effective or worthwhile. Farmer's assessment of the disaster as an "acute on chronic" situation serves as a warning that the scale of this disaster was not inevitable. Haiti already existed in a chronic disaster state in which public infrastructure could not sufficiently serve the majority of its people. The book continues with a variety of first-hand accounts from Haitians and foreign aid workers. These all lend different perspectives to the disaster and recovery. The overarching theme is that the international community must help Haiti to "build back better" and that this is probably best accomplished by direct assistance to Haiti's government for specific items such as teacher's salaries. The old Haiti, an underdeveloped country with a hodgepodge of uncoordinated NGOs running many of the social services, was clearly a disaster waiting to happen. show less