The term “preferential option for the poor” is a term bandied about by theologians and educators alike, especially those who have an interest and commitment to bettering the life conditions and opportunities of those who benefit least and suffer the most in our society and world at large. I have often used that term, and see myself as one committed to the addressing the issues of poverty, injustice and oppression in our world. However, when I read about Dr. Paul Farmer, the subject of Tracy Kidder’s book Mountains Beyond Mountains, I gained a deeper understanding of just what saying I am committed to helping the poor really is committing me to.
As Kidder portrays him, Dr. Paul Farmer is an infectious disease specialist with both an MD and PhD in anthropology, who has committed his life to serving the health needs of poorest of the world’s poor. His home base is rural Haiti, where he has served as a clinician for decades while sharing his experience and expertise regarding AIDS, TB and other infectious diseases at the highest levels and some of the most desperate localities in the world. The organization he founded with a few other like-minded individuals, Partners in Health (PIH), has a record of addressing some of those most pernicious diseases in some of the world’s poorest and oppressed places.
Farmer’s accomplishments alone cause him to stand out, but his radical commitment to the poor has translated into an approach to life and work that puts all of us who consider ourselves to be progressives and social justice activists on notice. For Farmer poverty is not an “issue,” but real individual people to whom he has made himself a servant. Even after gaining international renown for his breakthrough work on medical diseases, Kidder describes how Farmer walked 11 hours through the rough Haitian terrain to check up on one patient and his family from his clinic in Cange, Haiti. When asked if that was time well spent when he could be consulting around the world, Farmer replied “I am a doctor, he is my patient, that’s all that matters.”
More than that Farmer has not gathered to himself the material advantages of being a doctor and of being a globally-renowned figure. He often travels to meetings around the world with one rumpled suit bought for him at a thrift store. Wherever he goes he seeks out patients who may be in need of his services. Moreover, he judges the effectiveness of his program and of any national or international health policy, on how well it benefits the poorest of the poor. For that reason Farmer regards the Cuban health care system, with lower infectious disease rates than the United States to be one of the best in the world despite it supposedly Communist leanings. Poor people are served as well others – that system works. One can only wonder what he must think of the current debate in the US around universal health care, and whether or not we can “afford” to make sure 50 million uninsured Americans are covered. My guess is that Farmer would be extremely critical of the capitalistic assumptions underlying the debate and suggest that the health care system itself is bloated at the top by insurance companies, drug companies, physicians, and lawyers all fighting for their big piece of the pie, while the poor go untreated.
While Farmer has been successful at one level in providing insights into ways countries can address the infectious disease problems in their countries, serves on the faculty Harvard Medical School, and regularly consults with international health organizations, he recognizes that taking the option for the poor or the “O for P” as he calls it, is a long and frustrating struggle. Near the end of the book, Kidder quotes Farmer saying:
“I have fought my whole life a long defeat…I have fought the long defeat and brought other people on to fight the long defeat, and I’m not going to stop because we keep losing. Now I actually think sometimes we may win. I don’t dislike victory…You know, people from our background ….we’re used to being on a victory team, and actually what we’re really trying to in PIH is to make common cause with the losers. Those are two different things. We want to be on the winning team, but at the risk of turning our back on the losers, no, it’s not worth it. So you fight the long defeat” (p. 288).
To work on behalf of the poor requires personal sacrifice and a commitment to the long defeat with a few victories scattered in. Fighting the long defeat is not just volunteering or doing “pro bono” work every once and a while. Rather, it is to see one’s well being and destiny tied directly to real people with real needs who have been beaten down and neglected by the very systems that purport to help them. I thank Dr. Paul Farmer for helping me see that the option for the poor is a meaningless idea without putting my life behind it, and taking time to consider ways in which we may have allowed our lives to undermine our own rhetoric.