After exam week, finally got a chance to read Mountains Beyond Mountains - the best-selling biography of Paul Farmer. Very legit, an inspiring tale of how a student (and former Dukie!) can revolutionize health with passion, intelligence, and reckless ambition. Farmer's tale of defying the status quo serves as an empowering reminder that current protocol in domestic/global health is by no means ideal - that all it takes data and compelling reason (even if it comes from 20-year olds) to change the direction of an entire field.
From the book, you can tell Farmer's impact originated from source: dedication to individual patients. While he changed WHO policy left and right, that didn't matter to him as much as the one TB patient who needed help in Haiti. Rather than sit in conference rooms debating language for declarations, he would instead prefer hiking 7 hours to check whether his impoverished patients were taking their meds. This was his fuel - these faces and stories were his motivation. Sometimes, his solutions weren't "cost-effective" - why spend $20,000 on a Med-Evac for one patient when that could buy 1,000 vaccines for others? In a world of limited resources, Farmer's approach diametrically opposes that of public health - which aims to maximize health benefits or utility (or some other econ jargon) over a population.
This conflict is an important one for us students to figure out. Sure, it's easy to say that the best doctors will be both centered on the individual and cognizant of the population. But what will we care about more? As someone that's passionate about policy, I lean towards the public-health, "cost-effectiveness" side of spectrum - it's practical and realistic. But, maybe Farmer has a point. Maybe before we start talking like we know something, we need to get grounded in a community (whether that's Haiti or Durham). Perhaps that's the only way we'll know what social justice actually looks like.
Farmer caught a lot of flak for his position on treating individuals. There can't be possibly be enough resources to do that, right? Yet, maybe if we all had his collective "naivete", we could make his realization come true.
Thanks for this Sanjay.
ReplyDeleteRelated to this, one comment struck me @ the Newark Peace Summit (if you are interested, see more http://newarkpeace.org) with His Holiness the Dalai Lama, Martin Luther King III and Iranian peace activist Shirin Ebadi.
MLK III, the eldest son of Reverend MLK Jr and the late Coretta Scott King, relayed a teaching from MLK Jr on peace. He said we could either be thermometers or thermostats. Thermometers passively record the temperature whereas thermostats actively regulate the temperature -- up or down. He said to reach piece we need to pivot from documenting injustices to actually doing something about them --
This struck me. Now in my 10th year in a university community, I find that we (The Academy/ Academia ) are more than content to publish our work in leading journals (tenure committees, in particular, reward this). The pressures in leading universities are no doubt passed on to graduate students and to undergraduates -- we are led to believe collecting more and more evidence is the way to go. My training has led me to be a very adept thermometer.
But where is the training for becoming a thermostat? Advocacy? Has service-based learning taken off? Or is it restricted to just a select group of students at a select group of institutions? Is there curricular space/ protected time/ leading professors who are awarded tenure for their advocacy or community mobilization? If they are around, I haven't met them.
I'd be keen to learn how you or your institutions start to build a culture and climate of training folks to be thermostats, to thoughtfully translate evidence into action and to measure impact in sensible ways.
Ah, realized I spelled "peace", "piece". Awesome.
ReplyDelete