In May 1983, Farmer came to Cange, Haiti for the first time. He was immediately struck by the crudeness of the dwellings in the town—most were made of old wood. Many of the people he saw were also visibly ill in some way, and it seemed that there was no medicine available. Farmer was awestruck that an entire community could endure so much poverty.
Although Farmer grew up in a working-class home, he also grew up in America, meaning that he has no first-hand experience with the level of poverty he witnesses in this scene. In essence, this scene represents everything Farmer has to confront during his time in Haiti.
Farmer left Cange shortly after visiting, as he had more work to attend to in Port-au-Prince. It was there that he contracted dysentery. During his sickness, Farmer studied liberation theology, and read more about the history of Voodoo. In liberation theology, the emphasis is on righting the world’s wrongs here and now—not waiting for God to solve these problems in the afterlife. It especially emphasizes helping the poor, and also fixing wrongs that exist on an institutional level as well as a personal one.
Although Farmer has plenty of religious doubt, he embraces liberation theology—originally a quasi-socialist form of Catholicism, but now applied to other denominations as well. Farmer seems to accept this doctrine because of its usefulness: even if he doesn’t think that Catholicism is literally true, adhering to liberation theology helps people to focus on the here and now and address the world’s concrete problems.
Shortly after recovering from his dysentery, Farmer met a young American doctor. Once, when the young doctor was about to fly home, Farmer asked him if he was sad about being sent back to the U.S., where he’d be unable to continue helping the Haitians. The doctor replied, “I’m an American and I’m going home.” Farmer remains baffled by this mindset—the idea that people should restrict their kindness and generosity to people who are like them.
Most people think of themselves in national terms: as an American, a Haitian, an Italian, etc. Farmer finds this way of thinking self-consciously narrow-minded, and indeed can’t even relate to it. For him, The truly good person should be able to help anyone who needs help, whether he shares citizenship with them or not.
Inspired by his studies of liberation theology and his experience with the young doctor, Farmer set out establishing new hospital facilities in Haiti. Using his college connections in the U.S., he raised money for blood-banking equipment, and helped install it in a hospital in the town of Léogâne. But over time, Farmer became disillusioned with the hospital—it catered too exclusively to the wealthiest Haitians, leaving the truly desperate Haitians unaided. He decided to build “my own fucking hospital.”
Farmer’s criticism of existing healthcare in Haiti is that it only furthers the existing inequalities of Haitian society, rather than eliminating them. If the wealthiest and most powerful Haitians get the best healthcare, then over time inequality only becomes greater and greater—essentially echoing the way first-world countries treat Haiti as whole, so that poverty is never eliminated. Farmer’s emphatic phrasing shows just how frustrated he is by human corruption and limitations—not just that of Americans, but of Haitians as well.
Farmer went to the Haitian town of Mirebalais to work for the priest Père Lafontant. Lafontant’s clinic exemplified the same problems as many of the other clinics Farmer had seen in the country: patients had to wait in line for hours to see a doctor who didn’t ask about their medical history, and often gave them sub-par treatment. With Lafontant’s permission, Farmer began to spend more time in the poverty-stricken town of Cange, where there was no clinic at all. Farmer conducted research to determine what kind of clinic would be best suited to Cange’s needs. Farmer found that a huge percentage of premature deaths in Cange were infant or childbirth mortalities.
Farmer again uses his anthropological training to help others and improve his medical practice. While most doctors in the area confine their questions to the bare minimum—symptoms, etc.—Farmer uses his innate sense of compassion and curiosity to ask other pertinent questions, becoming a much more competent doctor in the process. Farmer conducts macroscopic research to determine what kind of help his patients need—a project that most doctors would find impractical.
In early 1984, Farmer was treating a young woman in Cange who suffered from malaria. While the woman’s father wanted her to be treated with Voodoo methods, Farmer convinced him to allow him to use his American medical training. Farmer’s treatments were a complete success. And yet he couldn’t stop thinking about the importance of Voodoo in Haiti. He quickly decided that the best doctor in Haiti would be one who had mastered American medicine while also respecting and understanding Voodoo culture. Only this kind of doctor would be able to separate his patients’ bodily problems from superstitions, and provide the best treatments.
It’s almost common sense that a good Haitian doctor should understand Voodoo, even if he doesn’t believe it. The fact that so few American doctors practicing in Haiti understand Voodoo at all is evidence of the nationalism and condescension often inherent in American healthcare in the Third World. While there are many goodhearted doctors who devote their time to helping the Haitians, they still think of the Haitians as somehow alien or childish. Western beliefs like Christianity are considered valid “religion,” while Voodoo is only “superstition.”
Kidder loops back to discuss Farmer’s training in medicine. In 1984, the 24-year-old Farmer enrolled at Harvard Medical School. He spent almost half of this year in Haiti, and only showed up at medical school just often enough to pass his classes, but no more. And yet Farmer’s grades were some of the best in his class. He was highly respected among his fellow students, as they knew that he was devoting his time to helping the Haitians.
It’s impressive that Farmer maintains impeccable grades during this entire time, and this only reiterates the fact that his decision to pursue hands-on work in Haiti is a true anomaly. Most doctors with Farmer’s academic brilliance would choose to go into high-level research and never see a patient again, while Farmer, by contrast, establishes his own practice, and even still performs house calls.