It’s almost impossible to understand Doctor Paul Farmer’s attitude toward healthcare and nonprofit work without first understanding his attitude toward American foreign policy. In general, it’s important to understand the way Farmer defines the uneasy relationship between the First World—countries with wealth and power—and the Third World—countries that lack these things.
In Farmer’s view, the United States has been a major imperialist aggressor for hundreds of years, with often-disastrous consequences for the Third World. Although the Caribbean nation of Haiti became an independent republic in the 1790s—only a few years after the U.S. itself—it would be decades before America recognized Haiti as such. Instead, America treated Haiti as a tribute state, establishing businesses in Haiti that were designed to send the country’s key natural resources back to the U.S. As the U.S. became the major military power in the Western hemisphere, and then the world, it pursued a strategy of funding military dictatorships in Haiti, believing that a repressive Haitian state would be advantageous for American business interests. Farmer contrasts Haiti—an impoverished country that’s been effectively controlled by the American military and economy for the last 200 years—with Cuba—a healthier, far more prosperous country that’s largely avoided American imperialism, and has been condemned in America for its Communist leadership.
Understanding Haiti’s fraught history with the U.S. is a vital part of Farmer’s work in the country. Many who live in America know nothing about their country’s relationship with Haiti, or assume that the relationship has always been friendly and supportive. As a result, there is a tendency in America to “blame the victims”—in other words, to conclude that the Haitians (or, for that matter, the people of any Third World country) are impoverished and unhealthy because of their culture or society. Farmer believes that the opposite is the case: if anything, the suffering in Haiti is indicative of a long, unfair relationship with the U.S. that has kept Haiti poor and disorganized, and was to some extent designed to do so.
Although Farmer often has to censor his own political views (his collaborators and donors don’t always share his beliefs), his view of the U.S. and of the First World is an important aspect of his work. The role of the doctor, he believes, isn’t simply to cure the sick, but rather to fight the structural inequalities that cause sickness throughout the Third World. An ordinary doctor might treat Haitian typhoid victims, but a politically-minded doctor like Farmer might try to rebuild the Haitian sewer system that was destroyed in wars sponsored in part by U.S. government officials. Perhaps Farmer’s most important political action is to broadcast his views of Haiti and the U.S. in books and interviews. In doing so, he educates people in the First World and makes it more difficult for them to blame the victims in the Third World.
America, Imperialism, and the First World ThemeTracker
America, Imperialism, and the First World Quotes in Mountains Beyond Mountains
The world is full of miserable places. One way of living comfortably is not to think about them or, when you do, to send money.
And then of course it dawned on him that he knew plenty of Americans—he was one himself—who held apparently contradictory beliefs, such as faith in both medicine and prayer. He felt, he said, as though he hung in the air before his patient, “suspended by her sympathy and bemusement.”
But independence had been followed by nearly two hundred years of misrule, aided and abetted by foreign powers, especially France and the United States. (From 1915 to 1934, the U.S. Marines had occupied and run the country.) To Farmer, Haiti’s history seemed, indeed, like The Lord of the Rings, an ongoing story of a great and terrible struggle between the rich and the poor, between good and evil.
A doctor who knew nothing about local beliefs might end up at war with Voodoo priests, but a doctor-anthropologist who understood those beliefs could find ways to make Voodoo houngans his allies. A doctor who didn’t understand local culture would probably mistake many patients’ complaints for bizarre superstitions.
Some people said that medicine addresses only the symptoms of poverty. This, they agreed, was true, and they’d make “common cause” with anyone sincerely trying to change the “political economies” of countries like Haiti. But it didn’t follow, as some self-styled radicals said, that good works without revolution only prolonged the status quo, that the only thing projects like Cange really accomplish is the creation of “dependency.”
He’d write about how the Centers for Disease Control, a federal U.S. agency, had gone so far as to identify Haitians as a “risk group,” along with several other groups whose names began with h—homosexuals, hemophiliacs, and heroin users—and about the incalculable harm all this had done to Haiti’s fragile economy and to Haitians wherever they lived. In his thesis, he’d marshal a host of epidemiological data to show that AIDS had almost certainly come from North America to Haiti.
In early 1994, just before The Uses of Haiti came out, Farmer wrote an editorial for The Miami Herald. The gist of it was: “Should the U.S. military intervene in Haiti? We already have. Now we should do so in a new way, to restore democracy.”
Farmer was forty now, and he had the credentials to operate in the way Hiatt envisioned, on a purely executive level. In academic circles his reputation had grown. He was about to become a tenured Harvard professor. He was near the head of the line for the big prizes in medical anthropology; some of his peers were now saying that he’d “redefined” the field.
If you say, Well, I just think how much could have been done with twenty thousand dollars, you sound thoughtful, sensible, you know, reasonable, rational, someone you really want on your side. However, if you were to point out, But a young attending physician makes one hundred thousand dollars, not twenty, and that’s five times what it cost to try to save a boy’s life—that just makes you sound like an asshole. Same world, same numbers, same figures, same currency.