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Paul Farmer
Pathologies of Power: Health, Human Rights, and the New War on the
Poor
University of California, Berkeley, 2003, 402 pp. hb
Pathologies of Power is a progressive book by a medical doctor and anthropologist who has worked 20 years in Haiti. He has also done some work in Lima, Tomsk and Boston with a focus on serving the poor that he says is inspired by Liberation Theology, the Catholic movement of Latin America that took its analysis from Marxism.
Though an anthropologist, Farmer has considered and rejected post-modernism. In his studies, culture is not a strong explanatory factor. In fact, people of the same superstitious beliefs enjoy different levels of health because of money according to Farmer, who says that his study of rural people in Haiti proved to him that culture is not an important explanation of the health gap between rich and poor.
Farmer calls himself a positivist without explaining how he connects that to Liberation Theology. Apparently the agenda is Liberation Theology while the rest may be positivism.(p. 69) The relevant post-modernists would call MIM "positivist" as well for rejecting post-modernism and believing that Marxism is scientific.
In a review of an interdisciplinary book on violence, MIM said that it is now more likely that an analysis of structural violence will appear in epidemiology than the imperialist country humanities or social sciences. Farmer's book appears as a vindication of that prediction.
Farmer's basic point is internationalist, that the elephant standing in the room is the structural violence against the global poor. We also agree with Farmer on his global priorities.
Gender
Farmer is a rare writer who agrees with MIM on gender. His witnessing of how an AIDS epidemic developed in Haiti caused him to question the whole idea of "'consensual sex.'"(p. 39) It was only too apparent to Farmer that wimmin ended up with AIDS from men that wimmin needed for economic reasons.
We can say as the Liberals do that Haitian wimmin or African wimmin knowingly "choose" to have sex with HIV-infected soldiers with the advantage of government salaries. MIM points out instead that stupid Liberals are then saying that people "choose" to die young. Liberalism on AIDS in poor countries where proper medications are lacking is even more pointless than saying that Katrina victims chose to die instead of paying for a bus ticket out of town. The suffering and deaths should have been a clue to the Liberals that their view of choice is worse than irrelevant. We need to do as Marx did and look below the surface of what people say to the real social relations underneath.
Farmer also has a few pointed elbows for imperialist country pseudo-feminism that he senses misleads people on the real sources of the largest problems. For example, he is concerned that the agenda against the "glass-ceiling" misses the real inequality in the world.
Ex-Soviet bloc
Farmer goes into some detail on Cuba without swearing by its alleged socialism. We agree with him that neighbor Haiti run by the United $tates is a total wreck compared with Cuba. Farmer gives us the details on the sanatoria for AIDS in Cuba. At first these sounded repressive in the West, but when we look at the results, it's easy to see how many countries did so much worse than Cuba on the AIDS question. So while we consider Cuba state-capitalist, we do not begrudge Farmer on the facts or his comparison with Haiti.
Farmer is also engaged in serving the poor in Tomsk, Siberia. There again, Farmer is right on the money with prisons and internationalism. People who study tuberculosis, prisons and the international situation are highly likely to come to MIM-like conclusions.
Farmer points out as MIM does that Russia and the United $tates lead in imprisonment. Vicious anti-lumpen ideology endangers not just the lumpen but all people in the world, because poor treatment of prisoners leads to the formation of drug-resistant strains of tuberculosis (TB). Whenever tuberculosis rears its ugly head and whenever we find it, we (the species) have a self-interest in eradicating it as soon as possible, both so new "bugs" do not develop and because being mean to prisoners only ends up costing all of society more resources and deaths later.
Many people in Russia are developing multi-drug resistant TB, because aid agencies and the Western medical profession believe that second-line drugs necessary are too expensive for Russia to implement and that it will end up being done poorly in such a way that even more new TB bugs will develop. These doctors believe that once TB defeats the second-line drugs, the risk of a TB epidemic increases even further, even for the rich, so they are holding back from treating the Russians. In contrast, Farmer says he succeeded in treating multi-drug resistant TB in Haiti, so why not Russia.
In fact, we owe Farmer for a first. MIM had never heard of any Soviet era dissidents doing prison work in the post-Soviet era. Farmer not only knows of one but offers us this little snippet: "'During my six years in Soviet prisons I lived through many horrors.'" The same dissident now says that with the explosion of prison crowding and tuberculosis, "conditions in normal jails were not this bad even under Stalin."(p. 190)
Now Russian prison officials admit to failing to live up to international standards and violating the law of their own land. They simply do not have the resources to be able to implement what they would like. (MIM would say that the turn to U.$.-style capitalism made this inevitable, because the more prisoners a system puts away, the more resources necessary to care for them.) So with the crowding and tuberculosis situation bad in both the United $tates and Russia but even worse in Russia, Russia too has a claim for being the world's worst prison situation overall. The young men dying of TB in Russian prisons or shortly after release are just another reason that Russia's life expectancy plummeted by trying to copy the united $tates.
Amerika
Having spent 20 years in Haiti, Farmer is a natural for the MIM line on the U.$. public. Even though the U.S. Government only approves 0.5% of applications by Haitians seeking asylum in the united $tates, 55% of the U.$. public thinks that is too much. Only 20% favors a more open border policy toward Haiti. (p. 68) This is exactly the percentage MIM points to all the time in reference to a group we are seeking to mobilize.
"I can't help but making connections between the surfeit on one side--and the paucity on the other. As an infectious-disease consultant, I feel that my job in Haiti is to say, 'Quickly, start the antibiotics,' whereas my job in Boston often comes down to 'stop the antibiotics.'"(pp. 203-4) In Amerika most of the ethics issues seem to come in at the end of a long life. Meanwhile in Haiti, he has to explain to patients why it is not in the budget to treat them while in Boston he may meet Haitians who he has to advise to take the drugs available to them.
On the whole Farmer does not agree with MIM's line, but in the concrete details we can see in this book many of the pieces of MIM line.