Pathologies of Power: Health, Human Rights and the New War on the Poor by Paul Farmer, was, over-all, well worth reading.
It’s a tough, academic book and covers challenging subject matter dealing with suffering and even torture of human beings.
He weaves together both his personal experience as a physician working in some of the world’s most impoverished communities with medical and anthropological knowledge.
The book covers clinics in Haiti, case studies in Peru, multi-drug resistant tuberculosis in Russian prisons, peasant uprisings in Mexico and Central America and even health care inequality in inner-city America, to name a few.
It makes for a strong call to work for justice for the least of these and addresses structural inequality and violence articulately, compassionately, humanely and with both anger at the reality and hop for a better future.
He also examines the limitations of anthropology in studying cultures and human suffering. The standard arguments about cultural relativism are placed in a solid context of power and injustice and the role researchers play in perpetuating injustice by examining a tiny piece of a picture while ignoring the wider frame and inter-c0nnected nature of global economics and politics.
It does seem that he skips over the role of gender in injustice. Across cultures women tend to bear the brunt of hunger, thirst, cold, violence and lack of medical care. It is addressed, briefly, and then blanketed in a general cry against poverty. Unfortunately women are disproportionately affected by poverty with we look at Haiti or Africa or even North America. He does mention this but it is as a passing, secondary issue. I feel rather strongly that devaluing women in any context contributes to devaluing women in every context and is a huge factor in global poverty and injustice.
One thing that often strikes me in looking at poverty in North America is an emphasis on inner cities with poverty levels in the 40% range. I, personally, live on the border of a Native American reservation and send my children to a school with a 90% poverty rate. Rural poverty is, too often, ignored. However, one doctor can’t be everywhere and see everything. I would love to see similar studies addressing this area with the lenses he uses. He touches on the topic indirectly:
it is a striking fact that wealthy societies riven by social inequality have poorer health indices than societies in which comparable levels of wealth are more evenly distributed.
He makes a solid attempt to provide a framework of the marginalized and suffering to speak for themselves. This is a tricky endeavor to undertake but a critically needed stand. Dismissing the voices of the less-powerful effectively adds insult to injury and serves to create more injustice.
The central thesis of this book is that human rights abuses are best understood (that is, most accurately and comprehensively grasped) from the point of view of the poor.
He ends the book with an urge to seek pragmatic solidarity as a way of helping to alleviate the injustice of global economic systems causing such suffering. I do wish he had provided more concrete information on just what pragmatic solidarity really looks like. His commentary and analysis of the differences between charity, development and social justice approaches to poverty are intelligent and sustainable thinking. I think he could have taken this section one step further. He does do a decent job of addressing the failures of “do-gooder” organizations that seek to impose their ideologies from outside without stopping to first bear witness to the real needs of struggling, suffering communities.
It’s a book well worth reading but will need to have time and attention devoted to it. The subject is often gritty and horrifying and it is not an easy read, either mentally or emotionally. I can’t say I enjoyed this book, I didn’t, which in this case makes it all the more valuable and important.