Sunday, April 12, 2009

Efficiency and Compassion

The first time I read Mountains, I was so overwhelmed by Paul Farmer's biography that I just couldn't imagine any other way to work for the global poor other than being a jet-setting, Ivy-League-trained doctor-anthropologist. My mind was thrilled at the idea of a person operating at maximum efficiency, getting, as it were, as many lives-saved-per-minute as his machine could possibly handle. When I evaluated my own my life in those terms, it felt pretty suboptimal. But upon rereading the book, I see that not everyone agreed with my overawed assessment of Farmer's time management. One of his academic overseer thought Paul Farmer was wasting time by treating individual patients instead of focusing systemic problems:
Farmer, [Harvard Professor Howard] Hiatt seemed to say, should be solely engaged in the battle against those scourges, and at a level commensurate with their size. 'The six months a year that Paul's looking after patients one-on-one in Haiti, if that time were converted to a major program for treating prisoners with TB in Russia and other easter European countries or malaria around the world, or AIDS in southern Africa—it doesn't matter where or what because you know he'll do important things. Because look at what he's done with only part of his time on MDR. Look what he's done with his skills and political acumen!' (181)
But what Professor Hiatt saw as a tragic inefficiency ("if that time time were converted," as if our lives were simple arithmetic), Farmer regards as the lynchpin of his work (see his list of priorities in the second paragraph of p. 182). Had I been in Hiatt's position, I would have made the same criticism. Had I been in Judas' position, I also would have demanded to know why Mary had wasted such a fortune in an ostentatious emotional display. And had I been at that meeting of top TB policy makers, I would have probably nodded my headed and smirked smugly when a Russian TB director insisted, "I only have six million dollars" to implement this program (p. 161). One of the most astonishing takeaways from Mountains for me, then, is to see the way that a certain compassion for the people and situation immediately before you yields long-term results. This kind of compassion is repeated not just by Paul Farmer but throughout PIH (in Jim Kim's refusal to give up on MDR-TB patients, and the astonishing story of John, the Haitian boy nasopharyngal carcinoma, and Serena, in Chapter 25). I have often questioned the church's seemingly imprudent affection for "small" problems that I felt promoted more egoism than compassion. But here are a group of people admire, at a "secular" organization, doing exactly as Jesus did, for the reason he did it, in the way he did it: addressing people's immediate needs, in a rash of compassion, inadvisedly. It echoes Mother Teresa's maxim about "small acts of great love," an impulse I've always struggled to effect.

3 comments:

  1. Great thoughts! I'm definitely one of those people who find it easy to love "the poor" but can barely muster the compassion or selflessness to share my food with my roommates or listen to my mom go through yet another rendition of "You'll never guess who I ran into at the store today..." At least not without conveying an extreme sense of annoyance and superiority.

    I, too, find one of Farmers's most impressive attributes to be his ability to slow down and really listen and respond to the people in front of him. Of course, another take away would be that he goes to great lengths to make sure that the neediest, most overlooked, and desperate people are the ones right in front of him.

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  2. I've been thinking about this imprudently and wastefully caring for individual people thing. I think it begs the question of whether one actually loves and cares about people or just perceives them as an ethical problem to be defeated for one's own personal glory or appeasement of guilt. We can try to intellectually dismiss the actual love and care bit as sentimental and useless. Except, that so much of Farmer's large scale success seems to stem from the way he deals with individuals on a small scale. I can't help but contrast this with the callousness of many large institutions toward the actual people they purport to serve. It's hard to effectively serve people you don't actually like or want to hang out with.
    Question: Do we actually love 'the poor?'

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  3. I've just finished reading Pathologies of Power, and the premise of the text is an argument for the existence of structural violence and systemic oppression. It seems that as Farmer grew as an advocate for the global poor, he took on the role of combating systemic problems. This seems like a natural progression to me. Before a person is in a place to challenge the overarching system, s/he must first have a heart, knowledge, experience, and expertise of the people, the problems they face, and the systems that stand in opposition to solving those problems. Farmer gained these first by loving individuals and rooting himself in liberation theology, and then and only then was he equipped to be a voice against the status quo. I think this is important because movements start small and then grow through devotion and learning. He couldn't have called out the structural violence effectively first because no one would have listened. Instead, he first did the work he later challenged the community to participate in, and once he established himself as a physician and an advocate for the poor, he put himself in a position for others to listen as he railed against states, human rights organizations, and the medical community at large.

    This is all to say...he started with loving individuals and continues to pour himself into individuals, but he didn't stop there. He eventually did take on the role of challenging structural violence.

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