16401: Karshan: A doctor cries out for the neglected millions (Boston Globe) (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: MKarshan@aol.com

Boston Globe

A doctor cries out for the neglected millions

By By Maywa Montenegro, Globe Correspondent, 8/12/2003

When the soldier first began flirting with 19-year-old Acephie as she
carried her goods to market in Haiti's Central Plateau, the attention seemed
innocent enough. When they began sleeping together, she never thought to ask
about his health. Then three years later, long after their relationship was
over,
word reached Acephie - who was now working as a maid in Port au Prince - that
the soldier had fallen ill with unexplained fevers and had died. Soon after,
Acephie also became sick. Blood tests showed she was HIV-positive.

AIDS struck down Acephie and the soldier quickly and remorselessly, but
there were other victims as well: The soldier's wife, children, and numerous
other girlfriends all contracted the virus, as did the baby Acephie gave birth
to shortly before she died. And Acephie's father, still in the prime of life,
hanged himself in shame over his daughter's dishonorable death.

It's a horrifying but commonplace scenario, according to Paul Farmer,
author of ``Pathologies of Power.'' This book is Farmer's account of the
Acephies of the world - the disenfranchised poor whose lives so often end in
tragic
and yet, he contended, wholly predictable ways. They are victims of
`structural violence,'' falling prey to treatable illnesses, preventable
hunger, and
crime, all for the sole reason of having no money.

In the first half of the book, Farmer writes through the lens of his own
experience as an infectious disease specialist. Haiti is the country he
knows best and it is from there that he draws most of his examples, but he
also has spent time in Cuba, Russia, Mexico, Peru, and Boston, where he is on
staff at Brigham and Women's Hospital and on the faculty at Harvard Medical
School.

>From the hopeful successes of AIDS sanatoriums in Havana to the dismal
state of tuberculosis-racked prisons in Siberia, Farmer documents what he and
other public health workers have encountered in clinics and hospitals, as well
as in prisons and backstreets around the world.

He contrasts a common ethical dilemma in Boston - whether to continue
giving life support to a brain-dead patient - with an ethical dilemma in Haiti
- whether to begin giving AIDS drugs to someone like Acephie if there is
no guarantee of the clinic having a continuous supply of medications.
Money, apparently, dictates not only the standards of care, but also how we
have come to define the term ``medical ethics.''

In the second half of the book, Farmer addresses human-rights issues at
length, offering suggestions for policy measures that might begin to
heal the ailing public-health system. Change, it seems, will not come easy.
Farmer argues that the incidence of disease among the world's poorest people
is
preordained by the very structure of today's ``free-trade'' markets, and
that nothing short of systemic overhaul is needed. Capitalism, by definition,
does not distribute goods or services equally, so ways must be found to
allocate health care, education, and nutrition evenly, and among all people.
These things, Farmer states, are not privileges, but basic human rights.

Farmer's indictments, especially in the latter half of the book, can be
repetitive and heavy-handed. On the other hand, an unrelenting voice of
protest is perhaps the only way to spur the largely complacent developed
world into action.

What Farmer does most successfully in this book is pull the problem of
justice in health care into unforgiving focus. ``Pathologies of Power'' is a
cry
for those whose own shouts go unheard. It is a bitter dose of medicine doled
out on behalf of the nameless, faceless millions who have no medicines of
their own.

Pathologies of Power: Health, Human Rights, and the New War on the Poor
By Paul Farmer
University of California Press, 419 pages, $27.50

© Copyright 2003 Globe Newspaper Company.

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