Life of Discovery
AIDS, Anthropology and Voodoo
Maureen Murphy, Professor Curriculum and Teaching
In his March 2009, Epilogue to Mountains Beyond Mountains, Tracy Kidder says that his experience writing his study of Paul Farmer demonstrated to him that one person can, indeed, make a difference; however, six years later, Farmer has become more human than heroic to Kidder who thinks of Farmer simply as a friend. He is grateful “that he is living on the planet.” Some readers of Mountains Beyond Mountains see the hero in Farmer; some may consider him a twenty-first century Albert Schweitzer, a Schweitzer who practices a higher standard of medical care and has a less patronizing attitude toward the people he serves - the poorest of the poor.
Farmer holds a Ph. D. from Harvard in anthropology as well as an M.D. from Harvard Medical School. In one of Farmer’s own books, AIDS and Accusation. Haiti and the Geography of Blame (1992), he presents an anthropological analysis of AIDS. Haitian AIDS victims are often the object of blame because the disease is seen as “sent sickness” – a sickness sent as a voodoo curse. Farmer had the humility to ask questions like; did the practice of voodoo have anything to do with AIDS? Was voodoo responsible for the transmission of disease?
How did Farmer conduct his research? What are the implication of his conclusions?
As an anthropologist, Farmer knew that it was important for him to put his scientific training aside and to investigate “the victims’ moral reading of the sources of their suffering” (pg. 263, AIDS and Accusation). Farmer concluded that AIDS was not tied to voodoo or maji (sorcery) but to poverty; however he also concluded that voodoo and maji do operate in a climate of inequality. Farmer’s friend, a progressive community builder, Père Jacques Alexis of the Église Épiscopale d’Haiti, defines voodoo as a form of sorcery; “a system of beliefs concerning man’s relation to the spirit–world, and how to get by in this world” (pg. 198, AIDS and Accusation). For Farmer’s Haitians, it is a way to negotiate social relationships in the world of the sick and the poor. While historically the French Catholic clergy and the Haitian elite tried to suppress voodoo, Farmer and Alexis agree that the rural Haitians were involved “in both voodoo and Christianity.” In his analysis of voodoo and AIDS, Farmer quotes Shirley Lindenbaum’s study of sorcery in New Guinea, a study that concluded that “in the absence of alternative methods of settling disputes, sorcery may serve to regulate relations between individuals who must cooperate and also compete” (pg. 246, AIDS and Accusation).
While the author of Mountains Beyond Mountains focuses on Dr. Paul Farmer, Farmer’s attention focuses on the poor. One measure of Farmer’s commitment to his Haitian patients is his study of anthropology. He used anthropology to broaden the framework for his analysis of the AIDS epidemic in the country through his study of Haitian voodoo. That fact that many Haitians linked AIDS with voodoo called for an anthropological as well an epidemiological response.
Mountains Beyond Mountains
For Common Reading Discussion sessions, Summer 2011
Amy Baehr, Department of Philosophy
Mountains Beyond Mountains1 is a philosophical book, engaging the branch of philosophy called ‘ethics: the study of what is good and right, and how we should live. It engages ethics by describing the lives and work of “priests and nuns and professors and secretaries and businessmen and church ladies and peasants and … medical students and doctors” (295) involved with an organization called ‘Partners in Health.’ But the focus is Dr. Paul Farmer, founder and leader of Partners in Health. Through learning about how Farmer lives, what he does, and what he says, we come to understand Farmer’s ethics.
Early in the book, Farmer delivers to Joe, a sick patient of his in a homeless shelter, “a six-pack of beer, disguised in wrapping paper.” “As Farmer was leaving the shelter, he heard Joe say to another resident … ‘That guy’s a fuckin’ saint.’” Overhearing this, Farmer explains, “People call me a saint and I think, I have to work harder. Because a saint would be a great thing to be” (16).2
Farmer explains: “All the great religious traditions … say, Love thy neighbor as thyself. My answer is, I’m sorry, I can’t, but I’m gonna keep on trying” (213). Trying gives Farmer’s life structure, meaning and satisfaction (187).3 His reward is “inward clarity” (210), the knowledge that he is doing the right thing.4
What is the right thing? “Eating shit5 for the poor” (131),6 also called taking the “option for the poor” (210). Farmer paraphrases: “’Matthew twenty-five’ said Farmer. ‘Inasmuch as you have done it unto the least of these my brethren, you have done it unto me, …When I was hungry, you fed me. When I was thirsty, you gave me something to drink. When I was a stranger, you took me in. When I was naked, you gave me clothes. When I was sick, when I was in prison, you visited me. Then it says, Inasmuch as you did not, you’re screwed” (185). Farmer does not … think one need be religious to opt for the poor. (He does think religious faith of some kind makes a good deal of sense since the poor tend to have it (84).) Those whose suffering is worst should be attended to first – that is the idea (286), part of all religious traditions.
This means keeping people from dying unnecessarily, as poor people often do (102);7 treating each person as if she/he mattered equally, which social inequality makes so difficult.8 But there are two ways one might go about attending to the poor.
One could provide care to as many poor people as possible (referred to as “cost efficacy” (25)). It requires that you treat first those who can be cost-effectively saved. The deaths of those whose treatment would be expensive is accepted “philosophically,” as the inevitable result of doing the right thing.
Farmer takes “great pleasure in violating the principle of cost-efficacy” (25), focusing instead on the one individual patient in front of him. Farmer tells us: “One thing that comes back to me, with all this cost-efficiency crap, if I saved one patient in my whole life, that wouldn’t be too bad. What did you do with your life? I saved Michela” (187). “Paying attention to individual patients [is] a moral imperative” (146). Serena puts this well pulling out all the stops to help a desperately ill child: “I’m only looking at one child” (270); I’m looking at John as if he “had been my son” (279). Just as good parents do anything to promote the health of their children (not that of all the other children they could be benefitting), Farmer and his associates do just about anything to promote the health of each particular patient in front of them.vArata Kochi tells us the conflict between cost-efficacy and the moral imperative to treat the patient in front of you at all costs is “unsolvable” (160). Surely the tens of thousands of dollars Serena spends on John could have been spent saving or dramatically improving many lives (261-279). But Farmer seems to deny the conflict.
Farmer: “God gives us humans everything we need to flourish, but he’s not the one who’s supposed to divvy up the loot. That charge was laid upon us” (79). Cost-efficacy presupposes that “the loot” we all “need to flourish” is extremely scarce, and concludes that we must deny some what they need to flourish. But, Farmer suggests, there is, in fact, enough for everyone! We have only failed to divvy the loot up fairly. Farmer: there are “inescapable connections between the gleaming corporate offices of Paris and New York and a legless man lying on the mud floor of a hut in the remotest part of remote Haiti” (218). The poor will have their fair share9 when the rich have less (40). Then doctors will have no reason to refuse to treat patients whose cures are costly. When the loot is divvied up fairly, we’ll see that being treated as an individual is what all patients deserve. Doing so now as Farmer does is a way of denying the legitimacy of the current distribution of wealth. In this sense, Farmer’s doctoring is a form of justice, giving people what they deserve (207).
1 Tracy Kidder, Mountains Beyond Mountains (Random House, 2004).
2 If Farmer is a saint, why does he break the rules, bringing beer into a homeless shelter? There are many instances of Farmer and his colleagues breaking the rules in the book. A microscope and plenty of medicine are stolen from the Harvard Medical School (90); Paul and Jim practice medicine in Peru without a license (144); and so on. Father Jack, a priest and an associate, says “better to ask forgiveness than permission.” We are told that this was also “Farmer’s rule of thumb” (149). So being a good person, on Farmer’s view, does not necessary involve following the rules.
3 Farmer explains: “I’ve never known despair and I don’t think I ever will” (189). And, he tells us, I feel “most alive” when I’m “helping people” (295).
4 But we are also told about “the often unacknowledged uneasiness that some of the fortunate feel about their place in the world, the thing [Farmer] once told me he designed his life to avoid” (295). The guilt he wants to avoid feeling is often quite helpful. Kidder explains: “the guilt some rich people felt toward the poor [is good] because it could cause them to part with some of their money. And they ought to feel guilty besides.” Interestingly, though, Farmer explains that he is not from a rich family but is “white trash.”
5 Farmer does not seem to think that swearing is unethical.
6 “It should be enough to humbly serve the poor” (256).
7 “If people could be kept from dying unnecessarily, then one had to act” (102).
8 “Equity is the only acceptable goal” (261). “The idea that some lives matter less is the root of all that’s wrong with the world” (294). “I’m an American? How do people classify themselves… Was being an American sufficient identity unto itself?... ‘We’re all human beings…’” (80).
9 “In Farmer’s conception … services to the destitute [should be provided] for free, and those services should meet the real needs of the place and of individual patients” (82). “Clean water and health care and school and food and tin roofs and cement floors, all of these things should constitute a set of basics that people must have as birthrights” (91).
Don’t Quit This Day Job
Karen S. Sibert