Paul Farmer MD

The Anthropology of Affliction

 I have had to grapple with the image of such a magnificent human being, most of my medical life.  I couldn’t be what he was.   He was stellar in every way.  He could function on almost no sleep, and had the vise-like grip of a photographic memory and the ability to brilliantly work out both diagnosis and treatment plan while holding the patient’s hand and asking them what they ate for breakfast, and who took care of them and brought them to the clinic.  And also figuring out how to get the medicine he intended to prescribe delivered to the patient.   He understood poverty and illness, he understood that the sick are poor, and the poor are sick. The book Mountains Beyond Mountains, about Paul’s life, came out in 2003. I was in the Peace Corps in South America from 1972-74. I started practicing OB-Gyn in 1990. I did not have his personal charismatic model or his ability to use the language of liberation theology in the early years. But once I knew about him, I knew he existed, and that his way was TRUE. It was ballast against all that is wrong in medicine, and all the barriers society sets up. I truly hope, as did his college roommate John Dear, that he is canonized, and also named a Doctor of the Church. Because he changed the world! And he did it like St. Francis did– with love and joy, not out of a sense of duty. I loved that he said he could sleep when he got to Cuba, because everyone there had a doctor. Having a doctor you could call on was the gist of what he wanted to make possible. And a good doctor, who wanted to save your life, with dedication and compassion.
He grew up in poverty, living on a bus his dad drove around,  for a lot of his childhood.  That he made it to Duke and then Harvard was a miracle.  He didn’t get to go to Vienna.  He didn’t study music or go to the opera.  His friends were the best in each field, and the most creative minds in our time, full of passionate energy.    
But we are not called to be who he was, we are just called to be inspired by him; to allow what he showed us about how we could be more fully human, more engaged and compassionate.  One of the most poignant chapters in Mountains beyond Mountains is when he marries Didi, and they have a child, and he says to himself that he must not love his own child more than all the children he has cared for.  He grapples with the limits of how much we can love, and whether we can morally love our own families more. And I learned from that question that we all have to love whom we love, the best we can.  Simply trying to do the best we can, without judging ourselves, without torturing ourselves with questions about quantity and quality.  I think his faith was what gave him the ground for those decisions, to just do the best we can.  Putting the outcome in God’s hands, but doing the best we can.  He didn’t waste time with second-guessing and self-doubt.  He understood very truly the limits we all have to function within.  He had enormous energy, and some people don’t have even a quarter of what he had.  But they are just called to be who THEY are, not to be something different.  That was part of his brilliance.  Jim Kim was a strategic systems thinker, and he could see the way through, to get the medications made in a less-expensive way.  He wasn’t focused on the individual patient the way Paul was, and it was brilliant that he did what HE could do to help.  It changed the world!  

Paul inspired each person to give what they could give.  It was like loaves and fishes, in so many ways.  Here is the poem I wrote about the work Jim Kim MD did in the Siberian prison camps, where both TB and AIDS were rampant, and the Soviets didn’t want to have to spend money to treat prisoners. A travel fluke made him have to deal with the Russian generals, instead of Paul. He had a karaoke machine, and he sang to them!


THE SNGING GULAGMEISTERS

(For Jim Kim, MD)

They were swilling vodka

And cared nothing for the Siberian prisoners.

It was winter

Like Varykino in Doctor Zhivago

Snow-lace and bear rugs

Wolves howling in the foothills.

He brought out the karaoke machine, 

And hoped for the best;

Flushed with vodka, 

Singing “My Way” with the Sinatra swing.

While spreadin’ the news,

Death and dyin’;

Grim not glamorous;

Siberian prisons

Full of T.B.

He wanted to treat the prisoners

On behalf of mankind, 

He sang to the generals.

Men in olive drab,

With chests full of medals

And flushed cheeks

Began to join the minister,

Whose clear baritone

Led them in a Russian ballad, 

Answering song for song;

And a miracle happened.

They said yes, 

To this most improbable idea;

Treating the prisoners with T.B.

In the gulags, 

Something good for this Earth.

Published in 2007, in Walking on Stars and Water, by Martina NIcholson MD

(available on Kindle, or contact me for a book)

THE DEATH OF THE MANGO LADY

(FOR PAUL FARMER, MD)

The ladies in the little overturned truck

Spilled like mangos onto the road.

The mangos, in rainbow sherbet colors,

Like sunrise and sunset in Haiti,

Spilled out all over the road,

Spilled and splattered open,

Their soft apricot and coral juicy flesh

Sweetening the dust,

A whole months’ wages lost.

Grangou, grangou:  hungry children

Scrambled to retrieve the unbroken ones;

And the mango ladies

Holding their moaning mouths

Watched

The driver lay a piece of cardboard

Over the body of their friend,

Her legs and feet still uncovered.

Surrounded by mangos,

An altar offering– 

Fruit of the world, 

Suffering of the world,

Women on their way to market
Waylaid by death.  

Squatting by the roadside,

Watched by the hungry children,

Moaning;

Stopping the rhythm of daily life

Trying  to get enough

Food for the children;

Stopping to grieve,

Broken open 

Like sunrise and sunset

All over the dusty road.

Published in Walking on Stars and Water, 2007, by Martina Nicholson MD

DONKEY AMBULANCE

(FOR PAUL FARMER, MD)

Whimpering whispering,
”I am sick, I am hungry”

 Rises like steam from 

The not fast ambulance, as it  

Comes toward us with the child-woman 

Groaning and vomiting,

Feverish and swollen- bellied,

Father and brother and spouse 

Walking alongside the narrow pallet. 

No one is sure whether she can be saved,

No one is at all sure

Whether there was sorcery

Or bad luck,

Or what is happening to her.

The donkeys plod along

Pacing themselves on the road.   

I think it is appendicitis,

I think she needs surgery,

I think and say, “bring the lamps”

Get her onto the table,

Call the operating team.

She is moaning,

Her lips are trembling and blue,
I am still listening

With total concentration

To her belly; as I bend over with

My forehead pressed to the fetoscope, 

Listening for the tiny thump-thump

Quick- paced rhythm of a fetal heartbeat.  

The donkeys stand.

They stand with their heads lowered,

Patiently,

Waiting for someone to feed them.  

Published in Walking on Stars and Water, 2007, by Martina Nicholson MD

THE ANTHROPOLOGY OF AFFLICTION

(FOR PAUL FARMER, MD)

Poverty and AIDS;
While standing at the blackboard,
What I was going to say before I heard
That hacking Tubercular cough from 
That hungry skinny patient,
Leaning down, squatting against
The filthy wall in this clinic
With Mother Hubbard’s cupboards.

People in the first world keep talking about choices.
These people have no choices;
Ignorance and hunger and sickness
Are their daily fare.
Grangou, grangou.
Hungry, hungry.

Here there is no way to hide
With existentialist bullshit
The truth about the hunger.

AIDS is the lurking shadow
If you sell for a pittance
The access to the vagina
Just to be able to feed the hunger.

My mind goes around the mouth
Around the vagina
Around the swollen belly
of the kid in the middle of the room.

What I was going to say
Before:
About affliction
About choice, 
Getting swallowed up in the hunger. 

Published in Walking on Stars and Water, 2007, by Martina Nicholson MD

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