To Repair the World: Paul Farmer Speaks to the Next Generation (California Series in Public Anthropology)

“Bravo, Dr. Farmer, for saying what most clinicians are loathe to admit.”

Paul Farmer shows us the way to our renewed humanity in a world with crushing despair and self-interest. The book is worth reading if only to understand how a “trailer park kid” can achieve such heights by serving the poverty stricken and voiceless.

Dr. Farmer is indeed a marvel, and in reading his speeches perhaps a little of that genius will rub off.

Though Dr. Farmer is one of three founders of Partners in Health, a global nonprofit health care service, he is the huckster, the comedian, the “front man,” and this is exactly what the Haitians and Rwandans and others need in order to get the public coffers engaged in their plight.

Where he really shines is in his public addresses to the fraternity of clinicians, where he confronts the inequities in the US health care system and drowns it in humor, but leaves just a kernel that won’t go down easily.

In his speech to Harvard Medical School graduates he addresses the pharmacological carpet-bombing of America (my metaphor), the short-dating of medications for profit versus patients, and even questioning the work ethic of physicians compared to other fields—unheard of and unholy in this trinity, but he pulls it off with aplomb. He states whatever your specialty (because who in the US is a primary care doc these days?), “it’s not about us, our incomes, or our sense of personal efficacy, but what happens to our patients.”

Bravo, Dr. Farmer, for saying what most clinicians are loathe to admit.

He goes on to talk about the dark side of progress and how terribly behind we are in equity both globally but also in the United States. And what may be the best line in the book is his reference to the end of his speech as “the dismount”— hysterical.

In “The Tetanus Speech” Dr. Farmer declares that regardless of all of our money we don’t have a health care system we can rely on, in Miami or central Haiti, which is shockingly true for anyone who has researched clinical outcomes and health equity.

In “Health Human Rights and Natural Disasters” he discusses linking health care technology to health equity and not just better medicine for a few. He quotes famed economist, John Kenneth Galbraith, who despairs of the rising inequality throughout the world despite national income changes, or as pediatrician Paul Wise says, the “outcome gap.”

Yet when Dr. Farmer talks about pressing the point of arguing for the right to health care rather than spending paltry sums that would never do half the job, his words ring true in the miasma of the US health care debate in which we are paying more for less and not targeting the ones who need it the most.

Lest you think Dr. Farmer is all dire platitudes, here is an excerpt from his Georgetown University Commencement speech of 2011, “Your kind looking faces reassure me; as I love Georgetown, I accepted this speaking gig only because it was to occur on May 21, 2011, and that meant I wouldn’t actually have to give the talk, since they told me the Rapture was to have occurred today.”

Dr. Farmer speaks of service, solidarity, and social justice, by stating “It is the poor, wounded, vulnerable people who can reveal the world to us, quoting Dietrich Bonhoeffer, who from his Nazi prison cell asked, ‘Who stands fast?’”

You owe it to yourself to read this book as Dr. Farmer regales us of his adventures, fills us with mirth, and still makes us take note on the work awaiting us in the morn.