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Global Health through Dr. Paul Farmer’s Eyes

Kathryn S Crim

School of Nursing, James Madison University

NSG 469: Caring for the Public’s Health: Community Health Nursing

Tammy Kiser, DNP, RN

July 22, 2021

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Global Health through Dr. Paul Farmer’s Eyes

| Paul Farmer finds ways of connecting with people whose backgrounds are vastly
different from his own. How does he do this? Are his methods something to which
we can all aspire? Why or why not? What lessons can you learn from him to apply
to your own nursing practice? Cite specific examples from the book.

Farmer is a compassionate and empathetic man who seeks to eliminate inequality in the
world. His determination and will to connect with his patients is what makes his approach
to medical care so unique. He creates friendships with patients before any medical issues
are discussed. He doesn’t set himself up as being of higher class, he puts himself on the
same level of the patient and openly talks to his patients. He treats all patients’ problems,
not just medical. For example, a man was blind and wanted glasses – Farmer got him
glasses out of kindness. Farmer would do anything for his patient, he journeys up steep,
rocky, unsafe mountains to give a patient his medication. He doesn’t let demographics
such as race, class or nationality interfere. An example that stands out is early in the
book, when he meets a patient named Joe, Joe has HIV. Upon walking in the room,
Farmer sits on the bed with Joe, remains at the same eye level with him and talks to him.
He gets to know him as a man, he finds out he is a cocaine user and doesn’t have much of
a support system. Farmer uses his communication skills to wager with Joe. He knows that
realistically he is not going to be able to stop drinking hard alcohol or stop using cocaine.
Farmer and Joe discuss options - cut out living in the cold, half gallon of vodka and bad
drugs for good drugs, shelter and access to a six pack of beer.

While Farmer is an inspiration to all healthcare providers, it is not necessary to follow his
path exactly. You don’t need to attend an ivy league school, create Partners in Health, or
travel to third world countries. You can do your part by avoiding discrimination,
disregarding backgrounds and use the ability you have to help others who are less
fortunate. Farmer mentions that “someone needs to stand up for the Haitians”, this can be
used as nurses need to stand up and advocate for their patients.

| What is the “epi-divide” and how does the incidence of TB fall along that
divide? Also, Farmer designed a study to find out whether there was a correlation
between his Haitian patients’ belief in sorcery as the cause of TB and their recovery
from that disease through medical treatment. What did he discover about the
relative importance of cultural beliefs among his impoverished patients and their
material circumstances? Do you think that this discovery might have broad
application – for instance, to situations in the U.S.?

The “epi-divide” was the separation of the infected and the non-infected. HIV and AIDS
along with the associated TB are the disease. You can also affiliate it with “richer” versus
“poorer”. The incidence of TB is higher on the poor side because lack of resources: less
nutrition, poor hygiene, communities are overcrowded, living in tight areas and lack of
medication. Also, a contributing factor such as poor educational status interferes with the
ability to decipher signs and symptoms and seek early treatment, but also, the lack of
ability to seek treatment. The study conducted by Farmer was based on the correlation
between the belief in sorcery and medical treatment. Farmer asked an older lady how she
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got sick, her response was “germs”, but after she got treatment and was healthier her
response was, she still that she believes in voodoo and knows a person targeted her.
Farmer learned that one’s belief in faith and science affects how people view and address
their illness. He concluded that sorcery doesn’t affect health but follow up care is what
makes the difference.

Farmer did a study where he gave a group of sick people (with TB) just medication and
another group (with TB) medication, money and resources to determine which group
thrived better. He discovered that the group that received the medication, money and
other resources favored better than the group that only received the medication. This
study shows that medication alone is not the only factor involved in healthcare, a patient
needs financial means, access to resources (water, food, shelter, sanitation) and the proper
medical treatment. Farmer believes that the poor are in a situation they are unable to get
out of, they are put in a place where they are unable to provide basis needs – increasing
their risk of disease. Famer wants to eliminate this inequality in the world so that
everyone has an equal chance of survival.

I do think that this discovery is relevant in the United States, there are many
communities’ members who get severely ill or have chronic diseases, simply because of
their lack of resources. The U.S. is a country associated with wealth; however, we have
high rates of poverty as well. The poverty-stricken individuals live in small communities
where diseases are easily spread, lack immunizations, poor nutrition and poor sanitation –
all things that contribute to a weakened immune system and high susceptibility to
infectious diseases. I witnessed this during the summer practicum hours at a community
clinic; many individuals lack proper sanitation and poor education status and were unable
to manage their chronic diseases. The access to the community made it easy for
community members to receive vaccinations, low-cost medication and assistance with
resources.

| Kidder points out that Farmer is dissatisfied with the current distribution of money
and medicine in the world.  Consider the following:
How specifically has this book influenced your understanding of worldwide health
disparities, both in the U.S. and around the world? 
This book has opened my eyes to the blessings we have in the U.S. As a nurse today, we
are able to provide care for our patients with the appropriate resources; unlike in third
world countries where resources are not adequate. The past year with the pandemic and
lack of appropriate PPE, in the U.S, PPE was limited for a while, but we never ran out. In
other countries around the world, they still do not have the appropriate masks to care for
patients – having to reuse them patient after patient.
What is your opinion of the distribution of these forms of wealth? 
The amount of money a person has should not change the care they receive. I believe
everyone should have access to medical care despite their financial status. For example, a
rich political man should receive the same care a homeless man who came through the
emergency room.
What would you change if you could? 
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If I could, I would make healthcare more affordable and more universal. It would be nice
if countries worked together to create a universal healthcare throughout the world, so no
one area is different; therefore, everyone could have the opportunity to receive the same
care worldwide.
What role, if any, would you as a nurse play in beginning to rectify this vast
disparity? 
I would continue to advocate for my patient and their rights to ensure they received the
care they deserve.
In your opinion, is there a moral imperative to change the way that things are
currently distributed both in the U.S. and around the world? 
Yes, there needs to be a more universal healthcare throughout the world, something
consistent no matter where you live, race, nationality, etc. I believe that leaders need to
take more of a stance on healthcare disparities.
How will this influence your nursing practice stateside and/or abroad?
I will continue to advocate for my patients, get the appropriate resources they need to be
successful in life and their health outcomes. Also, spreading information regarding the
conditions of other countries, the lack of healthcare, lack of resources and the healthcare
disparities that exist. Lack of knowledge is a real threat to healthcare.

| Mountains Beyond Mountains is written by a white man from the United States
about another white man from the United States who seeks to improve the lives of
poor people of color in Haiti and other parts of the so-called Third World. What
issues and assumptions regarding race, class, and nationality in relation to service
and activism are raised, both implicitly and explicitly, by the book? Be specific. How
might your thoughts on this question relate to your nursing practice here in the
U.S., when you consider your care of patients who might differ from you in one or
all of those ways?

Paul Farmer had the privilege of his race and being a knowledgeable human. He wasn’t a
wealthy man, but he used his knowledge and wit to persuade donors to help him in his
journey. He was referred to as the “poor people doctor”. Many individuals questioned his
motives, stating that he has the privilege of being a good doctor and providing care at a
prestige hospital in United States, where he will make more money, but Farmer didn’t not
want that. He wants to simply help those in need. He didn’t become a doctor to get rich.
There are assumptions that Farmer (a person who serves other) could not possibly enjoy
it, but it’s doing it based on sacrifice rather than enjoyment. Farmer enjoyed taking care
of the Haitians, but he also enjoyed the finer things in life – upscale apartment, fancy
wine and restaurants. Farmers views the work he does in Haiti as right versus wrong and
your moral principles. Jim Kim, an associate of Farmers decides to dedicate his work to
decreasing poverty in third world countries; however, his views of Haiti are a bit
different. Jim Kim is a Korean man who grew up a minority and faced challenges
himself, he views his work as racial solidarity and connects with the communities based
on his own person experiences.

The race, class and nationality throughout the book are primarily poor Haitians with the
exception of military men, Paul Famer and a few other people of the white class. Most of
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the countries associated in the book are military ran; therefore, they are run by white men
in what can be viewed as a dictatorship. Most of the poor countries have people of color
or a minority, ultimately leaving them to be run by the government, examples such as
Central America – Guatemala, El Salvador and Africa countries. Throughout the book it
is noted that the government prefers to keep the citizens sick and weak, so they are
unable to revolt again them. A dictatorship type of government, which is what I view in
the book, does not distribute wealth and resources well. For example, in the book the U.S
government built a damn which flooded homes forcing people to move from fertile land
to unfertile land. Another example involves the slaughtering of the pigs due to swine flu,
the government replaced the pigs, but they couldn’t survive the harsh conditions. The
government did not think about the repercussions their decisions would have on the
community members already struggling to survive.

When it comes to my nursing practice in the United States, I practice by treating

everyone the same, no matter the race, class or nationality. Often times, we have patients
who are physician’s family members or affiliated with the U.S government, some nurses
tend to give these patients more attention and care which ultimately takes away time and
quality care you could be providing your other patients. I approach my nursing care to
each of my patients different, treating no one different; despite your association with a
physician. I have not had the experience of practicing in other countries besides the U.S;
however, I do see issues such as lack of resources, poverty, poor economic status, etc. I
do admit that I will provide extra attention when it comes to involving case management
and ensuring the patient has the resources outside the hospital to be healthy and avoid
readmission.
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Reference

Kidder, T. (2003). Mountains beyond mountains. New York: Random House.