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Dr. Paul Farmer of Partners in Health offers effective solutions for Haiti

Dr. Paul Farmer, kneeling right, makes a diagnosis at a Haiti hospital with no extra beds in 2004. To control waterborne disease, he advocates upgrading systems, antibiotic use and vaccination.

Daniel Wallace | Times (2004)

Dr. Paul Farmer, kneeling right, makes a diagnosis at a Haiti hospital with no extra beds in 2004. To control waterborne disease, he advocates upgrading systems, antibiotic use and vaccination.

Paul Farmer, as you may have heard, recently released a book with the self-explanatory title, Haiti After the Earthquake.

Public radio and television interviewers have given Farmer the respectful treatment the supporters in his hometown of Brooksville have come to expect, treatment that comes from 30 years of pioneering work providing health care in poor countries.

But reviews in the Toronto Star, the Financial Times and even the Boston Globe — the home paper of the organization Farmer helped found, Partners in Health — haven't been nearly as kind.

Too many pages are devoted to praise for Partners, the reviewers said. There's too much name-dropping, too much recounting of high-level meetings with the likes of U.N. Special Envoy to Haiti Bill Clinton, and even a mention of attending the wedding of Clinton's daughter, Chelsea.

And though Farmer criticizes general patterns of providing post-earthquake aid, in most cases he doesn't name names. He doesn't single out organizations that have taken in vast sums of money and have little to show for it. And he doesn't sound angry, wrote Jennifer Wells, in the Star.

"It would be good to hear an angry Paul Farmer right now. Given his stature, such words just might have some effect."

She has a point. After the Earthquake isn't going to leave you seething with outrage as did Uses of Haiti, Farmer's 1994 book on the exploitation of the country by rich Western powers.

That was the work of an outsider — a doctor and anthropologist running a small clinic in central Haiti.

After the Earthquake, of course, comes from an insider — the public face of a large, multinational aid agency (one whose heroic work after the quake, by the way, deserves all the praise Farmer could heap on it), the U.N.'s deputy special envoy and chairman of a Harvard University school for global health. And if that status isn't as good for producing compelling books, it is for helping sick people in poor countries.

That's because Farmer didn't get to be an insider by changing his views on global health. He got there because a lot of powerful people came around to his way of thinking. And they came because his methods worked and because it turns out he's pretty good at being an insider — writing op-ed pieces in national newspapers, testifying before the U.S. Senate, getting the ear of people such as Clinton.

Thanks to Farmer, there's now a widespread assumption that aid organizations should work with governments of poor countries, helping to strengthen them, rather than working around them as many groups have done for decades. Global health care experts are also a lot more likely to agree with what once was one of Farmer's most radical views: that poor patients have a right to the same care as rich ones.

Why, for example, are the rates of new HIV infections plummeting in developing countries? Because of expensive drugs that Partners and a few other aid groups insisted on using more than a decade ago.

But it's easier to say you agree with these approaches than to carry them out, as is clear from Farmer's book. Eight months after the earthquake, only 0.3 percent of the recovery money sent by donor nations had gone to the Haitian government.

And 10 months after cholera first appeared in the country, it has killed about 5,500 people. At the start of this year's rainy season, between April and June, the country's ministry of health had recorded 86,000 new cases of the waterborne illness.

So the cheap, prevailing, method of controlling the epidemic — rehydrating victims and passing out water purification tablets — isn't working.

This, on the other hand, is the approach Farmer favors: Upgrade Haiti's miserably inadequate water supply and sanitation systems, treat patients with antibiotics as well as saline solutions, and vaccinate all Haitians.

He has led a group of health care experts, including those in the Haitian government, to push for these methods, especially more vaccinations. Two weeks ago, the group received the support of the Pan American Health Organization.

So maybe Farmer's not as angry as he used to be. But he might be more effective than ever.

Dr. Paul Farmer of Partners in Health offers effective solutions for Haiti 07/23/11 [Last modified: Saturday, July 23, 2011 12:08pm]

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