Thoughts on Paul Farmer

Disclaimer: I just submitted this as my weekly post to the discussion board a global health ethics class that I’m taking at Duke University…so forgive me if you’ve already seen it there. This post is a follow-up to the previous (and much more coherent) piece about reading Partner to the Poor: A Paul Farmer Reader, which I do highly recommend. I’d love to hear your thoughts about these issues, or any others (including whether you liked the book!!).


Paul Farmer is very clear about where he stands: health is a human right, and both physicians and states are morally obligated to do all within their power to combat illness and disease, even if it will bankrupt them in the process (although he argues that it will not). However, some would argue that Farmer is overstepping the boundaries of what constitutes ethical behavior by pushing us from “treating others as we would want to be treated” to “treating others as they want to be treated”—that is, a shift from merely leaving others to their own affairs to actively getting involved to do something for/with others. Part of the danger then with Farmer’s argument is how far do we take this—was the 2003 invasion of Iraq ethical because we were ostensibly “protecting the rights of citizens”? Is there an ethical obligation to get involved militarily in North Korea? Does this include ignoring national sovereignty in the interest of best serving the people of a country (who constitutes “the people”?)? Is there a point where this type of interventionism becomes paternalistic and just a 21st century version of “the White Man’s Burden”?

Furthermore, Farmer is highly critical of medical ethics boards, which he argues overlook basic moral tenets. The examples he cites certainly make this seem the case. But if so, how did/do we allow researchers to become so removed from the humanity of their “guinea pigs” that these types of things happen? I would argue that the proverbial “Ivory Tower” is not filled with sociopaths, so then how do we explain the disconnect? Is it the structure of grant proposals and journal articles—e.g. the conventional formality of such writings force a dehumanization of the subject in order to facilitate a sufficiently scholarly write-up and discussion? But more importantly, once we identify the problematic structures that convert academia into a “human rights violator” (defining “human rights” broadly, as Farmer does) how do we address them in a way that keeps academia effective (I struggle to say impartial here because I personally have yet to see a truly impartial piece of scholarship)?



Learning to Unlearn

After receiving (or perhaps more aptly, earning) a rather unflattering 4,5 out of 7 on my first paper for Gabriel Salazar (my 20th century Chilean history professor) I went to go talk to the big man himself about what my mistakes had been. To preface all this, let’s just say I was really nervous about talking to the contemporary Chilean history expert. But he was incredibly sympathetic and willing to talk about the problems with the paper.

The main problem was a the simplicity of the piece, which he kindly attributed to the language barrier (and my supposed inability to express my complex thoughts) rather than to stupidity or inside-the-box thinking on my part. He counseled me to worry less about reading all the sources and to focus more on analysis and developing my own ideas about the texts I’ve read.

I didn’t hit me until about fifteen minutes later on the bus ride home that I realized that he was basically telling me the same thing my fantastic AP United States History teacher, Mr. Robinson, told me every month in my book reports (for sophomore year at least…I would like to think I had figured it out by junior year): stop hiding behind the authors and write what you think.

By the time I graduated high school, I was writing somewhat original pieces and at least attempting to think outside of the box. But, sorry to say, when I arrived at college my creativity wasn’t always received as well and I, like most undergrads, was crushed under the weight of an educational system that insists on clearly(and distinctly) defining the roles of professor and student as “entity that generates knowledge” and “receptacle for said knowledge”. Much as I complained and railed against the system, I unwittingly conformed and started playing by the rules. Which begs the same question that I posed to myself in the last post, perhaps this time with a slightly darker perspective: would I really be willing to fight for an ideal if my life were on the line or would I fold under the pressure?

The beauty of this history class is that Salazar is granting me the opportunity to reclaim my lost intellectual freedom and to relearn how to stand on my own two ideological feet and challenge what the “experts” say (and more importantly, to develop my own theories about the material I’m being presented with). In short, to unlearn what’s been drilled into me for the past two years. Here’s to hoping I don’t blow it.

The Price of Protest

Yesterday we went to Santiago’s Cemetario General, the largest cemetery in the city. Originally the cemetery only served Catholics, but with the huge influx of British, French, and German immigrants in the 19th century, the Catholic Church opened up the burial grounds to disidentes as well. At first, “heretics” had to be buried on the other side of a high 3-meter-thick brick wall, so as not to contaminar the Catholic corpses, but this restriction was lifted in 1925 with President Arturo Alessandri Palma’s Constitution, which separated the Church and the State. Today the Patio de Disidentes is being preserved for historical reasons only, and it’s quite stunning to pass through the gate to that part of the cemetary and suddenly see headstones in English, French and German, among other languages, instead of Spanish.

We didn’t make it to Patio 29, the Pinochet-era mass grave site for a different kind of dissident (political in his case), but we did go over the a huge wall that’s been erected for those disappeared” and executed during the dictatorship. The desaparecidos are listed by name on the left side of the monument, along with their age at the time of their disappearance and the date they were last seen. There are some 5000 names listed. On the right-hand side of the memorial are the 3,000-odd names of those known to me executed by the Pinochet regime, along with their ages at the time of execution and the date of said execution. Keep in mind that this all happened in a country with a population of 12 million.

This all being said, I’ve certainly spoken with a lot of folks here in Chile that insist that the dictatorship wasn’t all that bad. “He only killed 3,000 people,” they tell me. “Pinochet was a ‘soft’ dictator, compared to Argentina and Peru.” these folks all kept their heads down during the dictatorship and didn’t lose anyone close to them. I wonder if their thoughts on the military government would be different if they had.

But it also makes me wonder what kind of person I would be in their situation. Would I be willing to risk my life–and the lives of my loved ones–for a cause and a political ideal, or would I too bow my head and try to keep a low profile until it was over? It’s very easy to be critical now, but my life’s not on the line. And it’s the same with every Amnesty International petition I sign and every angry email I send to my government representatives. I have the ability to protest, both at home and abroad, without actually sacrificing anything other than a little of my time (not saying it was/is always that easy in the U.S, but I have been so blessed). Which then begs the question–is my action of protesting less meaningful because I don’t have to give anything up to realize it or am I now obliged to protest when something strikes me as unjust because I am guaranteed a very significant level of immunity?

Cocalero and the Qualities of a Leader (reflections on Bolivia Part III)

So turns out Cocalero is available to watch in segments on youtube. Yay!!! Also just so happens that there’s a really interesting little segment at the end of part 2 of 10 about leadership, and what it takes to be a leader. The context is a meeting of FECAMTROP (Federación Campesina de Mujeres del Trópico), a women’s cocalera (coca farmer) union in Chapare, outside of Cochabamba. It’s election time, and the women have gathered to select a new head of the organization. As the women prepare to cast their votes, a man stands up and gives a brief speech about what does, and what does not, constitute a leader.

Compañeras y compañeros, para ser líder no se necesita estatura. No se necesita ser alto, ni rubio. Para ser líder, ¿hay que ser ingéniero, doctor o abogado? No. Entonces, para ser líder, la cualidad personal no tiene que ver con su formación. Puede haber compañeras y compañeros que por no haber podido ir a la escuela, no escriban bien. Entonces, no necesariamente él que escribe mejor va a ser un buen líder. Cuando vamos a elegir un líder del sindicato, no buscamos nada de esto. Pero si nos fijamos en su honestidad.

Comrades, to be a leader you don’t need height. You don’t have to be tall, or blond. To be a leader, do you have to be an engineer, a doctor, or a lawyer? No. So, the personal qualities needed to be a leader have nothing to do with external characteristics (physical or social). There may be comrades who, for want of access to education, do not write well. So the best writer is not necessarily the best leader. When we elect a leader of the union, we don’t look for any of this. But we do focus on honesty.

In Latin America–like in many parts of the world–the more European one appears, the more favorable discrimination one will encounter. The blonds in my exchange program often get stopped or chased down by random Chileans on the street, eager to practice their English or make a gringo friend. Just yesterday, a tall blue-eyed classmate commented that an old woman had seen him the other day, stared for a good several minutes, and then said “Ay…que guapo!!!” although they didn’t know one another. It’s a fairly normal occurrence. The guy is handsome, don’t get me wrong, but one of our Chilean professors commented that these instances have way more to do with the Chilean psyche, and it’s relation to extranjeros than to the actual physical appearance of any of the students. Personally, I’ve noticed that when my (almond-shaped) eyes are covered by sunglasses or the like, I can move through the city without a single stare or comment. As soon as the glasses come off though, I have to steel myself for comments about the appeal of the razas asiáticas. All because with the removal of my “disguise”  I am no longer another short dark-haired/fair-skinned woman on the metro but an exoticized “Other.” To be fair, it’s not all that different from in the U.S.  But to make a long story short, the first several characteristics negated by this fellow in the movie speak specifically to the exaltation of the European (as more civilized, as more intelligent, as more capable), while the following ones speak more to the more subtle sides of imposed Occidental authority, particularly formal education.

Now, this isn’t to say I don’t believe in education and the power/importance of education. However, there are many different types of education and the valorization of one type over another (particularly when there are powerful and unequal determining factors that control access to the most highly-valued form, such as poverty or any of the -isms) converts education from a tool of empowerment to a weapon of oppression.

In the U.S., this is represented by the divide between public and private schools,  often reinforced by racial and socioeconomic disparities. Our society’s over-valorization of book-learning and the ability to regurgitate information onto a standardized multiple-choice test creates an artificial divide that allows us to over-value the successful progeny and producers of this system (private schools) while negating the value of those who don’t (public schools). It permits us to write-off students who don’t do well in this environment as inherent failures–lazy or just plain stupid–and focus on those who do flourish, even though those “smart” individuals may not necessarily be the most “useful” to our society. Case in point: Thomas Edison who was kicked out of school in first grade.

On a global scale, this same ideology allows us to write off entire nations and peoples as lazy or just plain stupid when poverty or other social factors prevent or hinder the uptake  of formal Occidental schooling. We justify political-economic-cultural imperialism on “intelligence” arguments that have little to do with actual intelligence, but a lot to do with the valorization of one cosmovision over another (“intellectual imperialism”). In the case of FECAMTROP, Occidental metrics of intelligence are irrelevant. The ability to read, write, or perform well on a test don’t necessarily equate with the ability to lead a coca-growers union. Here, a more organic metric is needed–honesty–or what in modern business/leadership jargon, one might call “integrity.” So…question of the day…how do we construct a metric for integrity?

Of farmers and presidents (Bolivia Part III)

Once we got out to Lake Titicaca, we had to disembark from the bus in order to cross in boats (the bus itself crossed on a separate barge). I had a little misunderstanding and didn’t end up getting back on the bus, but it gave me a great chance to wander a bit and get to know some of the Bolivian countryside. One of the things that had really struck me in La Paz was the plethora of murals urging people to vote (in order to eliminate illiteracy, in order to better the economy, in order to clean up the city, etc.). Imagine my surprise (and extreme interest) when I saw similar paintings on the sides of farmers’ houses. I wonder how that impacts voter turnout and the degree of citizen participation in Bolivia.

The only thing I can say to that is that Bolivia currently is being led by it’s first indigenous president, Evo Morales (most of the murals in La Paz supported him although in the campo they were all for a different party and candidate), who’s definitely implemented some interesting policies since assuming power in 2006. Morales is the leader of the Movimiento al Socialismo so the nationalization of Bolivia’s petroleum in the beginning of 2006 came as no surprise. But the Constitutional Reform of 2009 (which renamed Bolivia theEstado Plurinacional de Bolivia to indicate the indigenous population and decreed that the Wiphara, or indigenous flag, was to be flown along with the old yellow-red-and-green flag) was somewhat unexpected. On top of that, Morales has managed to get himself into a few tangles with the Catholic Church. The quote below may offer an explanation as to why.

El Presidente de Bolivia, Evo Morales, dijo … en el contexto del Foro Social Mundial que la Iglesia Católica en Bolivia es la “principal enemiga” de las reformas que su gobierno quiere implementar en su país y, dijo que era necesario reemplazarla14

Bolivian president, Evo Morales, said…during the World Social Forum that the Catholic Church in Bolivia is the “principal enemy” of the reforms that his government wants to implement in the country, and called for it to be replaced.

In short, he seems like a really interesting guy and I’m going to be keeping my eyes peeled for what else he gets up to over the rest of his term. Although I haven’t yet seen it, the documentary Cocalero deals with Evo Morales’ rise to the presidency and is supposed to be quite good (Sundance accreditation etc.). Let’s see if I can manage to find a copy anywhere here in Santiago.

¿Quién defina…? (Bolivia Part II)

Sorry for the delay folks: between catching up on sleep from a whirlwind weekend, trying to stay on top of daylight savings time (it’s on a different day here), and getting a handle on classwork the week got away from me.

Saturday, after dropping my bag at the hostel I headed out to the Cemetario General to catch a bus out to Copacabana, on the shores of Lake Titicaca. The ticket runs between 15 and 20 bolivianos (2-3 USD) and the first bus heads out at 6 a.m. Since I was there a little early, I I bought breakfast (a hot apple drink fortified with oatmeal to keep you full throughout the day) and watched as various vendors set up their tables and laid out there wares, preparing for the onslaught of folks that would head up to the cemetery looking for transport later in the day. The difference from Santiago could not have been more striking.

In many ways, the women’s dress in La Paz reminded me of Ladysmith, South Africa–dresses with long skirts, flats, a thick blanket tied or pinned around the shoulders, and a hat. In South Africa, this was often a wool beanie but in La Paz the hats varied from the plain wool beanie to tall top-hats. The men were mostly dressed somewhat formally, but working-class clothes rather than suits. Given how cold it was, it was maybe the lack of coats that surprised me the most.

As we started driving up the crazy steep hills (think San Francisco, except in the Andes), I noticed a herd of burros walking down a parallel street. Finally! I thought, An authentic Latin American experience!! But as soon as the thought sipped through my head I stopped myself. What makes La Paz anymore “authentically” Latin American than Santiago? The fact that in it’s poverty it’s closer to the gringo stereotype of what Latin America is or should be? To be fair, riding the colorful 1960s-era buses around La Paz with salsa music blasting made me feel like I was in some Hollywood movie–scene: protagonist travels through unidentified poor Latin American nation, finds herself profoundly moved by the squalor and poverty (vital character development that will influence her decisions at a crucial moment later in the film)–but the reality is that Latin America has experienced (and still is experiencing) some pretty intense changes. More and more of the continent’s cities are like Santiago de Chile and would seem quite familiar to an American or European visitor (in that all-big-cities-kind-of-have-the-same-feel kind of way). A while plenty of Latin America would still be recognizable to a young, Motorcycle Diaries-era Che Guevara, we’ve got to break ourselves (myself quite obviously included) of the assumption that it’s all still that way.

Postulando la visa y el valor de hablar español (aka Bolivia, Part I)

As regular readers already know, I headed out to Bolivia this weekend to give myself a little break from la vida chilena. Bolivia and Chile have a somewhat contentious relationship, born of the 1879-1883 Guerra del Pacífico, in which Chile ended up taking a lot of (very important, mineral-rich) territory from Peru and Bolivia, including Bolivia’s only coastal region. Bolivians trace the poverty of their country back to this war, particularly due to huge quantities of money gained by Chile due to the mines in this territory. On top of this, as of 2007 American citizens have to apply (and pay) for a tourist visa to enter the country, a special reciprocal requirement imposed by President Evo Morales (actually a really interesting figure, and the nation’s first indigenous president…more on that later). So I was a little worried that I had chosen to visit a country in which I wasn’t particularly welcome due to either of my identities.

The visa process, though, was surprisingly simple. I had done my research and gotten all my papers in order before the trip (application form, passport photo, bank statement, hostel reservation, yellow fever vaccination certificate) but the immigration officers didn’t ask a thing about them once I handed them over. The only thing that seemed to matter was the $135 entrance fee (maybe just because it was 4 a.m.). Interestingly enough, the thing that seemed to impress them the most was that I spoke Spanish. One of the immigration officers gave me a whole speech about how he had to learn English for the job because all the other American tourists who come to visit refuse to learn ni una palabra de español. I apologized for the arrogance of my compatriots (which I got to see later in full flagrance) and explained that I was studying in Chile for the semester and only had a weekend, muy poco tiempo, to visit Bolivia. The immigrations folks were kind enough as to give me several suggestions of things to do…high on the list was a visit to Lake Titikaka, the world’s highest navigable lake. I had been planning on doing that trip but didn’t think I had enough time but the women in immigration assured me that it was doable in a day.

Afterwards, I had to pass through customs. I had totally forgotten that you can’t bring anything with seeds through the borders and I had thrown an apple and an orange in my bag for breakfast , along with pan con queso y mermelada. The customs officer apologized profusely for having to take my fruits from me and two of the women working in immigration, with whom I’d been talking earlier, actually started arguing with him on my behalf–pero sólo son frutitas, que es el problema, es su desayuno pués!! After I assured him that it was really ok, that I had bread to eat as well, he shook my hand and they all wished me well on my travels. All for being a gringa who spoke Spanish.

Afterwards, I took a cab to The Point hostel on Calle Alto de la Alianza (which I would recommend, based on the cleanliness, friendliness/helpfulness, hot showers, good food, and bilingualness of the staff–it was actually an effort to get some of them to speak to me in Spanish) to drop my bag off. The fellow at the desk called me a cab to the Cemetario General so I could catch the first bus (6 a.m.) to Copacabana, on the shores of Lake Titicaca. More on that in the next post.