Physician works to improve health care for everyone

An infectious disease specialist believes that more doctors should work for global health equity.

By Damon Adams, amednews staff. Dec. 15, 2003.

For more than two decades, Paul Farmer, MD, PhD, has worked to improve care for the poor.

The physician and anthropologist is a world-renowned authority on tuberculosis treatment and control. He is founding director of Partners In Health, an international charity organization that provides health care to those living in poverty. He pioneered community-based treatment strategies for infectious diseases and is medical co-director at Clinique Bon Sauveur, a charity hospital in Cange, Haiti.

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Dr. Farmer, 44, a professor of medical anthropology in the Dept. of Social Medicine at the Harvard Medical School in Boston, has written books on global health inequity, most recently Pathologies of Power: Health, Human Rights, and the New War on the Poor. He recently visited Chicago for the American Anthropological Assn.'s annual meeting and spoke at the Chicago Symposium on Medicine, Ethics and Society, which was co-sponsored by the AMA. He talked with AMNews.

Question: What is the biggest challenge facing the medical community?

Answer: The issue of access to modern medical care for people living in poverty. So far, the medical profession as a whole hasn't taken access to care as seriously as it could, or we would have resolved the problem in this country. We haven't taken this on globally, either.

Q: Do doctors do enough to improve health care globally?

A: It would be great if more doctors could go abroad and see how the bottom billion live and die without access to the fruits of modern medicine. It would engage them more in thinking about the equity issues. There's not a single doctor who couldn't help in one way or another, often without ever leaving their home state. I'm not just talking about giving money and supplies. I'm talking about changing the basic attitude of our profession about equity.

Q: What more should doctors be doing?

A: Any physician can ask him or herself the question, How am I doing on the equity front? Whether that's rethinking one's own position on reimbursement or doing more for indigent patients, including not just serving them in a homeless shelter clinic, but also asking about the structural determents of who has access to care and who doesn't. Once you think about equity and access as human rights issues, then the door opens for more doctors to get involved.

Q: How bad is the health care situation in Haiti?

A: I got an e-mail from one of my colleagues in Haiti, and he said a Haitian with TB and HIV had died. It's because he got diagnosed too late. We call that failure to treat, not treatment failure. When you see these young people dying of two different diseases, it's nothing if it's not heartbreak. To see someone die in childbirth is a terrible thing. We've tried to wipe that out by making sure that there was modern obstetric care available.

Q: What do you find fulfilling about working in Haiti?

A: What I like most is seeing patients and doing home visits. Some people think that's a waste of my time because they say I should be working on policy issues. Seeing patients and following them over time, I really like that. A lot of the patients are co-workers of mine now. If someone who 13 years ago was dying of AIDS is now your co-worker, that's pretty gratifying for a doctor.

Q: Some view your work as trying to save the world one patient at a time. Is that accurate?

A: What a doctor does is take care of each patient as best he or she can, and that's sort of saving the world one patient at a time. My [practice] includes a fair number of slums and prisons and squatters' settlements, but I don't regard what I'm doing as profoundly different from other doctors.

Q: What books do you have in the works?

A: I'm going to work on a book on violence, and I'm also very tempted to work on a book on scaling up responding to AIDS in really poor countries and how to do it the right way.