Poverty VS The World- The Physician’s Point of View

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“Preventable diseases can indeed be prevented, curable ailments can certainly be cured, and controllable maladies call out for control. Rather than lamenting the adversity of nature, we have to look for a better comprehension of the social causes of horror and also of our tolerance of societal abominations” (Farmer, 2005).



The book Pathologies of Power by Paul Farmer is an intriguing and powerfully written book, depicting the injustices and cruelty that comes from the government and those in power around the world, concerning the poor. His work as a medical anthropologist has taken him to many country, and witnessed some unimaginable crimes against humanity. He passionately shares his experiences, capturing what it’s like to be someone living in poverty, where it seems that their rights to be healthy don’t exist, let alone any other basic human rights. Farmer also explores the causes of this social injustice and analyzes the politics and situations in the countries he had the privilege of working in. Not only does he write with passion and authority, but he writes with the history and knowledge he has obtained from each of these countries, making the voices of the poor be heard.

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Pathologies of Power Summarized

This book explores structural violence and how it affects the world around us, in many different cultures and countries. As Farmer says, there is no way to point a finger at solely one person, since the acts of these crimes are carried out by so many, in all different forms (2005). He compares his experiences from around the globe, whether it’s from Russia, Haiti, or Peru, and criticizes society’s need to value money over the lives of millions. He speaks of how suffering cannot be measured since many cannot place themselves in the shoes of the suffering, and how it can be influenced by many factors, whether it’s social, political, or economic. He mentions how it is the “norm” in many countries, especially in Haiti, to live in such poor conditions and to suffer in so many ways. In many of the case studies throughout the book, many issues can be traced back to the power of the military, government, or law, whether it was them exerting their power over the vulnerable or secondarily causing the spread of disease. Either way, the control is in the hands of those that are already privileged and base their priorities on those who can afford healthcare and other essential services.


Ethnographic Characteristics

I would like to use Marcus and Cushman’s 9 Characteristics of a Realist Ethnography as my basis of what makes a good ethnography with some slight modifications. Farmer does not discuss their daily situations other than what might involve medical practices, or the lifestyles of the individuals he did his case studies on. Native concepts were also not used in his writing, or the use of third-person writing, however I do not believe writing in the third person is necessary, and it makes the writing less personal and relatable. In some aspects he uses the Whole Culture factor in the sense that he talks about some of the traditional beliefs of some Haitians which oppose the use of medications, and also mentions their ways of sustenance which included mostly farming crops.

I believe one of the more important factors of a good ethnography is demonstrated frequently in this book: the emphasis on the native point of view. Farmer depicts this very well since he himself was immersed in their way of life for so long, knowing specifics about their problems and speaking to them about how they view their lives and the opinions they had about those higher in status. The author does a good job of comparing the views of those that are privileged and underprivileged, since he himself comes from a privileged lifestyle. He even compares the differences in very different environments, from working at a hospital in Boston to working in the rural communities of Haiti. In chapter eight he talks about the economic injustice for patients taking medication for AIDS: Patients in Haiti beg for the opportunity to receive medication whereas those in Boston sometimes refuse to take them (Farmer, 2005).

Farmer had the opportunity to develop a very good sense of another important factor in a good ethnography: data based on ethnographic fieldwork. Being a physician in every place he had traveled, Farmer observed and participated in healthcare facilities from Haiti, to Mexico, to Russia. He witnessed first-hand the effects that poverty had on the poor and their personal views on society itself. From working for over 20 years in Haiti, Farmer could progressively witness the effects of poverty on health and the social injustices within their corrupt government.

Lastly, I think another crucial factor in a good ethnography is having individual’s stories, although this is not a characteristic from Marcus and Cushman’s list. I believe this make an ethnography more interesting when you can follow the story line of specific individuals, see how they interact with their society, and if they deviate from the “normal” individual from their culture. By recognizing characters within the book, it makes the ethnography more real and relatable for the reader. Farmer brings to life some of the individuals he met along his travels, telling their story and how it relates to the effects of poverty.

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His Audience

The audience for Pathologies of Power that I feel would be greatly influenced would be both high school students and university students who are looking into an area of study or are looking for motivation to go out and make a change in the world. By educating a young population about the injustices of our world towards the poor and their healthcare, a more informed generation could be formed and perhaps make an impact as Paul Farmer did, but in greater numbers. Physicians and wealthy people could also be greatly influenced by this book since they would have a greater chance of getting attention from those who could make political changes. Physicians could have the knowledge to know what certain populations need, since, as Farmer says, more funding needs to go into the healing of those that are already sick rather than funding into preventative measures.


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Gaining Knowledge

From this ethnography, I have learned more than just the technical aspects of the physician’s work in impoverished countries, but also the opinions and statements that Farmer has made concerning basic human rights and social injustices. This book is much more than an anthropologist’s observation of different cultures: it’s a cry of help out to the public to raise awareness and bring justice to those who are lacking it. Ren Chung, an Advocacy Officer in the United States summarizes a good point in his article, stating it’s not that these governments are lacking money; it’s that their funds aren’t going towards the appropriate factors. Another point he made is, as Farmer says, that the technology or medical information is there: it’s merely a matter of funding for citizens to obtain these drugs, which, as we discussed, could be fully paid for (Chung, 2014).

It is not new news to me to hear of corrupt governments not distributing their money appropriately, or being concerned with all their citizens equally. For example, the news of Haiti being a corrupt government is not new, ever since hearing of the earthquake in 2010, in which millions of dollars poured in to help those in need. Yet many of those without shelter are still homeless today, and the government remains quiet. Healthcare had never crossed my mind as being a great issue in many of these impoverished countries, since it’s not the subject you often hear of. The issues usually heard of on the news include the need for jobs, shelter, and food. It’s incredibly sad to think of something else we take for granted in Canada (our healthcare) is clearly not an option in many countries.

Overall I think this book is incredibly well written and could really make a difference in the world if it gets into the hands of the right people. Those with the motivation to impact and change the world can do their part by merely raising awareness. As Claudio Schuftan, a Chilean physican, writes in his critiquing article, “In the Afterword, Dr Farmer asks why we should give a damn? And the ‘because’ is loud and clear: It is not useless to complain!” By working in numbers, we can hopefully open the eyes of those causing these injustices. “Pathologies of power damage everybody, but kill chiefly the poor. We cannot, therefore, stay in our comfort and innocence” (Schuftan, 2010).



Chung, Ren. “12 takeaways from Paul Farmer’s Pathologies of Power.” Ren Chung’s blog. February 20, 2014. Accessed March 26, 2017. http://www.renchung.com/2014/02/20/12-takeaways-from-paul-farmers-pathologies-of-power/.

Farmer, Paul. Pathologies of power: health, human rights, and the new war on the poor. Berkeley: University of California Pr., 2005.

Scuftan, Claudio. “BOOK REVIEW- PATHOLOGIES OF POWER: Health, human rights, and the new war on the poor.” JHPN. 2010. Accessed March 26, 2017. http://www.jhpn.net/index.php/jhpn/article/viewFile/220/215.


Katriona Atkinson

Word Count: 1 419


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