Review of Paul Farmer’s Pathologies of Power by Alicia David

Paul Farmer offers us a sneak peak into the world of medical anthropology in his ethnography “Pathologies of Power”. Farmer is not only an anthropologist but also a doctor which gives him significant privilege and power over those who he chooses to study. He is using a downwards approach in way he chooses to study populations. His ethnography brings us into the world of poverty in developing countries that are facing the detrimental effects of diseases such as tuberculosis and AIDs in countries like Haiti and Russia. His analysis of poverty links the root causes to structural violence, neoliberalism and global capitalism. Those who are rich decide who are worthy of modern medicine, and who are not.

Every time we turn on the television we hear about how a 30 cent donation can vaccinate however many children from such and such disease that we have virtually eradicated here in the Western world. Farmer and I can both agree upon the fact that the Western world very much controls the realm of medicine and who will be deemed worthy enough to live. The right to survive is our most basic human right that all of our laws and social norms are based upon. Farmer brings us out of our comfort zones by examining how not all of us have the same right to survive as others.

As a student, Farmer’s ethnography had many of the qualities that I would consider to be in a good ethnography for undergraduate courses. It was not filled with jargon making it impossibly dry and hard to get through like most traditional ethnographies. He draws upon his personal experiences to justify what he is trying to argue to his audiences and these stories also help to break up the theory and anthropological explanations of what he is viewing. It brings life to this ethnography making it ideal for students considering it is a more lengthy novel.

Willis and Trondman have laid out their wishlist for ethnographies which I support in being ways to determine whether or not an ethnography can be deemed good or not. One of the aspects that must be included in a good ethnography is that they will help the audiences to better understand what is going on (Willis and Trondman 2000). Farmer’s ethnography fell into this category and really helped us to get a better understanding of what is occurring in the developing world to the poorest of the poor in regards to health care. They are virtually being ignored by the rest of the world and no one in positions of power, who can actually make any significant changes, are doing anything to change this structural violence. His ethnography allows us to also better understand why this is occurring through topics such as structural violence, neoliberalist policies, and global capitalism. Willis and Trondman also say that there should be a critical focus on power inequalities and how they impact lived social relations (Willis and Trondman 2000). Farmer’s entire ethnography is based around this idea and is very critical of power inequalities and how they impact the poor.

As a development studies student, this ethnography was very appealing to me and I believe it’s most suitable for others who are in this type of field of study. His audience is structured towards people who have an interest in medical anthropology in developing regions and how privilege and power is given to some and stripped from others. This ethnography would be most accepted by those of us who have previous knowledge of the inner workings of our global power structures. Audiences who live in ignorance of privilege and power would not be good audiences for this type of reading as it delves deep into how we maintain our power structures of oppression. It is also not overly heavy in theory which to me makes this less likely to be an ethnography directed towards the field of anthropology in itself. Development work, however, would be an excellent example of an appropriate audience as it works to give an anthropological perspective of the development of health care. It furthers our knowledge of privilege and power not only on a local level but also on a global scale.

This type of study opens our eyes to the world and what is really happening versus what we are seeing. It allows us to question how we contribute to this type of global system that continuously allows for this type of action to take place. If it is not directly affecting us, most of us simply do not care enough or know any better to educate ourselves on the issues that are facing others. Especially we as Canadians, we often take healthcare for granted as it’s not a social problem we really need to be overly concerned about in our own lives.

Eric Stover’s review of Farmer’s ethnography in American Scientist Journal chooses to focus in on the issues he addresses in Russian prisons. Farmer was able to use his privilege as a doctor to gain access to these prisoners who were suffering from MDRTB (Stover 2004). This was a way in which Farmer was able to use his power for good while studying vulnerable populations. Stover says how in our current era of globalization we should easily be able to find ways in which we can better account for a more just and equitable world (Stover 2004). I agree that with all of the negatives globalization can often bring to developing populations, the realm of healthcare should be improving rather than further deteriorating. Unfortunately, like Stover mentions in his review, Farmer’s suggestions to better the lives of those suffering from MDRTB in Russian prisons which are known for their abuse, were left unheard as the treatments are costly and no one was willing to step up to fund the needs of these vulnerable populations, including organizations like the World Bank (Stover 2004).

Ben Brucato on the other hand, choose to focus on Farmer’s look into Haiti and Chiapas. Brucato was for critical of Farmer’s ethnography bringing up 3 major themes that were missed by Farmer. These included his failure to address many of the root causes that lead to health problems in relation to industrial production and the industrialization of modern medicine, the destruction of cultures at the hands of industrialization and colonialism and lastly he failed to incorporate the role that traditional medicine and healing practices play in the lives of these local populations (Brucato 2011).  I agree that Farmer did not deeply analyze these areas which may have provided some important additional understandings of the environments however I also don’t believe that it took away from his ethnography either. These are important questions to further on the ground work that Farmer has laid out for us. Farmer also was very broad in his study and in my opinion was trying to incorporate too many groups into the same type of study for this ethnography which could be why these topics were left unmentioned.

Overall, Farmer did an excellent job at bringing us into the lives of those who are silenced due to their social economic status not only locally but globally. Going back to what the critique that Brucato had on the ethnography, Farmer did not cover everything and left us with some questions but he in my opinion, did give us a good foundation to work on. Development work can benefit from Farmer’s study as well as advocacy groups who are struggling to find new ways in which they can get their foot in the door when it comes to global healthcare. He includes many of the prerequisites I have for a good ethnography and I would highly recommend this to all of you who are interested in furthering your knowledge of global health dynamics.

Word Count: 1299

Sources:

Brucato, Ben. 2011. “Review of Pathologies of Power: Health, Human Rights and the New War on the Poor, by Paul Farmer, University of California Press, 2003” Accessed on March 30, 2017. http://www.benbrucato.com/?p=125

Farmer, Paul. 2003. Pathologies of Power: Health, Human Rights and the New War on Poverty., London: University of California Press

Stover, Eric. 2004. “Review: Beyond the Law: Pathologies of Power: Health, Human Rights, and the New War on the Poor by Paul Farmer”. American Scientist 92, no. 2: 178-80.Farmer

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