Paul Farmer talks about saving lives in Haiti, Rwanda's healthcare system and how to improve humanitarian aid.
Self-study activity:
Watch the video and say whether the statements below are true or false. The activity is suitable for Advanced students.
1 Paul Farmer is a doctor.
2 We have the technological and human resources to make healthcare available for all the people in the world.
3 Accompaniment is usually criticised for being very expensive to implement.
4 Paul Farmer is an asthmatic.
5 Paul Farmer's patient suffering from asthma finally died.
6 Paul Farmer received a present for his action.
7 Child mortality has increased in Rwanda in the last 10 years.
Paul Farmer is a physician who has tried, and actually kind of succeeded in bringing gold standard healthcare to the poorest people in the poorest nations. He has a new book, To Repair the World, and I’m delighted to say that he’s here with us at Time today. Dr Farmer, welcome.
Thank you very much.
You say the biggest failure that we have in providing healthcare to the people who are very poor is a failure of the imagination.
It must be a failure of the imagination because a lot of the technologies that you need or the human resources that you need to do a good job in settings of poverty, we have them elsewhere. You know, the idea that you could send a rover to Mars but not, you know, build a healthcare system for... that protects poor people is, is just not possible that we couldn’t do that.
You write in the book about accompaniment rather than aid. Can you explain what that means?
Well, you know, accompaniment is what a physician ought to be doing, or a nurse. That is, you don’t say to a patient, hey, here’s the beginning of your illness and here’s the end of it. You really say, okay, I’m gonna be your doctor for a long time. It seems to me, looking at aid that it would be a better model than some of the other ones that have preceded it.
So you think that this idea of accompaniment, you are a champion of, of great healthcare for the poorest. And the problem that a lot of people have with that is that is really expensive and really difficult to provide such healthcare.
Great healthcare may be less expensive than a radically administered or tardedly administered healthcare, at least I think it is. I’ve been lucky enough to work in places where there is, you know, enormous constraint on healthcare expenditures, rural Haiti, rural Rwanda, and seeing you can build systems that can provide compassionate prevention and care for the whole population with a focus on serving the poorest, probably for relatively limited amounts of money.
So there’s a story you tell in the book about happening upon a man who was about to die from an asthma attack. And it just so happened that the only piece of medical equipment you have on you at the time was an inhaler because you yourself are an asthmatic. and you managed to get enough of this inhaler substance into the man that he could recover. I mean, what, what do you take away from that story?
I had been there, in his village, in Haiti for another reason, for a community meeting, and I didn’t have a stethoscope and I didn’t have my bag. His wife said, please, doctor, please. And so I went, and, if you’re having an asthma attack and you can get... his medication was just Albuterol, it feels, it looks like a miracle, but it’s not a miracle. Then the next day he came to see me in the clinic, and brought me, you know, a rooster and he prays on me and everybody in the village did. And you kind of like that when you’re a doctor.
Right, who doesn’t want a rooster? Right.
And who doesn’t want a rooster. I was thinking more of the praise. But then to say, you know, the best thing you can do, of course, is build systems that protect people from that kind of risk.
So it sound to me that it exhilarates you more to actually change public policy, to get prevention in place rather than the hands-on healing of one guy.
Yeah. In the last 10 years life expectancy has almost doubled in Rwanda. Child mortality has plummeted. Death during childbirth and deaths from patients who already have Aids or tuberculosis has dropped precipitously. Now, is that because someone like me went and delivered care to an individual patient, or is it because people thought about the systems of healthcare delivery and how to bring them up to scale for all Rwandans? It’s really the latter.
Dr Farmer, thank you.
Thank you very much, Belinda.
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