Distribution of Wealth and Healthcare
Throughout Tracy Kidder’s book, Mountains Beyond Mountains, various economic and political issues are addressed that pertain to Dr. Paul Farmer’s work in Haiti, including two very prevalent social justice issues: distribution of wealth (economic inequality) and healthcare. The inequality in distribution of wealth, resulting in elite groups gaining power, prestige, and resources while the poor suffer in poverty oppression, not only exists on an individual basis, but also on an international scale. In Kidder’s book, Farmer addresses the disparity of money and power between the haves and have-nots, juxtaposing the elite Haitians as a people of power and the poor Haitians as the oppressed population. The poor in Haiti are also juxtaposed to the Western world’s inhabitants (more notably, the United States). To further understand this economic inequality, it is important to look at concrete numbers to reflect this disparity. For instance, the average Haitian makes one dollar or less a day in per capita income, while American doctors are grossing hundreds of thousands of dollars a year (Kidder, 2004, p. 20). It can be easy for Americans to brush this fact aside, claiming that their privileges and wealth has nothing to do with Haiti. Farmer, however, repeatedly challenges this notion. The United States’ government has been an integral force in shaping Haiti’s present situation, and the wealth distribution, Parmer argues, can be blamed largely on U.S. transnational corporate interests (Kidder, 2004). Noam Chomsky also asserts that the United States, France, and other affluent foreign powers are large players in international distribution of wealth:
Free capital movements provide a powerful weapon against social justice and democracy. There is nothing inevitable about any of the developments that are reshaping the international order. They are not laws of nature or economics, but the results of decisions, which can be changed, made within human institutions that can be replaced by others that are more free and more just… (Chomsky, 1998, para. 31).
Farmer constantly echoes Chomsky’s sentiments and challenges the “free” trade capitalist model in favor for Aristide’s Marxian liberation theological model which advocates fir equal access to resources such as housing, transportation, and most importantly, healthcare (Kidder, 2004) .
Healthcare, another issue of social justice, can be seen in conjunction with wealth distribution. Farmer’s work is centered on making healthcare available to everyone, especially the poor and oppressed, and views healthcare as an extension of basic human rights, not merely as a privilege for the wealthy.
Social and economic rights, which include the right to health care, have been termed the ‘neglected stepchildren’ of the human rights movements and held up in opposition to the political and civil rights now embraced, at least on paper, by many of the world’s most powerful governments (Farmer, 2006, p. 152).
The poor, as seen in Zanmi Lasante in Haiti, not only lack decent medical care, but are also required to pay a fee, oftentimes a tremendous sum in comparison to what they earn. More often than not, the poor in Haiti go without treatment and die from medical complications. “The people who have died without a single dose of effective therapy over the past decade are, almost without exception, people who lived and died in poverty” (Farmer, 2005, p. 151). Joseph, an AIDS victim in Haiti, has a story that reflects this very sobering fact: “My father sold nearly all that he had—our crops, our land, and our livestock—to pay the healer, but I kept getting worse. My family barely had enough to eat, but they sold everything to try to save me” (Farmer, 2006, p. 146). The need for adequate healthcare is at the heart of social justice and is an issue that has strong economic and political underpinnings. As Virchow wrote, “medicine is a social science, and politics is nothing but medicine on a large scale” (Kidder, 2004, p. 61).
Wealth Distribution and Healthcare: Underlying Historical, Political, and Economic Aspects
It is of utmost importance to understand the historical, political, and economic aspects that underlie the incredible disproportionate wealth distribution and lack of healthcare in Haiti. First of all, from a historical perspective, it is important to take into account Haiti’s’ struggle as a colonized country ravaged by the slave trade. Though historically Haiti was the first “black republic” (Chomsky, 1998, para. 1), ending slave trade before the United States, it immediately had struggles following its emancipation. For one, Haiti was alone in its celebration of its personal end of the slave trade and its subsequent liberation from France. Furthermore, Haiti became unpopular with other countries that sided with France, including the U.S., which shunned Haiti and refused to recognize its independence (Farmer, 2004). As early as the 1800s, Haiti was struggling to maintain its self-sufficiency due to its lack of international support (Zinn, 1997).
The political situation in Haiti, both current and past, has been a constant state of conflict. Haiti has had a long struggle with establishing a constant form of reliable government. Despots, such as Baby Doc and Duvalier, have been ousted and replaced by more egalitarian leaders, such as Jean-Bertrand Aristide, a friend of Farmer’s and a fellow grass-roots advocate for the poor (Kidder, 2004). Aristide, though supported by many of the oppressed and poor Haitians, has not been supported by foreign powers; the United States has referred to Aristide as a threat to justice – in reports and articles, writers and politicians label him as a “psychopath” (Perousse, 1995, p. 61). The political aspects of Haiti involve largely both U.S. and European interests over Haiti’s economy and control of resources. Reagan vehemently opposed liberation theology, insisting Aristide was more communist than Christian and, fearing communism’s rise to power, called for military force to stop the threat (Farmer, 2006). The United States has obscured relevant information to the public regarding its military interventions and strong economic and historical ties with Haiti (Zinn, 1997). U.S. history conveniently does not mention its involvement with Haiti’s violent despotic rulers, forced military intervention, and control over its plantations. “Gone from ‘history’… is the restoration of virtual slavery, the dismantling of the constitutional system, the establishment of a state terrorist force (the US National Guard) that has kept its iron grip on the population ever since, and the takeover of Haiti by US corporations” (Chomsky, 1993, p. 153). Why do the United States and other foreign powers want to remove Aristide of power? The answer is tightly woven into economic reasons, as Farmer explains below:
Father Aristide’s government’s policies reflected liberation theology: ambitious programs to promote adult literacy, public health, and primary education were quickly launched, as were campaigns to raise the minimum wage, opposed vigorously by Haitian and U.S. factory owners, and to promote land reform, opposed by those with large and often fallow landholdings (Farmer, 2005, p. 166).
Aristide also refuses to pay off the debt that Haiti owes to the international community, instead calling on France to make reparations to Haiti (Farmer, 2004). This also has not been supported by the United States, whom has historically supported France’s insistence that “Haiti pay a huge indemnity for the crime of liberating itself, a burden it has never escaped” (Chomsky, 2004, para. 5).
Haiti’s economic situation is closely tied into its political and historical past. As mentioned above, Haiti’s vision of a just, equal society free of slave trade and colonial rule did not truly ever happen due to lack of international support and recognition. Haiti’s economics have been controlled by elite groups and are tied into European and American economic interests. These interests concern cheap labor, which has been described as “a marvelous opportunity for American investment: the run-of-the-mill Haitian is handy, easily directed, and gives a hard day’s labor for 20 cents, while in Panama the same day’s work cost $3” (Chomsky, 1994, p. 205). U.S. corporations have grown to extreme numbers, from 13 companies to 154 companies between 1966 and 1981, contributing to almost half of Haiti’s export business which, of course provided “limited employment or other benefits for Haitians, apart from new opportunities for enrichment for the traditional elite” (Chomsky, 1994, p. 205).
Haiti and the United States: A Look at Populations-at-Risk
By looking at the prevalence of environmental racism and disparities in healthcare, the poor in Haiti can easily be compared with the poor in the U.S. Racism is alive and active in both the United States and Haiti. Chomsky, as stated above, refers to Haiti’s treatment of its poor as “virtual slavery”. Environmental racism is ever-present in Haiti and the United States where “racial minority and low income groups bare a disproportionate burden of environment risks” (Cutter, 1995, p. 111). The Haitians’ environment, living in communities seeped in sewage, human waste, and other hazards is very similar to dangerous chemical plants, sewage systems, and oil spills that exist alongside black communities (Cutter, 1995). The disparity in healthcare is also prevalent in black and immigrant communities where it has been noted that black Americans and immigrants receive subpar treatment due to the lack of power and social status (Smedley, Stith, & Nelson, 2003). Along with healthcare and environmental disparities is the practice of victim-blaming against minority groups, prevalent in both the U.S. and Haiti. The incredible maltreatment of black Americans (note: a nondominant, minority group) can be seen in the Tuskegee syphilis study. In this study, black patients were given partial treatment or were denied treatment in order to be used as guinea pigs to further scientific testing of treating syphilis (Thomas & Quinn, 1991). Like the victims in the Tuskegee study, the poor in Haiti have received either only minimal treatment or none at all to treat diseases such as tuberculosis, HIV/AIDS, and malaria. The opposition to providing the treatment is the argument that “…it is simply not possible, or even wise, to deliver complex medical services in settings as poor as rural Haiti, where prevention should be the sole focus” (Farmer, 2006, p. 149). The question Paul Farmer is addressing in Kidder’s book is why should medical efforts be any less complex and developed for the poor than for the wealthy? Why do such disparities in healthcare exist for the poor not only in Haiti but also the United states?
Though the treatment of Haitians and black Americans is comparable, there is marked difference between the two: what differs most is their context and intensity of their suffering, which Parmer refers to as the “levels of suffering” (Kidder, 2004, p. 126). Farmer maintains, “Absolute poverty, the lack of almost every necessity – clean water and shoes, medicine and food – [is] in a place like Haiti. Relative poverty in a place like New York” (Kidder, 2004, p. 126). The struggle to survive in Haiti is the primary health concern of its inhabitants. In terms of the level of suffering, the minorities situation in America is not quite as comparable to the suffering of the Haitian poor, who know few if no resources, hospitals, or doctors. Though black Americans and other minorities may not receive top-notch treatment and are denied insurance, there is a welfare system in place, as faulty as it is, as well as free clinics and sliding-scale hospitals in most every city. Financial aid, Medicaid, and Medicare, though bureaucratic and stringent in their requirements, do help those whom are poor or have disabilities receive medical care.
Social Justice and Social Action: Lessons from Paul Farmer
Paul Farmer’s work takes on the very core of social work’s mission which is “to enhance human well-being and help meet the basic needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty” (NASW, 2000, p. 1). Farmer works in a culturally competent manner to empower the poor of Haiti and to advocate for their cause. Farmer as a social justice advocate argues for the necessity to not make such tremendous gap between “this world” and the world of Haiti, arguing the relation between “the massive accumulation of wealth in one part of the world and abject misery in another” (Kidder, 2004, p. 218). Farmer’s mission also sets out to educate people that wealth accumulated by the elite and middle class, directly affects the poor, even in a place as far away as Haiti seems. Kidder summarizes Farmer’s view of Haiti when he writes, “This view of drowned farmland, the result of a dam that had made his patients some of the poorest of the poor was a lens on the world… Look through it and you’d begin to see all the world’s impoverished in their billions and the many linked causes of their misery” (Kidder, 2004, p.44). Through constant lectures, journals, and policy work, Farmer proves that advocacy is the only way for social justice causes to be heard and acted on. Farmer, though his relentless battles and tremendous commitment to the poor and oppressed, breaking the status quo of the “way things are done,” and often breaking rules, is after more than just education. Kidder realizes this as he writes, “Education wasn’t what he [Farmer] wanted to perform on the world… He was after transformation” (Kidder, 2004, p. 44).
The Ethical Issues and Dilemmas in Foreign Military Intervention and Provision of Aid
Farmer’s work in Haiti is not without controversy. Ethical dilemmas arise when providing services and aid to third world countries. The two addressed issues below concern foreign (U.S.) military intervention and aid provision. The military has intervened many times in Haiti with the self-aggrandizing idea that “in ‘failed states’ like Haiti…the U.S. must become engaged in benevolent ‘nation-building’ (Chomsky, 2004, para. 4). Farmer believes in the use of military intervention only if it is done on behalf of truly working toward social justice. Farmer calls for foreign intervention to instead “restore democracy” (Kidder, 2004, p. 116) and vehemently protests against viewing Haiti as a “failed state”, arguing that this viewpoint will just lead to victim-blaming. However, looking at past military interventions, the dilemma arises of how to define democracy, who defines it, and is it necessary or beneficial to Haiti to assert U.S. power in their own country? And how is military power enforced?
Foreign aid in healthcare is another highly debated topic. One argument is that foreign aid provision is actually harmful to the receiving country, feeding the level of dependency the third world country has on its benefactor. Opponents to aid argue that “the only thing projects like Cange really accomplish is the creation of ‘dependency’” (Kidder, 2004, p. 100). The amount of money that Farmer has used to treat one patient, including a $20,000 plane ride to Boston, his critics argue, could be used more efficiently than just saving save one life (Kidder, 2004, p. 288). The ethical dilemma here poses the question of which is more important: the life that is in front of you or the money that may go on to eventually save more lives? Farmer’s answer is clear and makes no apologies: to “provide services to the desperately poor – directly, now” (Kidder, 2004, p. 101).
Resources
Chomsky, N. (1993). World Order and Its Rules: Variations on Some Themes. Journal of Law and
Society. Cardiff: Blackwell Publishing. (20)2, 145-166.
Chomsky, N. (1994). Year 501: The Conquest Continues. Boston: South End Press.
Chomsky, N. (1998). A Century Later. Peace Review, (10)3, 313. Retrieved 10/14/09 from
Academic Search Complete.
Chomsky, N. (2004). U.S.-Haiti. Znet. Retrieved 10/14/09 from
http://www.chomsky.info/articles/20040309.htm
Cutter, S. (1995). Race, class, and environmental justice. Progress in Human Geography.
Columbia: University of South Carolina. (19)1, 111- 122.
Farmer, P. (2004). Who removed Aristide? Paul Farmer reports from Haiti. LRB letters page.
London Review of Books. Retrieved from http://www.lrb.co.uk/v26/n08/farm01_.html
Farmer P. (2006). Never again? Reflections on human values and human rights. The Tanner
Lectures on Human Values. Salt Lake City: University of Utah Press, 137-188.
Kidder, T. (2004). Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who
Would Cure the World. New York: Random House, Inc.
National Association of Social Workers (NASW). (2000). NASW. Code of Ethics. Washington, DC: NASW
Nesbitt, N. (2009). Alter-Rights: Haiti and the singularization of universal human rights, 1804–
2004. International Journal of Francophone Studies (12)1, 93–108, doi:
10.1386/ijfs.12.1.93/1
Perousse, R. (1995) Haitian democracy restored: 1991 – 1995. Lanham, MD: University Press of
America.
Smedley, B., Stith, A., Nelson A. (Eds.) . (2003). Unequal Treatment: Confronting Racial and
Ethnic Disparities in Health Care. Washington, D.C.: National Academies Press.
Thomas, S. & Quinn, S. (1991) Public Health Then and Now: The Tuskegee Syphilis Study, 1932-
1972: Implications for HIV Education and AIDS Risk Education Programs in the Black
Community. American Journal of Public Health. 81(11): 1498 – 1504.
Zinn, H. (1997). A People’s History of the United States. New York: New Press.
