Pathologies of Power uses harrowing stories of life—and death—in extreme situations to interrogate our understanding of human rights. Paul Farmer, a physician and anthropologist with twenty years of experience working in Haiti, Peru, and Russia, argues that promoting the social and economic rights of the world’s poor is the most important human rights struggle of our times. With passionate eyewitness accounts from the prisons of Russia and the beleaguered villages of Haiti and Chiapas, this book links the lived experiences of individual victims to a broader analysis of structural violence. Farmer challenges conventional thinking within human rights circles and exposes the relationships between political and economic injustice, on one hand, and the suffering and illness of the powerless, on the other.

Farmer shows that the same social forces that give rise to epidemic diseases such as HIV and tuberculosis also sculpt risk for human rights violations. He illustrates the ways that racism and gender inequality in the United States are embodied as disease and death. Yet this book is far from a hopeless inventory of abuse. Farmer’s disturbing examples are linked to a guarded optimism that new medical and social technologies will develop in tandem with a more informed sense of social justice. Otherwise, he concludes, we will be guilty of managing social inequality rather than addressing structural violence. Farmer’s urgent plea to think about human rights in the context of global public health and to consider critical issues of quality and access for the world’s poor should be of fundamental concern to a world characterized by the bizarre proximity of surfeit and suffering.

"If you have come here to help me, you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together."
—Lilla Watson, Aboriginal activist and artist

World-renowned physician and public health pioneer Dr. Paul Farmer has long been devoted to caring and advocating for the world's poorest people, and challenging wealthy Western countries to address the underlying causes of poverty and disease in the developing world. He and the organization he cofounded, Partners In Health, have built medical centers and health systems first in Haiti and then around the world—in Rwanda, Mexico, Nepal, Sierra Leone, Russia, the U.S. and more—that also address patients' social, nutritional, financial, and long-term care needs.

But as he and his colleagues have learned in assessing their own efforts, and indeed all efforts, to turn goodwill into a robust and enduring response to the profound problems of structural poverty, they have learned that success requires more than good intentions, expertise, and material resources. It requires replacing time-limited, contractual, and almost invariably inegalitarian arrangements between aid workers and aid recipients with an approach based on genuine partnership and solidarity. Farmer calls this new model for assisting the poor accompaniment. Accompaniment, he explains, is about sticking with a task until it's deemed completed, not by the accompagnateur but by the person being accompanied.

Through stories about his experiences and the evolution of his thinking,and incisive analysis of both existing data and the lessons of history, Farmer explains in this book what accompaniment means and how it works. In Part II of the book, a group of colleagues draw on their own experiences and studies to showcase accompaniment in action, illuminating both its enormous potential for transforming the lives of the poor, and the challenges and dilemmas they face.

Many people in the world of foreign aid and charitable giving have long championed the principles of accompaniment, but there remains a huge gap between rhetoric and implementation. Part of the reason for that gap has been an absence of data about the effectiveness of accompaniment-based initiatives. This book provides compelling, concrete data that accompaniment works—and that it works better than other approaches.

Inspiring, thought-provoking, and likely controversial, this is important reading for anyone who, like Farmer, seeks to create a better world.
Pathologies of Power uses harrowing stories of life—and death—in extreme situations to interrogate our understanding of human rights. Paul Farmer, a physician and anthropologist with twenty years of experience working in Haiti, Peru, and Russia, argues that promoting the social and economic rights of the world’s poor is the most important human rights struggle of our times. With passionate eyewitness accounts from the prisons of Russia and the beleaguered villages of Haiti and Chiapas, this book links the lived experiences of individual victims to a broader analysis of structural violence. Farmer challenges conventional thinking within human rights circles and exposes the relationships between political and economic injustice, on one hand, and the suffering and illness of the powerless, on the other.

Farmer shows that the same social forces that give rise to epidemic diseases such as HIV and tuberculosis also sculpt risk for human rights violations. He illustrates the ways that racism and gender inequality in the United States are embodied as disease and death. Yet this book is far from a hopeless inventory of abuse. Farmer’s disturbing examples are linked to a guarded optimism that new medical and social technologies will develop in tandem with a more informed sense of social justice. Otherwise, he concludes, we will be guilty of managing social inequality rather than addressing structural violence. Farmer’s urgent plea to think about human rights in the context of global public health and to consider critical issues of quality and access for the world’s poor should be of fundamental concern to a world characterized by the bizarre proximity of surfeit and suffering.
On January 12, 2010, a major earthquake struck near Port-au-Prince, Haiti. Hundreds of thousands of people died, and the greater part of the capital was demolished. Dr. Paul Farmer, U.N. deputy special envoy to Haiti, who had worked in the country for nearly thirty years treating infectious diseases like tuberculosis and AIDS, and former President Bill Clinton, the U.N. special envoy to Haiti, had just begun to work on an extensive development plan to improve living conditions in Haiti. Now their project was transformed into a massive international rescue and relief effort. In his own words, Farmer documents this effort, including the harrowing obstacles and the small triumphs. Despite an outpouring of aid, the challenges were astronomical. U.N. plans were crippled by Haiti’s fragile infrastructure and the death of U.N. staff members who had been based in Port-au-Prince. In chronicling the relief effort, Farmer draws attention to the social issues that made Haiti so vulnerable to this natural disaster. Yet Farmer’s account is not a gloomy catalog of impenetrable problems. As devastating as Haiti’s circumstances are, its population manages to keep going. Farmer shows how, even in the barest camps, Haitians organize themselves, creating small businesses such as beauty parlors. His narrative is interwoven with stories from Haitians themselves and from doctors and others working on the ground. Ultimately this is a story of human endurance and humility in difficult circumstances and seemingly overwhelming odds.
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