Organization Provides Health Care To Poorest People In The World

MAUREEN CAVANAUGH: This is KPBS Midday Edition, I am Maureen Cavanaugh. We're all used to seeing the images of sick and desperate people in the poorest nations of the world. Some of us may be moved to send it to nation and many of us will simply be thankful that our lives are better. Only a few of us see images like that and say, this must change. My guest Doctor Farmer is one of those few. Doctor farmer and his organization partners in health, they are known internationally as providing first world health care to some of the first people in the world. In the process, advocating for a process of world health that goes far beyond a pill or vaccine. Paul was the subject of price winning biography Mountains beyond Mountains, written by Tracy Kidder. And Doctor farmer has written several books himself including to repair the world. He is speaking tonight at the Point Loma Nazarene University, it's my pleasure to welcome Doctor farmer to the show. Thank you for coming in. I think health care is often thought of as a gift or a generous gesture that the developed world extends to underprivileged people, I understand that you don't see it that way. What you see healthcare as? PAUL FARMER: Well, I mean healthcare if it were conceived as a gift will not be In the developing world and that notion would be wrong to say on the grounds as I come to pass. There are other ways of thinking more fruitfully about it, even the notion of health care as a right or as a useful way of framing the problem work after all, we'll live in one world, not three world. First second and third, even trying to use the notion and that paradigm of healthcare is a right but to work with others in partnership to build systems and provide basic services but also protection. You use the term first world, there is a lot of need to improve health care in the first world as well and some of the lessons we have learned in Rwanda over the last decade, I think it would have a broad application in the United States. Again, those paradigms as I just mentioned three, the rights paradigm and the investment and health, it's a good investment as a high to use a high return on investment, we also talked to people in the position to make those decisions about the prudence the and importance of investing in healthcare. As a way to create development. MAUREEN CAVANAUGH: When did you first encounter patients who you knew were suffering from diseases or conditions that could be easily cured if they either had more money or the lives elsewhere? PAUL FARMER: I am grateful to be able to say as a college student the first time I ever had to think about it or was allowed to think about it in a classroom, encountering patients is also working in a research area and this was over thirty years ago as an undergrad writing about whole race, class and insurance should the experience of emergency room as a volunteer just learning and trying to be a decent student and that is what led me to Haiti as well. Working in North Carolina and thinking about the problems faced by migrant farmworkers in North Carolina. A lot of them were Haitian at the time and that is how I end up in Haiti before medical school. MAUREEN CAVANAUGH: When you are in a nation like Haiti which is overwhelmed with the myriad of problems, and the healthcare situation is at times so desperate, I know this is not your first consideration but had you handle that emotionally? PAUL FARMER: In a sense it is one's first consideration whether you acknowledge it or not. Right here in the face of someone else's suffering, and so as the young man and as a physician and training it was possible to say well, it's not about my emotional reaction to this patient, and there is a lot of merit in remembering that. But it is still nonetheless wrenching and the way that my coworkers and I, I don't want to move away from myself to quickly but it's really about us and the teams that you are together to build health systems. The way we respond this to attend to this suffering before us and think hard about the many and take care of it all product scale. My answer is, we respond to suffering with a real pragmatism. How can we lessen it? There is also a very close idea to what you should be doing in medicine and thinking critically about those health system so that others who you want to meet, who you can never meet because you can never see that many individual patients as a physician or nurse, thinking very broadly about how to prevent suffering from people you never meet. That takes a discipline and again, teamwork. A cold in Haiti MAUREEN CAVANAUGH: In Haiti, I understand that you have a phrase that you use. It's called a stupid death, what is a stupid death? PAUL FARMER: I first heard that term when I was back in medical school, or just starting medical school. A friend of mine who'd been working with us from a nearby town in central Haiti the first place I went in 1983, she had been working with us and she was not particularly trained to be a health professional. She was working in patient records and she had a manic depressive disorder and in any case she died in childbirth right after childbirth, and I remember her brother saying ñ her little brother was a teenager and he said that is what we call a stupid death and had heard that many times and by that he said she had no reason to die if she had modern method metal care and if she was working with a medical organization trying to be born, it happened several times. A number of coworkers that we could not without a health system, we were incapable of saving their lives and I think that is what the term means, people die because they did not have access to something that should be a right. MAUREEN CAVANAUGH: And that is one of the essential things that you and your organization would like to step in and stop. Deaths that did not have to happen. PAUL FARMER: And we like to do that by building partnerships and again to use the term thrown along a lot, with local people who live in the area and that is been our MO all along. That is included academic universities and institutions and I've been looking at working with Harvard for thirty years, there need to be local institutions to train doctors, nurses, pharmacists, and managers, etc. That is how we try to address that suffering to build local capacity. MAUREEN CAVANAUGH: Doctor Farmer, you told us here in the beginning of our conversation that one of the aspects of your effort is to try to convince people that high-quality healthcare as an investment actually can actually be low-cost healthcare because of the returns and the investment in healthcare and that can actually result in a huge amount of return for a country, for a community, how you go about to convincing that? There is one thing that people think they know about quality health care is that it's expensive. PAUL FARMER: I think in order to convince, you need information. It really is an argument and we would like to think that amassing information and prove of that principle is going to make a difference. It's kind of an enlightenment I get that actually knowing about something makes it easier to sell an argument and we have a lot of information out. From all across the world, the investments and primary care and women's health, and making sure that we plucked the low hanging fruit. Again by that term in medicine everyone would agree that vaccine and preventable illness, prenatal care, if you look at the return on that we arty have a lot of information to show that it makes a huge difference. And you look at the United States putting 16% in two healthcare, we don't really have a good enough delivery system to see the return on that and we're trying to study that here but in places all over the world where we work and in other words, to leverage this provision of medical care with learning and training and that is hard to do and say, but it's possible. So, that is what we are doing. Here's the evidence, you can use that evidence to bring people into work but also to enhance people in position of making those decisions, Rwanda for example it is investing fairly heavily in healthcare delivery of the last decade. They've been seeing a great return no matter if they look at economic growth or the reduction in premature mortality. They are seeing entering this as well. MAUREEN CAVANAUGH: I want to talk to more about Rwanda and the healthcare system you've helped to create in the country but at least the back for a minute because one of the things that you advocate when it comes to this comprehensive notion of health, and of global health, is that it does not just stop with a pill or vaccine. It has to do with social justice, and has to do with poverty. It has to do with violence and crime. And when you start talking about the vision of global health, that moves beyond sending vaccines or pills to sick children, do you tend to lose people? PAUL FARMER: I think to be honest and modest we do lose people. The fragments are too complex and not as compelling as saying here's suffering and you can stop it and should. I also think is a compelling arguments but the term global health equity is meant to help remind us and as I was reminded as young man looking up migrant farmworkers that this is not a separate world, these worlds are connected your capture in a place like San Diego that is obvious. This is an area where there's a lot of movement across borders of all kinds. And indeed, most of the places I have worked that is true. And that is true in Haiti, in Guatemala, in Russia. People are moving around and the idea that we can shut away some unnecessary suffering and focus on this, hence the keyword global. I'm not sure if we lose people because we're not turning enough time underlining the importance of equity, fairness, and justice, or maybe we're bringing people and because we insist on that. I have to say as a teacher everywhere in the world we see young people interested in global health, a term that I never heard in medical school thirty years ago when I was starting. By that, healthcare problems from people far away from where they are, but to many people it means global health and it's true that this is a powerful notion. Just like the notion of the right to health care is a powerful motion as well, we will keep using it and finding other ways to engage people because these are matters of concern to everyone. MAUREEN CAVANAUGH: The right to health care is not something that everyone agrees about in this country as you well know, and I am wondering, your focus is an international but have you been involved in the date ñ debate over the have affordable care act in getting people to our healthcare system? PAUL FARMER: I've certainly been engaged I hope all American civic physicians are engaged at least and I've spent most of my time outside in terms of healthcare delivery over the last ten years, outside of the United States. I am engaged and we are all engaged because we care again about those first principles, the notion of the right to health care and the notion that a couple of other ideas that sometimes bring people in when you think about it, what is the leading cause of taking a family and moving them from poor to destitute? All across the world there is catastrophic illness and that is another area where we can say do you think that is a good idea? That is a leading cause of destitution in the world? In the United States it's a major problem. People have a sick family member and they become insecure financially. Maybe I am a little too optimistic that I think that is a terrible idea and people will know that it's not good, hence the idea again to keep sharing in teaching and engaging people, we do not want families pushed into poverty or insecurity and be unable to do things that they would like to do for their kids by serious illness. It makes no economic sense either. MAUREEN CAVANAUGH: You and your family live in Rwanda now and have done for some time and you were given the opportunity on the challenge and welcomed by the government of Rwanda to come in and create a healthcare system for that nation. Have you been surprised that we've been able to do? PAUL FARMER: One minor correction, it was to create with Rwandans, so we understood at the outset that the work that we had done elsewhere including in Haiti was appealing for several reasons, one because we're focused on rural areas and Rwanda is a fairly rural place, most people still live in rural areas or are involved in agriculture. Another is that it was after the worst spasm of violence probably in the history of that continent and we felt that we know how to operate in that space and we were also pushing a community-based care model that relied, especially on Trinity health workers. We were anticipating with many other partners, without strong support from the government in the sense of the public health authorities, we're anticipating success. The scale of the success and the rate at which unnecessary deaths dropped in the last decade, that was gratifying. MAUREEN CAVANAUGH: More on this tonight, Doctor Paul Farmer will be giving in the grip ñ an address on this and if you want to find more about this and if you want to go you can go to the point Loma website pointloma.edu/farmer. Doctor Paul Farmer, thank you so much for coming in and speaking with us. PAUL FARMER: It has been a pleasure, thank you for inviting me.

MAUREEN CAVANAUGH: This is KPBS Midday Edition, I am Maureen Cavanaugh. We're all used to seeing the images of sick and desperate people in the poorest nations of the world. Some of us may be moved to send it to nation and many of us will simply be thankful that our lives are better. Only a few of us see images like that and say, this must change. My guest Doctor Farmer is one of those few. Doctor farmer and his organization partners in health, they are known internationally as providing first world health care to some of the first people in the world. In the process, advocating for a process of world health that goes far beyond a pill or vaccine. Paul was the subject of price winning biography Mountains beyond Mountains, written by Tracy Kidder. And Doctor farmer has written several books himself including to repair the world. He is speaking tonight at the Point Loma Nazarene University, it's my pleasure to welcome Doctor farmer to the show. Thank you for coming in. I think health care is often thought of as a gift or a generous gesture that the developed world extends to underprivileged people, I understand that you don't see it that way. What you see healthcare as? PAUL FARMER: Well, I mean healthcare if it were conceived as a gift will not be In the developing world and that notion would be wrong to say on the grounds as I come to pass. There are other ways of thinking more fruitfully about it, even the notion of health care as a right or as a useful way of framing the problem work after all, we'll live in one world, not three world. First second and third, even trying to use the notion and that paradigm of healthcare is a right but to work with others in partnership to build systems and provide basic services but also protection. You use the term first world, there is a lot of need to improve health care in the first world as well and some of the lessons we have learned in Rwanda over the last decade, I think it would have a broad application in the United States. Again, those paradigms as I just mentioned three, the rights paradigm and the investment and health, it's a good investment as a high to use a high return on investment, we also talked to people in the position to make those decisions about the prudence the and importance of investing in healthcare. As a way to create development. MAUREEN CAVANAUGH: When did you first encounter patients who you knew were suffering from diseases or conditions that could be easily cured if they either had more money or the lives elsewhere? PAUL FARMER: I am grateful to be able to say as a college student the first time I ever had to think about it or was allowed to think about it in a classroom, encountering patients is also working in a research area and this was over thirty years ago as an undergrad writing about whole race, class and insurance should the experience of emergency room as a volunteer just learning and trying to be a decent student and that is what led me to Haiti as well. Working in North Carolina and thinking about the problems faced by migrant farmworkers in North Carolina. A lot of them were Haitian at the time and that is how I end up in Haiti before medical school. MAUREEN CAVANAUGH: When you are in a nation like Haiti which is overwhelmed with the myriad of problems, and the healthcare situation is at times so desperate, I know this is not your first consideration but had you handle that emotionally? PAUL FARMER: In a sense it is one's first consideration whether you acknowledge it or not. Right here in the face of someone else's suffering, and so as the young man and as a physician and training it was possible to say well, it's not about my emotional reaction to this patient, and there is a lot of merit in remembering that. But it is still nonetheless wrenching and the way that my coworkers and I, I don't want to move away from myself to quickly but it's really about us and the teams that you are together to build health systems. The way we respond this to attend to this suffering before us and think hard about the many and take care of it all product scale. My answer is, we respond to suffering with a real pragmatism. How can we lessen it? There is also a very close idea to what you should be doing in medicine and thinking critically about those health system so that others who you want to meet, who you can never meet because you can never see that many individual patients as a physician or nurse, thinking very broadly about how to prevent suffering from people you never meet. That takes a discipline and again, teamwork. A cold in Haiti MAUREEN CAVANAUGH: In Haiti, I understand that you have a phrase that you use. It's called a stupid death, what is a stupid death? PAUL FARMER: I first heard that term when I was back in medical school, or just starting medical school. A friend of mine who'd been working with us from a nearby town in central Haiti the first place I went in 1983, she had been working with us and she was not particularly trained to be a health professional. She was working in patient records and she had a manic depressive disorder and in any case she died in childbirth right after childbirth, and I remember her brother saying ñ her little brother was a teenager and he said that is what we call a stupid death and had heard that many times and by that he said she had no reason to die if she had modern method metal care and if she was working with a medical organization trying to be born, it happened several times. A number of coworkers that we could not without a health system, we were incapable of saving their lives and I think that is what the term means, people die because they did not have access to something that should be a right. MAUREEN CAVANAUGH: And that is one of the essential things that you and your organization would like to step in and stop. Deaths that did not have to happen. PAUL FARMER: And we like to do that by building partnerships and again to use the term thrown along a lot, with local people who live in the area and that is been our MO all along. That is included academic universities and institutions and I've been looking at working with Harvard for thirty years, there need to be local institutions to train doctors, nurses, pharmacists, and managers, etc. That is how we try to address that suffering to build local capacity. MAUREEN CAVANAUGH: Doctor Farmer, you told us here in the beginning of our conversation that one of the aspects of your effort is to try to convince people that high-quality healthcare as an investment actually can actually be low-cost healthcare because of the returns and the investment in healthcare and that can actually result in a huge amount of return for a country, for a community, how you go about to convincing that? There is one thing that people think they know about quality health care is that it's expensive. PAUL FARMER: I think in order to convince, you need information. It really is an argument and we would like to think that amassing information and prove of that principle is going to make a difference. It's kind of an enlightenment I get that actually knowing about something makes it easier to sell an argument and we have a lot of information out. From all across the world, the investments and primary care and women's health, and making sure that we plucked the low hanging fruit. Again by that term in medicine everyone would agree that vaccine and preventable illness, prenatal care, if you look at the return on that we arty have a lot of information to show that it makes a huge difference. And you look at the United States putting 16% in two healthcare, we don't really have a good enough delivery system to see the return on that and we're trying to study that here but in places all over the world where we work and in other words, to leverage this provision of medical care with learning and training and that is hard to do and say, but it's possible. So, that is what we are doing. Here's the evidence, you can use that evidence to bring people into work but also to enhance people in position of making those decisions, Rwanda for example it is investing fairly heavily in healthcare delivery of the last decade. They've been seeing a great return no matter if they look at economic growth or the reduction in premature mortality. They are seeing entering this as well. MAUREEN CAVANAUGH: I want to talk to more about Rwanda and the healthcare system you've helped to create in the country but at least the back for a minute because one of the things that you advocate when it comes to this comprehensive notion of health, and of global health, is that it does not just stop with a pill or vaccine. It has to do with social justice, and has to do with poverty. It has to do with violence and crime. And when you start talking about the vision of global health, that moves beyond sending vaccines or pills to sick children, do you tend to lose people? PAUL FARMER: I think to be honest and modest we do lose people. The fragments are too complex and not as compelling as saying here's suffering and you can stop it and should. I also think is a compelling arguments but the term global health equity is meant to help remind us and as I was reminded as young man looking up migrant farmworkers that this is not a separate world, these worlds are connected your capture in a place like San Diego that is obvious. This is an area where there's a lot of movement across borders of all kinds. And indeed, most of the places I have worked that is true. And that is true in Haiti, in Guatemala, in Russia. People are moving around and the idea that we can shut away some unnecessary suffering and focus on this, hence the keyword global. I'm not sure if we lose people because we're not turning enough time underlining the importance of equity, fairness, and justice, or maybe we're bringing people and because we insist on that. I have to say as a teacher everywhere in the world we see young people interested in global health, a term that I never heard in medical school thirty years ago when I was starting. By that, healthcare problems from people far away from where they are, but to many people it means global health and it's true that this is a powerful notion. Just like the notion of the right to health care is a powerful motion as well, we will keep using it and finding other ways to engage people because these are matters of concern to everyone. MAUREEN CAVANAUGH: The right to health care is not something that everyone agrees about in this country as you well know, and I am wondering, your focus is an international but have you been involved in the date ñ debate over the have affordable care act in getting people to our healthcare system? PAUL FARMER: I've certainly been engaged I hope all American civic physicians are engaged at least and I've spent most of my time outside in terms of healthcare delivery over the last ten years, outside of the United States. I am engaged and we are all engaged because we care again about those first principles, the notion of the right to health care and the notion that a couple of other ideas that sometimes bring people in when you think about it, what is the leading cause of taking a family and moving them from poor to destitute? All across the world there is catastrophic illness and that is another area where we can say do you think that is a good idea? That is a leading cause of destitution in the world? In the United States it's a major problem. People have a sick family member and they become insecure financially. Maybe I am a little too optimistic that I think that is a terrible idea and people will know that it's not good, hence the idea again to keep sharing in teaching and engaging people, we do not want families pushed into poverty or insecurity and be unable to do things that they would like to do for their kids by serious illness. It makes no economic sense either. MAUREEN CAVANAUGH: You and your family live in Rwanda now and have done for some time and you were given the opportunity on the challenge and welcomed by the government of Rwanda to come in and create a healthcare system for that nation. Have you been surprised that we've been able to do? PAUL FARMER: One minor correction, it was to create with Rwandans, so we understood at the outset that the work that we had done elsewhere including in Haiti was appealing for several reasons, one because we're focused on rural areas and Rwanda is a fairly rural place, most people still live in rural areas or are involved in agriculture. Another is that it was after the worst spasm of violence probably in the history of that continent and we felt that we know how to operate in that space and we were also pushing a community-based care model that relied, especially on Trinity health workers. We were anticipating with many other partners, without strong support from the government in the sense of the public health authorities, we're anticipating success. The scale of the success and the rate at which unnecessary deaths dropped in the last decade, that was gratifying. MAUREEN CAVANAUGH: More on this tonight, Doctor Paul Farmer will be giving in the grip ñ an address on this and if you want to find more about this and if you want to go you can go to the point Loma website pointloma.edu/farmer. Doctor Paul Farmer, thank you so much for coming in and speaking with us. PAUL FARMER: It has been a pleasure, thank you for inviting me.