grew up with five brothers and sisters in a trailer park
in Florida. We lived in a bus. My father
was a schoolteacher who taught neighbors to read and always
rooted for the underdog. My mother, who is very well-read,
worked in a local grocery store. They always encouraged
us to engage with larger issues, and all my siblings made
it to college.
Before medical school I made
a trip to Haiti. Having grown up around migrant
farm workers, some of whom were Haitians and all of whom
were poor, I used to ask: 'What could possibly be so bad
about home that would make these workers travel so far
to work under such inhumane conditions?" Haiti was an incredible education
for me. It taught me about "structural violence"
and the impact on health. Structural violence might be
defined as a series of large-scale forces, ranging from
gender inequality and racism to poverty, which structure
unequal access to goods and services. Of course, such
violence makes people sick, and the sickness I saw in
Haiti was truly dreadful. Two years
later, in 1985, a group of friends and medical school
classmates began working with local people to build a
health clinic in Haiti's Central Plateau. It now
serves 35,000 patients a year, many of whom are landless
I've chosen to do most of
my work outside the United States, simply because I no longer
make many nationalistic distinctions. Many of my co-workers
agree: the only allegiance we have is to the poor, the
ignored, the victimized. It's
my privilege, when in the U.S., to work in the inner- city.
However, I feel more needed working in rural Haiti where--unlike in Boston--I know there is no one who
can take my place. In Haiti, people simply will go untreated
if I'm not available.
In 1993, as a result of some
research and writings on the health consequences of
economic and political marginalization, I was awarded
a MacArthur Foundation grant of $220,000-no strings attached.
Aside from being pleasantly shocked (one cannot apply
for a MacArthur Fellowship--the entire grant process is
conducted in secrecy), my immediate reaction was, "It's
not my money." I knew the entire amount needed to
go to Partners In Health, the
organization we'd set up to administer our clinic work
in Haiti, Peru, Mexico, and Boston. Thanks to the MacArthur
grant, we were able to create the Institute for Health
and Social justice to broaden our work in Haiti.
Friends and colleagues teased
me about not spending some of this money on myself. To
be sure, I'm no ascetic. But increasingly, I've come to
wonder how the accumulation of personal wealth can be
a morally sound endeavor in the face of such stark inequality.
I've never made much of a
distinction between my life and my work, so it gave me
great pleasure to give this money to an institution that
will preferentially serve the poor and always try to side
with them. I've been told I'm the first MacArthur recipient
to give away the entire grant, which surprises me. More
than anything, I just feel like it's not my money. In
a world full of suffering, how can you horde the wealth
when someone right next to you needs it so much?
- Paul Farmer
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