Dr. Paul Farmer, Dr. Alexander, and Incrementalism

Tuesday, September 5, 2006

I strongly recommend that all of the New Urbanism listservs subscribers, my friends, all government bureaucracies, and well-meaning do-gooders read Mountains Beyond Mountains, by the Pulitzer Prize winner Tracy Kidder. It is the story of Dr. Paul Farmer who took the Hippocratic Oath literally "to heal, not to harm". Farmer has spent his professional life mostly in Haiti and later in Peru and Russia, looking beyond mountains of ignorance, neglect, and bureaucratic rules to heal the sickest of the sick. He is a true hero, an exemplary man, a professional of professionals, obsessional, dedicated, inefficient by measures of cost and benefit, and aware that his limitations can and will be breached. Above all, he is a seeker of unseen solutions, a swashbuckling innovator, a healer, and an evolutionary thinker. He follows the same path of thinking, healing, and dedication to a "wholeness" that Christopher Alexander also treads.

Farmer's beliefs and practice are that healing each person heals everyone. When he arrived in Cange, Haiti, one of the remotest, poorest, and least healthy towns there, he found widespread suffering from diseases almost completely stamped out in rich countries and the proliferation of AIDS. He set up what became a modern hospital with Haitian doctors and health workers and with dedicated volunteers from the Harvard Medical School and the Boston hospital establishment. He enlisted the support of rich people wanting to give away their wealth for a real cause, from foundatons, the World Health Organization, the Gates Foundation, and the Haitian medical community. His goals beyond treating the patient and healing them and the community were first dedicated to eradicating common infection, malnutrition, unsanitary living conditions, and, later, to wiping out tuberculosis, and providing modern drugs to stem deaths from AIDS.

From the beginning to the present, Paul Farmer made and still makes "house calls" in addition to his hospital surgeries to a long line of sick patients. He deals with patients and not sickness. He wants to know the living conditions, the culture, of his patients - in this case voodo - and to monitor their course of drug treatment.

To reach his goal, Farmer walked mountains beyond moutains. He pursued drug companies to lower their prices of TB and AIDS drugs. He recognized multiple drug resistant Tuberculosis and that much of it was created not only by patients neglecting to take their drug regimen. By the medical establishment repeating the same course of treatment that failed to cure but also increased the drug resistant population. He instituted the use of "second line" TB drugs that eventually reduced the multiple drug resistant TB population not only in Cange, but also in Peru and a Siberian prison. Finally, Paul Farmer successfully convinced a good portion of the doubters to change their point of view on triage and effectiveness. Farmer made them understand that untreated sick people no matter where they live are the agents of increasing the sick population world wide.

Is Farmer's model of healing a model for problem solving of all kinds? Is it posssible to take "little projects with big visions" and have big successes? Can theory outrun practice? The answer is yes. Can Farmer's model work without him, his dedicated staff, and his genius? The author Kidder feels that it cannot.

I tend to agree with Kidder. In order for a project of this kind, say the implementation of Smart Code and a New Urbanist Plan, a committed leader with the political savvy to negotiate with all of the major players; a dedicated staff to monitor both code enforcement and plan maintenance; and, finally, the cooperation of develoers and a zoning or planning commission are absolutely necessary. Though a very huge accomplishment, merely putting out an NU plan and having a Smart Code adopted by the zoning and/or planning commission will not guarantee long term positive results.

Also to consider is that once theory is put into practice, the practice becomes bureaucratized. Using the city planning example, it is overseen and managed by a planning staff, a zoning commission, building permitting, fine arts and historic preservation commissions, etc. Political and ideological conditions blossom. Intepretations of the new practice become personalized and often confused. The goal of the new practice often becomes lost; and the new practice is hardened awaiting a new theory. The "whole" becomes lost and the process of change ceases to be healing.

Unless....................................a Paul Farmer-like planner/administrator is on the scene to take care of the patient and heal the whole community.

Comments

[catherine ande sinelien]

dear paul farmer

how you doing...this is catherine ande sinelien..i'm your daughter..i was born in haiti... you were the one who named me...you asked my mom if you can be my godfather..it was the first time you went to haiti....please i really need to meet you....

i don't know your number...i've been trying to call you....please contact me ....at malnininie@yahoo.com...asap

[catherine ande sinelien]

DEAR PAUL FARMER,

THIS IS YOUR GODDAUGHTER AGAIN...LIKE I TOLD YOU I'VE BEEN TRYING SOO LONG TO GET IN CONTACT WITH YOU, BUT I COULD NEVER REACH YOU... PLEASE CONTACT ME AT

617-595-6508 ASK FOR CATHERINE
617-268-5126 ASK FOR CATHERINE
1508-250-6640 ASK FOR CATHERINE OR NERLANDE

PLEASE PLEASE PLEASE AND BODY WHO KNOW PAUL FARMER PLEASE CALL ASAP.....