Accompaniment: Liberation Theology, Solidarity, and a Life of Service [with CC]


[MUSIC] Good evening, everyone. Thank you for your patience in getting in. As you know, there was a lot of interest and limited seating tonight, so again, appreciate you bearing with us. Thank you for being here for this special event featuring a conversation with Dr. Paul Farmer, and Professor Roberto Goizueta. This evening’s conversation will focus on the notion of accompaniment and how the preferential option for the poor, and other aspects of liberation theology, have impacted the lives of these two gentlemen, and all the people that they affect. My name is Erik Goldschmidt, I’m the Director of the Church in the 21st Century Center, and tonight’s event is part of our C21 series on exploring the catholic intellectual tradition. We are appreciative of our co-sponsors, the Theology Department, the School of Theology and Ministry, and a Center for Human Rights and International justice.>>[APPLAUSE]>>After a brief introduction Dr. Farmer and Professor Goizueta will speak for about an hour. We will then open up the conversation to your questions for about 20 minutes or so, and what we’ll do, is we’ll take questions in the middle there, in between the sections, and that afterwards I wanted to let you know that Dr. Farmer will be available in the lobby for conversation and signing of books, which you might have seen, we have his latest book that is coming out this month. So, before we begin this event we have Molly to introduce this evenings speakers. Molly is a freshmen in School of Education, and part of the Shaw Leadership Program. she’s close friends with Dr. Farmer who has served as a mentor to her for much of her life, and let us welcome Molly.>>[APPLAUSE]>>Dr. Paul Farmer once said, every night when I go to bed, I worry about how I’ll fulfill all the promises I have made, and every morning when I wake up, I think I haven’t made enough promises.>>[LAUGH]>>In their work and by their example, Paul Farmer and Roberto Goizueta both challenge us to ask, when we call ourselves Catholic Christians, what promises have we made to the poor and marginalized, what commitment have we made to our communities and to those communities that barely resemble our own? Both Farmer and Goizueta argued that the promise we must make is an all consuming commitment. In order to live a truly Christian and moral life we must promise to work on behalf of the poor and to accompany them in their struggles. We must create, as Jesus modeled for us in the gospels, a preferential option for the poor. Professor Roberto Goizueta is the Margaret O’Brien Flatley, Professor of Catholic Theology here at Boston College. Goizueta is a native of Cuba, who studied at Yale, and later went on to study systematic theology at Marquette University. In his seminal text, Caminemos con Jesus, or We Walk With Jesus, he asserts that our commitment to God and to our religion is the reason we should feel compelled to accompany the poor on their journey. He argues that if God is present preferentially among the poor, we could only know God if we places ourselves there also. The option for the poor is then the most important epistemological pre-condition for Christian faith. To know God we must first opt for the poor. Dr. Farmer who grew up in Central Florida and attended Duke University as an undergraduates. He continued on to Harvard Medical School and received an MDPHP in Medical Anthropology. Nearly 30 years ago, he went on to co-found the medical non-profit Partners in Health, in the central plateau of Haiti, whose mission statement is to provide a preferential option for the poor in healthcare. Having known Dr. Farmer since I was a little girl, it’s been my privilege to work alongside him on several projects in Haiti for the past five years. Under Paul’s guidance, I made a promise to the people of Haiti that I’d help them to build a school in their village. I made a promise to accompany them on their journey. It’s been a great privilege to get to know the children of and their parents, and to learn through personal experience that, in order to affect true change, we must work with the poor not for them. That by walking with the poor, we walk with Jesus. Dr. Farmer has said, that to accompany someone is to go somewhere with him or her, to be present on a journey with a beginning and end. I would like to thank him for modeling a life of true service for me and for everyone present here. I’d like to thank Professor Goizueta for sharing his wisdom and experience with us tonight, and thank you especially to Paul for accompanying me as I try to live out my Christian promise to opt for the poor. It is my honor to introduce to you Professor Roberto Goizueta and Dr. Paul Farmer.>>[APPLAUSE]>>Thank you so much Molly for that beautiful introduction. Thank you Erik. Welcome, first of all, Paul. It’s wonderful to have you here and thank you so much for joining us here at BC for giving us the honor of being present with us and joining us in this conversation.>>But I would add at the beginning that I’m a little unhappy, I’d forgotten about the Yale connection.>>Uh-oh, [LAUGH] that’s right. [LAUGH] All right.>>You see? Man.>>Go Bulldogs. But->>[LAUGH]>>Paul, to begin our conversation, what I’d like to do is to first ask you, I suspect that for a number of people, your connection with liberation theology is something that is not that well-known. So maybe you could explain to us and tell us a little bit about your first encounters with liberations theology and how those encounters with liberations theology help to shape early on your own vocation or [INAUDIBLE] career.>>Well, I always favor starting with the really easy question, so I think->>[LAUGH]>>Put your guests at ease.>>[LAUGH]>>Since the majority of people here are undergraduates, I’m happy to say that it was in college, really, and not so much growing up in a Catholic family, but in college, reading and taking a class. I took a class called medical anthropology. I didn’t know what that was. I mean, it had medical in it. It sounded good. I was pre-med, biochemistry major, and it really opened my eyes to a lot of issues I really only dimly understood. The impact of large scale social forces in the lives of people who became, everybody becomes a patient, in any case at the same time, which is prehistoric to some of you here. In 1980, was when Archbishop Romero was killed in El Salvador, and the honesty of his analysis of what was happening in his country was very disturbing to me, and I still didn’t really make any connections until I met actually a friend of mine who’s a nun, who’s right here. I met a nun, a Catholic nun working with migrant farmworkers. And I was interested, I was writing about migrant farmworkers for a student publication at Duke. And I thought, wow, these are pretty different people from the ones I remember from church in. My church in Florida, where I grew up, the mean age of the parishioners was 174.>>[LAUGH]>>And we were just bored by it as kids. Anyway, I shouldn’t say that. It sounds irreverent. I didn’t mean, it’s irreverent. So it was really learning about how certain parts of the world work. And then I went to Haiti after graduating and before I went to medical school. And it was a way to understand the gravity of these lessons and these ideas, and to never be able to forget them. So that’s kind of how it started for me, even before medical school.>>Did your experience in Haiti->>What’d you think, I learned it at Harvard?>>No. [LAUGH]>>[LAUGH]>>I love Harvard.>>Hopefully not.>>[LAUGH]>>Did your experience in Haiti change at all your understanding or appreciation of the Church and the Catholicism that you’ve been raised in?>>Very much so. In fact, during those years, just to be very technical about it because you asked me about my experience. The year that I went there was 1983. In 1985, and I’ve got some friends who are graduates, including graduate of BC High, BC, and BC Law, Brian Kincannon who’s somewhere here, wherever he is, there he is, who was in Haiti a decade after and still involved in Haiti. But I happened to go at the end of the family dictatorship. I didn’t know that. Why would I know? It was 1983. in 1985, there was a great deal of tumult. Now I had started medical school already, so I was kind of going back and forth between Harvard and Haiti. And it’s not an easy commute, in many ways.>>[LAUGH] In many different ways.>>But these food riots, you’ve written about, and I’m allowed to interview you too, by the way.>>Okay, all right.>>But you’ve written about how you really don’t understand these things from safe enclosures, I believe were your exact two words. And after being in Haiti, I didn’t really see why I shouldn’t go back and forth between Haiti and Harvard. In fact, I was living at St. Mary of The Angels in Roxbury. A number of my friends from those years, still my friends, are here tonight. And in 1985, the dictatorship started to totter and fall, as such social arrangements often do. And I just happened to be there. And in 1986, the dictatorship did fall. And I’ve never seen such dramatic events in my life, which I now then understood had been very sheltered, even though I didn’t know that growing up in Florida. But I did, and I just stuck with it because I met great people I was working with. And I’m still lucky enough work with many of those same people. Many of them have died and not as many as one would hope from natural causes at a good old age but rather died young of violence or structural violence. And I’ve been obsessed with it ever since.>>So what was it about that experience that most struck you or most challenged you that you didn’t expect in terms of the impact it had on you?>>Well, I didn’t really answer your last question.>>That’s why I was following up.>>That’s a good trick. They use that in psychiatry as well.>>[LAUGH]>>[LAUGH] A leading question, right?>>But one of the major forces for social justice in Haiti was the renascent liberation church, a Catholic church. And I knew some of these people and became friends with many of them. Still am friends, again some of them have since died. And just hearing about a preferential option for the poor as it was unrolling in these difficult circumstances was very moving to me. So really that or it was also, it could be that I’m here at BC talking to an eminent theologian and say, well, actually Roberto, the most surprising thing to me was its Catholic social teachings. But it’s sorta true.>>[LAUGH]>>And there were also some very painful, painful moments for me and the people I worked with. Again, many of whom died, or way too many to ever forget. And it was surprising in a different way. Because in college or in books, I could read about the impact of this kind of structural violence or violence on people’s lives that made them short and brutish. But being there in the middle of such social upheaval was in itself a surprise, even though not so much intellectually as affectively, as emotionally. And it marked me very deeply.>>This preferential option for the poor that you write a great deal about is obviously central to liberation theology. Could you talk a little bit about how you understand the preferential option for the poor and especially in your work in global health?>>Well, in my work in global health, if I leave aside the term, global health didn’t exist back then, that I ever heard. And here you could fill up an auditorium at BC with people interested in global health. But when we started having meetings of Harvard medical students, I started in the Fall of 84. We’d have meetings of people interested in international health, and one or two would show up, three or four. And it was really not a field that existed at that time. What I did study, in addition to my medical training in hospitals and clinical medicine, I studied epidemic disease. And so I said, wow, the microbes make a preferential option for the board too.>>[LAUGH]>>And I didn’t think that was a vastly witty or insightful conclusion. Any epidemiologist would tell you that. And they do go on and on about it actually.>>[LAUGH]>>I say that in the safe, what’d you call it safe enclosure? Far from that. Any epidemiologists there?>>[LAUGH]>>So in my own scholarly work in medical anthropology, I did pursue that dream of doing both a medical degree and a PhD in anthropology. I started reading in medicine and epidemiology and anthropology. And then I thought, wow, but the liberation theologians have some very powerful ideas that could help us understand not only epidemics. And again, I’m not talking about just epidemics of communicable disease. Like the epidemics of diabetes, for example, among Native Americans. Or alcoholism in the beginning of the late 19th Century, and still afflicting Native Americans and other people marginalized by social forces well beyond their control. But it could also help us understand How to do medicine more effectively, whether you’re talking about working in parts of Boston or in, now I’ll think of some B places, Bhutan, how about Bhutan? Borneo, Brazil, in other words, everywhere. I’ve never been to Borneo or Bhutan. I’m just saying I never been to a place where the idea of preferential option before in healthcare was not illuminating or useful.>>And what would you say for us->>You laughed at the Borneo Bhutan.>>[LAUGH]>>[LAUGH]>>Countries that begin with B.>>What would you say for us the biggest obstacles, do you think, to the option for the poor? When you talk about a preferential option for the poor in this country, you say, what for us, do you think, are the biggest barriers?>>The biggest barrier to option for the poor in health care, they’re all system barriers, they’re systemic. And that’s an obvious thing to say. Even when you look at some of the writings from Gustavo Gutierrez, when they talk about structural violence. It’s violence that gets done to people who are marginalized by poverty and other social forces, that is not always easy to see. How does racism get into the body? How does gender inequality get inside the bodies of people as pathology? So those are system problems. Today, I was talking to a student who is a nursing student here at BC, who actually worked at Partners In Health. I don’t know if Chloe is in here somewhere, I bet she is, otherwise she’s never getting a job. And so she’s working at Health Care for the Homeless now, had been in Haiti and elsewhere. And how does homelessness happen? What are the lines along which it happens? How does it expose people to risk of bad outcomes? How does it dissolve families? How is it related to mental illness? How is it related to the unfair incarceration programs. How is it related to shrinking economy or growing disparities? Those are really important things that we can learn about. And I think if we take those ideas, of preferential option of the poor, and say how would they illuminate, how better to serve people. You say, okay where is the health system? So there is a system problem at the level of delivery. And again, these are problems that are only just being studied now in medicine. What’s our delivery platform, to use a term that gets used in Information Technology? When people from that part of the world, talk about different cultures, Silicon Valley. When people that from that part of the world talk about platforms they mean communication platforms. But we can develop good systems to deliver healthcare for people who are marginalized by all these social forces. And improve the outcomes for their health problems like diabetes, major mental illness AIDS, tuberculosis, chronic hepatitis C infection, the list is long. So I think that those are the biggest barriers. They’re system is barriers that have their roots in history and economic disparities. And they’re really sometimes called perverse incentives in economics, though I don’t know much about economics. Although that doesn’t keep me from critiquing economics.>>[LAUGH]>>But they’re systems problems. In other words, they’re not volition problems. They’re not that people in this audience want to discriminate against poor people. They’re not that Peruvian doctors and nurses want to discriminate against poor people or that Haitian physicians and or nurses, so that>>I think that’s one of the important insights of liberation theology is that a lot of the roots of injustice are really structural systemic>>Exactly>>And it doesn’t mean that people are bad, individuals per se but we all participate in systems and structures that encourage certain forms of behavior and reward certain forms of behavior and discourage other forms of behavior. One of the things that you’ve been developing in terms of preferential option for the poor recently is you’re writing a book on accompaniment as an aspect of preferential options for the poor. Can you talk a little bit about that and how you’re implementing that notion in the work that you’re doing for example in Chiapas.>>Yeah, well I’m learning to trying to learn to make a distinction between accompaniment in settings disrupted by structural violence and violence. Peru at the tail end of a civil war and the tail end of a cholera epidemic related to these large scale sorts of forces. The beginning of an epidemic of drug resistant tuberculosis. Guatemala and Chiapas in the midst of or at the end of turmoil, Haiti in the years that I describe were one that after the genocide Siberia after the collapse of the Soviet Union. Those are a lot of the places that Partners in Health has work in and I’ve worked in all those places as well. So accompaniment is, in part, a notion to help improve, and this is a very pedestrian-sounding idea, but to improve the quality of care that we can deliver as doctors or nurses. We have to be able to reach into the everyday lives of patients whose lives are already disrupted. I told you, by all these large scale social forces that doctors and nurses aren’t trained to understand, much less remediate. So working with community health workers, you know we call it in Haiti [FOREIGN] in a lot of Latin American countries. It matters less what they are called and more what they do which is reach into the everyday lives of people and help deliver something good. In my case that is often involves diagnosis and care for chronic disease, but one could imagine other models of accompaniment. At the other end of the spectrum, I would say, because that’s the least we could do in medicine and nursing and psychology. There’s friend of mine who is a social psychologist here who would say the same thing and has written about it and teaches about it here at BC and thinking about other services. It seems like the least we can do is figure out how to get it right, which we haven’t done in the American healthcare system as I’ve said. On the other end, the spectrum are people of influence and power who can control a lot of the levers that could make this work for poor people a lot easier, or a lot more difficult. Now the accompaniment idea is not to leave behind the accompaniment of those living in poverty and suffering because of its effect in their lives but rather to try and take those ideas to people who control an extraordinary amounts of resources. I’ll just give the example of so-called foreign aid. That’s $150 billion worth of, again, the notion worth and cost I could interrogate those all night too. But $150 billion of aid. And one of the questions that I would ask after 30 years of doing this work is, how do you make that not only less painful and ineffective, but better and more effective? First place I went and in Haiti was a squatter settlement of people who had lost their land to a hydroelectric dam that was designed as a development project, and I bet people meant well too. We needed electricity in Haiti, we need to improve agriculture, which means controlling irrigation. So that’s, in my view, a very under appreciated form of accompaniment. Cuz if you just say, well, these people, as I’m sure all of you know, that’s a reference to a great new movie. Never mind, I’ll see if there are any. [LAUGH] Some of my proteges are gonna recognize that, what do you mean, you people? If you just assume that those powerful people are not interested in improving the quality of our accompaniment for people living with, say, both poverty and disease, that’s of course to make sure you don’t have to do that more difficult form of accompaniment. It’s a big mistake, I think.>>Now I think so. I remember the first time I met Gustavo Gutierrez, I was in graduate school at the time. And I was all excited, I was studying liberation theology. I was gonna be a lay missionary in Latin America, I was going to->>It’s not too late.>>[LAUGH] I don’t know, ask my wife, I think it is. [LAUGH] But and he looked at me, and he said, please don’t come [LAUGH] to Latin America. Come and visit us and spend time with us, but we need you in the United States. Bring back our insights and liberation theology to the United States.>>The man is wise. Unfortunately, I called him in an interview. He’s like the Yoda of our time.>>[LAUGH]>>And that’s now appearing in a book that’s too late to stop, it’s already gone to press. He didn’t know what I was talking about, really, Yoda, Star Wars, anyway.>>Yeah, I’m sure he didn’t know.>>We’re talking about Father Gustavo Gutierrez who’s in his mid 80s, but why do you think someone like that went to Vatican too? That’s policy work in his church, in that church.>>Right, exactly.>>Right, why would you go to Medellin or Puebla? So to me, that’s the same story. No wonder he said to you, don’t, you don’t have to come here. And that’s what Romero said about military aid to El Salvador in 1979, 1980 until the day he was killed. This is that, these are not three worlds, first world, second world, third world. One world, and it’s been a very challenging part of accompaniment for me.>>But I do think that we need to break down a lot of the barriers that we have created. And I think that’s one of the issues and one of the key characteristics, I think, and the import of accompaniment as an understanding of liberation. I think that one of the major barriers to preferential option for the poor is this kind of fundamental fear that we have of the other. People on the other side of the border, on the other side of the railroad tracks, on the other side of the street. And we live in a society that promotes and encourages those kinds of separations and compartmentalization. And what I think is really important is for us to learn to make connections between what happens in Guatemala and what happens here, what happens in Bhutan and Rwanda and how we live here. And so the ability to cross borders and to meet people on the other side as it were is crucial. Gustavo likes to say that there can be no option for the poor without friendships with poor people. Otherwise, the poor become you people, an abstraction. So how do we->>Tropic Thunder reference, I’m sure.>>[LAUGH]>>That’s the film I [CROSSTALK]>>That was the film that you referred. Yeah, so it’s that kind of need to make connections. And I really think that we’re afraid. And I think we’re afraid of that because we like to think that we live in secure, safe controlled enclosures and that that distinguishes us from those people who are powerless, who don’t live in safety and security. And that’s what I think we can learn from others, from the others is that in fact, we’re all in the same boat. In fact, we’re all ultimately powerless. And I think, in the end, that’s what we’re afraid of, is our own powerlessness ultimately. And so that’s why we resist opening ourselves to others. At least that’s what I’ve learned in my own work in communities of the poor, that they ultimately reveal to me and remind me of the fact that we are all in God’s hands, all of us. None of us is in complete control. And that ultimately is a liberating message, and that’s, I think, what a lot of the poor have discovered, is the liberation implicit in that understanding that we’re in God’s hands.>>And I think the other and you’ve written about this in your work, the other thing about accompaniment in medicine. And again, every time I say medicine, I mean in healthcare deliveries, so nurses, doctors, social workers, is it’s really humbling.>>Absolutely.>>It’s upsetting, when they’re talking about suffering. Unmerited suffering is not a term that I found very useful. I mean suffering, I abuse the term all the time, but suffering is very humbling. And you can imagine, I think anybody in this room could imagine what it might be like to be sick and alone and abandoned. And because everybody has had an experience of not being sick and alone, but knowing someone who was sick who they cared about. Bless you, and that’s my deep theology.>>[LAUGH]>>But that’s a very humbling thing because even well delivered medicine can do a lot. There’s almost no disease I can think of that should be called untreatable. You can always palliate suffering but it is very humbling thing to do. And it’s been a great teacher in a way of the humility that ought to go with accompaniment. It doesn’t always go with accompaniment.>>No.>>Because it’s just very hard for people to learn about other people, but to enter. Jim Keenan says, is that right, that some of these virtues that we extol, Father James Keenan, whether compassion, mercy, it involves entering into the chaos of another person’s life. And that’s a very, Humbling thing to do and very disturbing. And to do it as a profession, like in medicine or nursing or again, you go through the list. Practical theology, if I may, it’ll slap you down. That’s not Gustavo’s term.>>[LAUGH] It’s not a theological term. But I think my experience has been that one of people’s greatest fears is the fear, or experience, too often, of invisibility and abandonment. And the sense that, I’m going through this alone. I think that is what ultimately can be debilitating, and I think my experience has been that being with and accompanying others in their own suffering. The technical term is compassion, or to suffer with, is in a sense the birthplace, the first experience of empowerment in one’s own dignity. So that suffering that is shared is suffering that’s already in retreat in some way. So that, if you will, the crucifixion and the resurrection are two sides of the same coin. And that in the midst of crucifixion, people can experience hope, can experience resurrection, when we do it together. And I had that experience a number of times, I remember returning to Cuba for the first time since I left with my family when I was a child. I returned about seven years ago during a project with Catholic Charities. And very kind of anxious as to how I was gonna be received as a Cuban who had left the island. And when I returned, the messages that I received over and over again from the people of the island was, thank you for not forgetting us. Because they feel forgotten, the people, and thank you for not forgetting us. I think that, the simple act of being with of being present with people, I think is one of the ways in which we affirm the humanity of another person.>>Amen.>>[LAUGH]>>Sermon over.>>[LAUGH]>>I don’t know, I can’t get too much of this stuff, I think it’s very helpful. And I wish a lot of people in my profession of medicine, and again, writ large, had access or time to think about these matters. More and more time is being made for it, because it’s inevitable if you’re in these professions. To remind you of the need just to be present. In my line of work in infectious disease, and especially if you go to a place where, let’s just say there’s some new treatment that would be available in Boston, but not in rural Rwanda. Just give the example of rural Rwanda. When I was there in 2004 and trying to bring some of my colleagues from Partners in Health like Jack Connors over here, trying to get my colleagues to sign up to work in Rwanda, which we did. And we went there, it’s a rural area, there’s just so much malaria, a lot of tuberculosis and AIDS. And just those three illnesses alone, bringing them under control allowed us to see a dramatic, and there’s a lot of other problems, too, of course. But bringing some of those big problems under control, waterborne illness, vaccine-preventable illness, AIDS, tuberculosis, malaria, death during childbirth. Bringing them under control, well, obviously, with the Rwandan system, again, that public health system that was being rebuilt. Resulted in this fantastic, wonderful, miraculous, whatever the term may be, decline in mortality. In fact, we just reported along with our colleagues that these are the steepest declines in human mortality ever recorded. So imagine that, yeah, imagine that.>>[APPLAUSE]>>And I get choked up just thinking about it. Cuz to see that happen in less than 19 years after the worst spasm of violence in Africa ever. To see that happen, see it charted, but that doesn’t mean, of course, that people are not going to die one day. So far, as far as I’ve learned in my deep theological thinking, everybody dies at some point or another.>>[LAUGH]>>And so suffering and losing people who you care about, maybe they’ll die, like my grandmother at 95. But that doesn’t mean that it’s not suffering and painful. And so I think in medicine, and like I said, in my line of work, you can see these miraculous declines. Because you’re delivering the standard of care in a place that has never had modern medicine. And the results are dramatic, especially if you get that delivery platform down. And that doesn’t mean that we’re exempt from figuring out how to work with people and our friends and family and our patients too.>>To bring that conversation home, literally, could you talk a little about how colleges and universities. What role they might play in the work that you’re doing, in preferential options for the poor and delivering health globally.>>Well, I mean, I can, in fact, it’s the subject of the book that you just mentioned. No, I’m teasing, I’m not teasing that it’s the subject, but I’ve spent a lot of my time the last decade thinking about this. In part because at Harvard, I went through my medical training and started as a junior faculty member between the Brigham Women’s Hospital and Harvard Medical School. I knew that I wanted to work with partners in health the rest of my life. And it didn’t occur to me then that I would be able to become a professor at a university. And because I knew I would be in the field a lot. And the field meant for me then the Brigham Haiti, the Brigham Peru, the Brigham Rwanda. And as the years went by and I was kept on, promoted at a university. I saw more and more students there and elsewhere who were so deeply committed to this notion of global health equity. Which, as I said, when I started medical school, may have had resonance for my classmates, but the field wasn’t there. And now it’s like a torrent of young, good torrent, not a bad torrent, of young Americans. I say Americans cuz we’re sitting in said country, who are interested in equity and justice in a transnational, transregional way. So I know you probably meant American universities and colleges, so I’ll just say that there’s a wellspring of goodwill. If that can be channeled into a social movement. And look at the social movements of the past. The civil rights movement in the United Sates, the fight against slavery. Again, first it began with the slaves, right, not in Britain, not in France, and not in the United States. It was, again, from the bottom, from the oppressed. But it was echoed and amplified by people and ordinary citizens, including young people. In India, the fight for independence, again, the big movements of peaceful transition to full democracy with participation and with everyone with basic social and rights for everyone, those required major social movements. Now, do we have that for health equity? Well, probably not. But it’s great to see that there’s so much energy in American universities and colleges for these global social justice issues. And then there are all the young people and students who don’t get to go to college in Haiti, Rwanda, Malawi, go through the list. But they might if they had universities that were open to them. In fact, they would, of course, I know that. Like to get them, make sure they can get involved in being empowered to help to do better by their own citizens in their own countries too. So I’m full of optimism about that, harnessing it. Harnessing this real energy is, I think, an important task for all of us lucky enough to be teachers.>>And you talk about the students and the importance of a movement, a student movement for global health. What about institutionally, structurally, the universities themselves, is there anything that they can->>Well, by my reckoning, again, as a serious student of social science, universities are created largely by humans.>>[LAUGH]>>So I have to be optimistic. If you look at some work of like a sociologist like Pierre Bourdieu who was a really great French sociologist really worth remembering and reading. And he wrote, as do my teachers because most of them are still with me, my teachers at Harvard, he wrote about social suffering. So if suffering has social origins and institutions have social origins, then why can’t we change them to be the way that we want? Institutions always resist change. That’s true of the Catholic Church, it’s true of universities like BC, that there is resistance to change inside an institution. And those who study institutions know it to be true very broadly. But that doesn’t mean they can’t be changed. So I have optimism there, too. What causes institutions to be reactionary and to change more slowly? When we have economic contracture, like economic crisis, that’s when they become really reactionary and they circle the wagons. And just like the species does, our species, as opposed to some of the species I fight in my work against microbes. They probably circle the wagons too. But I’m not interested in the social psychology of microbes.>>[LAUGH]>>So that’s why I think if we believe that students can be involved in movements, then why can’t the administrators, the faculty, and when I say administrators, I mean the people who make up a university. The people who answer the phones, who keep the place clean, it just seems the least we could do is to try.>>Could you talk also a little bit about the various structural impediments and obstacles globally to global health delivery? Some of the things that you discuss in your book, Pathologies of Power.>>Well, again, I think the biggest problems are systems problems. And it’s very daunting to face institutions, which as I said, preserve privileged for some and deny privilege to others, that preserve access to the fruits of modernity for some, deny access to others. And I think, if you look at most global institutions, again, if I say, okay, what’s a global institution in 1600? There are global institutions or translocal social institutions. Like slavery, it’s an institution. The slave trade, it’s not a natural institution that comes from bad weather or God. It’s a social institution. You look at the Catholic Church, you look at emerging networks of merchants, whatever they may have been. Again, I’m not a historian of any century, including 1600. I don’t know where that came from.>>[LAUGH]>>I have a friend who’s right here, a theologian named Jenny Block who every time you ask her a question about theology said, well, things changed a lot in the 4th Century.>>[LAUGH]>>So her obsession is the 4th Century. In any case, if you look at global institutions then and global institutions now, for example, pick an institution that you want that’s a transregional, I don’t know, NATO. A trade agreement that binds together people, a non-aligned movement. Again, I think you could look at any or all of them, they’re social institutions. Are they more resistant to progressive social change or less so? I actually think they’re less resistant if we acknowledge our role in creating, sustaining, or replicating them. And so they’re the biggest barriers. But are they biggest barriers because they’re full of people who are against change? Or are they biggest barriers because that’s the nature of institutions to be self-protecting? And I don’t have the answer to that question. But I see it all the time in benign organizations. Let’s say in a hospital where you divide into departments, or a university where you divide into departments, there’s competition between them, too. There’s a lot of competition between institutions, people, NGOs, for example, in humanitarian work, when cooperation is what we need. And I’ve been humbled, again, by looking at this competition that leads us to add up to less than the sum of our parts. And I’ve been humbled because I say, wait, the people in those institutions are really nice people. And we’ve tried to make self-critique of NGOs. Not to criticize other NGOs, but to say, okay, how is it that you could have ten NGOs and add up to the work of, say, eight? And I think that’s a big challenge in human affairs. And it’s gonna require some systems change. Some of that system change will be driven, by the way, by legislation. Again back to, cuz my friend Jenny is sitting there, she said to me that almost every unofficial change for disabled people in this country came about through court injunction. Now, that’s pretty disturbing. And I think there are a lot of good things that we can do, and should do, that involve exhortation, bringing people on board, building up, improving our institutions. And some of them probably we’re gonna have to entrap ourselves into decency through rules, regulations, and changing the rules of the road. And I closed my eyes when I said it because it’s not an obvious thing to say, I’ll give you one example. It’s very expensive to give bad medical care to poor people in a rich country. It’s expensive in terms of the cost in American emergency rooms where you’re delivering primary care through emergency rooms. Is this expensive in outcomes? People who are vulnerable, don’t have insurance, don’t have social protection, safety net, they do less well than people who receive primary care And from a clinic or at home. Then, when we talk about American healthcare lingo, when people in medicine talk about the health home, the home where you get your healthcare, they still don’t mean the home. They mean the clinic where you get your healthcare is your medical home. And we’re saying, wait, your medical home should sometimes be your home. That’s where you should get care for your chronic disease like high blood pressure or some other. You shouldn’t have to go to a clinic. Anyway, I probably went a little bit long but as you can see I’m obsessed with the idea of how we can make institutions serve our species better. And particularly my constituents, poor people.>>Mm-hm, right, one of the transnational organizations, I think you could say that you were talking about>>One of those would be the church or churches.>>Yeah.>>Any role for the churches and what have you seen in terms of your own work in places like Haiti?>>Well, I’ve seen in my work, which it’s not that long. I mean, 30 years or so is not a long time to get to know something, alas. The good news is you guys, young people, you can master this stuff by the time you’re 80 no problem.>>[LAUGH]>>But I’ve seen in working in Latin America particularly because Latin America is quite different in my experience from a lot of places in Africa where I’ve worked. Which is Malawi, Rwanda, Luce Tua, not a lot although I spent a lot of the last ten years in Rwanda. But the church is very different there, it’s older, the Catholic church, 1492 and on. And you can see places and times where the church has been a barrier to progressive change. And places where it’s actually been the leading cheerleader and promoter of progressive social change. And the reason there’s such variation is because, again, it’s us humans who created it and staff it. That’s a term that I’m sure Sister Catherine doesn’t care for, staffing the church.>>[LAUGH]>>And populate it, it is a human institution.>>Yeah.>>So, and I don’t think theologians dispute that, right?>>Right.>>And so I think that the church can be an enormous force for social good. And should be because that’s in keeping with the catholic social teaching that I’m familiar with or learning about it.>>Can you give some examples of that?>>Yes, I can.>>Of the ways in which the churches a force for good in Latin America?>>Well, and again, inside one country, you’re going to see various branches of the church. Like Haiti, just as there was a movement from the Liberation Church-based communities fighting for social justice, mostly rooted in poor communities, many of them urban. There was the contrapuntal reactionary force within the church. Same thing I saw in Guatemala, same thing I saw in Peru. And in Peru, just to give an example, from a cholera epidemic in the 90s is the church was very involved in community and organizing in the places that I went, very involved. And in community organizing to do, what? A, to make sure that people didn’t die from cholera, which wasn’t entirely the job of the Catholic Church. I don’t see Saint Peter writing about the church and cholera control.>>[LAUGH]>>Thank you for laughing.>>[LAUGH]>>You can’t get a laugh at a university here. So it’s not like the early church leaders laid out the role of the church in infectious disease control. But what do they also do? They organized for public responses to more water and sanitation for poor communities in urban and then rural Peru. To me, that’s an example of the churches, which, after all, they use the term of pennies are new. Church means the people of God not just the institution. The hierarchy, you’ve written this as too, I know. So I think those are just examples that wouldn’t come to mind necessarily for a theologian. But if you’re a doctor or a health worker in a setting like that. And you’re waiting for the church to side with you against the pathogenic forces in pathogens, you gotta go and say, hey, church people, help us out here. Help a brother out.>>[LAUGH] Have things changed at all in the last, whatever, 20, 30 years?>>Well again, if you start the clock when I did in 1980, personally, yeah, there was war and strife in El Salvador, Guatemala, Honduras, Nicaragua. Haiti would undergo a period of great tumult that still goes on. But yes, things are different, Peru, tail end of civil war, things are different. And there is a marked improvement in the overall health and social welfare of people in Latin America and people in poor parts of Latin America. The problem is inequality is also part of the challenge. It’s like if everything is a little bit better for poor people but a lot better for non-poor people, that’s an equity challenge I think that everybody has to struggle with. The Catholic Church has been very vocal about the problem of persistent poverty and rising inequality. And it and we should be, I believe. But there’s a lot to be done to take on, and then globally, outside of Latin America, the world facts on poverty are still pretty disturbing. With huge numbers of people living on less than a $1.25 a day, the figure that is used a lot in international development circles. And one of the main reasons the MDGs, sorry, the Millennium Development Goals, there’s a lot of forward moving. One of the reasons is China has lifted a lot of people out of poverty, this one country. But there’s a lot of problems inside China. A lot of growing inequalities, collapse of the rural health system, the rise of chronic diseases that affect primarily people living in poverty or uprooted by economic and social change. So again, I’m not gonna say the poor will always be with us, it’s been said before.>>[LAUGH]>>But I am gonna say that there is improvement and that´s a good thing. But there’s a lot of structural violence and is still lot of violence in the world that, I have to believe that if it’s social suffering then social action can undo it.>>Talk a little bit about social suffering, the term itself is probably not a term that most people are familiar with.>>You´re right, it isn’t and I’ll tell you where I got it. In a way, the term accompaniment, I actually learned that from the Haitians, not from a book. Cuz they were always talking about it and then I was reading the books and saying, wow, liberation theologians talk about that too. So it was before you wrote your book, you see?>>[LAUGH]>>[LAUGH] That’s where I got it.>>Structural violence, I pretty much heard it hook, line, and sinker from the Haitians. They didn’t use that term, necessarily but they did use terms like violence. And so a lot of notions I got from experience and, what was your question again?>>[LAUGH]>>Could you talk a little about social suffering?>>Social suffering, yes indeed, don’t get me going.>>It’s related to it. [LAUGH]>>So anyway I was going back and forth to Harvard and Haiti, just to keep it short, but I think some of the students will be interested. In this. My mentor at Harvard is and was a man named Arthur Kleinman, a physician anthropologist. He works in China, and he would talk a lot, as we would tell him, a lot and a lot and a lot about social suffering. And I got to write with him about this, as all the students did, and teach with him about it, which is a lot of fun. Even taught as a graduate student with him. And so we said, well, if you think of it as natural suffering, like a natural disaster, is really an earthquake in Haiti a natural disaster? Well, if it’s natural, then why would the same size earthquake in another place, very crowded, cause so many fewer deaths? Even that’s not a natural disaster. It’s a social disaster. And you look at gender disparity in, say, India, poor family, well, that’s not a natural disaster, as any post-feminist reading of suffering in India would tell you. So if they’re not natural suffering that you’re doomed to because you’re human, what is it? Social suffering. The life expectancy at birth a few 100 years ago was all over the world probably about 25 years. Not too short. Not too good. What’s happening now is a massive increase in life expectancy all over the world. And that tells us that the suffering that happened before, around disease, privation, want, violence, wasn’t natural to our species. It was now we’re liberating ourselves, or can liberate ourselves from a lot of social suffering. So anyway, that’s where I got the term. I would welcome you to explore with the students here. I’ve used it a lot in our work, trying to understand structural violence.>>I think we live in such an individualistic culture that the social anything becomes questioned. And so I know that even the term social justice has been questioned by certain media pundits and others. But I think that in the Catholic tradition, certainly there’s a sense of the person as inherently social. And so everything we do has social implications, and we, in turn, are influenced by it.>>Well, I know we’re about to get the hook. But I would like to say one last thing.>>[LAUGH]>>You can’t see Roberto, but behind you looms Erik.>>Yeah. [LAUGH]>>[LAUGH]>>Why do people, why would pundits->>[NOISE]>>Bless you again.>>[LAUGH]>>If any of you needs a chest film afterwards, I’ll do it instead.>>[LAUGH]>>Why would someone say, no, that’s not social suffering? Don’t talk about social justice. Don’t talk about social anything. Because it leaves open the space that it may in fact be an accident, the hand of God, a biologically inherent outcome or a natural disease. Those are not true. They’re false. They’re social, so there’s a reason people react to it negatively. And it has to do with established privilege and defending structural violence in one way or the other. And it’s no fun to be yelled at. It’s no fun to have people say, well, don’t call it social justice or don’t talk about social suffering. I don’t care for that either, but the good news is that it happens to be true. So we have to push this forward, and including in places like universities.>>Great, thank you.>>[APPLAUSE]>>We’re not done yet. [LAUGH] Let’s open it up to your questions. You’ll see two microphones in the middle, and we can just take a minute.>>I never thought I’d hear a doctor approve of social movements. Thank you very much for your support. In 2002 in El Salvador, the Marcho Blanca was 50,000 people of doctors and nurses in their whites coming out and joining all the people of El Salvador. I know doctors wash their hands a lot, and I just wanna thank you with some homemade soap.>>Thank you, wow, thank you very much.>>[LAUGH] [APPLAUSE]>>That’s what we call pragmatic solidarity in my book. Thank you.>>This question is for Dr. Farmer. Dr. Farmer, as Partners in Health grows, I wondered what policies you all put in place or practices you emphasize, so that there’s a culture of accompaniment in the organization, and that accompaniment is a reality?>>Well, it’s a very difficult question. Because it’s hard to put in place policies around, just as it’s hard to understand what theological disputes as rendered by the media. It’s hard to know how to take an idea like that and make it into a policy. I hope that’s fair. Some of the things you could do, and I’ll be glad to share, and I have a number of colleagues here from Partners in Health tonight who would also be glad to talk to you. What about, one of the things you could do is say, look, we’re not in the business of short-term contractual arrangements. So if you guys started working in Haiti, you wouldn’t expect to say, okay, well, here is our metric by which we’ll evaluate success and we’ll determine whether or not we’ll leave. Cuz accompaniment leads you to a different approach. It would lead you to build up sister organizations with local capacity that are capable of enduring as long, as there is a need for preferential options, for the poor and healthcare. So that actually ends up having a lot of implications on management, program policies, budgets, assessments, how board works. Another would be, okay, now that we’ve figured out that we believe in basic health rights, who confers rights? Do NGOs confer rights in the United States? Haiti, Rwanda, Russia? No, but the public sector does, right? If you have the right to primary education, it doesn’t mean you have the right to go to Boston College. And so that leads to a different set of very difficult problems about, how can we make sure that our expansion not only builds local capacity that you can get by employing people from the places in which you’re working, which is an important form of accompaniment? But also, say, okay, how can we build the health system that will actually give poor people the right to healthcare? Good healthcare. And I could go on and on, and believe me I have. But there are ways definitely to make accompaniment a part of the policy. We already mentioned treating chronic disease, we use the term wraparound services. It’s not a very good term. But it means that if people are hungry and sick and you give them, let’s say, treatment for a disease but no way allowing them to eat enough, then you’re not doing accompaniment. And picking on Roberto’s book, If what you’re doing does not cause anxiety, it is not associated with churn and trouble, it’s probably not accompaniment. Because accompaniment’s really hard to do. And I think we’re learning all the time in our work in Partners in Health just how difficult it can be to try and move that into policies that would protect this work, especially in difficult times. Violence, war, big epidemics, you know, and then contractures of budget. When we don’t have enough money, we’re socializing ourselves for scarcity, just as poor people are socialized for scarcity. It’s extremely painful. And one of the ways to look at that honestly is to make sure your coworkers not only learn from what they do, because a lot of NGO work is not linked to learning, to discovering what it is you’re doing or looking critically at the outcomes. Not only learn what you do, to make sure and train others, especially the next generation, to take up the work because that’s another form of insurance against policies that you may have inherited or just aren’t good enough to move accompaniment forward. Thank you for this great question!>>We’ll take another couple questions. Yeah?>>Dr. Farmer, this question is for you. I’m a nurse practitioner and medical anthropologist and basically tried to copy you as best as I could.>>[LAUGH]>>Now I work in a community health center on Cape Cod, and a lot of what you were talking about with the preferential option for the poor is what I thought I was getting into But I feel like we run into barriers with such an entrenched system in the US for health care. Kind of what you´re saying about emergency room cost and the medical home, and I was wondering what you think, what small changes people like me and other nurses, physicians could make in community health that would start to change the system.>>Well it’s a great question. And I would just say that if I had to choose one, how do we make sure that we can work with community health workers and value their work? Poverty’s been very difficult. One of my colleagues, who’s a faculty member at Harvard Medical School and at the Brigham, Heidi Behforouz has worked on this for long years in neighborhoods around Boston. And it’s just very difficult to do because our system isn’t set up to support community health workers. It is set up to support, to some extent, doctors, nurse practitioners, right? But I think that’s one thing that’s within our reach. We’re putting huge amounts of money as a nation, as a state, as a region, into healthcare delivery, more than any other country in the world. But we’re not getting the return we want as far as value for that money goes. Just looking at value and looking at outcomes for the diagnoses and treatments that we make I think would lead us towards better community-based care. Not away from clinics like the one you work in or the hospital where I work or clinics I work, not away from that, but towards that third part of the triangle, community-based care. That’s just one thing that our country needs very badly. Like I said, it’s very expensive to give poor or mediocre medical care to poor people in a rich country.>>Thank you.>>Thank you.>>One more question.>>My question is from the theological perspective. I’m a student of theology from Brazil, so what do you think->>Ready, one of the Bs [LAUGH]>>[LAUGH]>>I remember when I was a student from Leonardo Boff, he was my professor in Brazil. He is one the most well-known liberation theologians, and he said when he came back from Germany, when he had done his doctorate, he went to work in Amazon, this very poor area in my country. And then he noted he should change his theology and make another theology, and theology come from the poor, come from the people. Then began liberation theology in Brazil, if another country in Latin America. So my question is, what do you think about the preferential option for the poor? When this concept left his local place among the poor and became in his local place became among the scholar people. Because I feel just movement in my country when the preferential option for the poor was among the poor in theology, where with the poor, this concept, it was very strong. Because it wasn’t one concept, but in practice it. And you can change my counter, for example, change for the regime. And change a dictatorship from democrat country. Now the option for the poor became a concept and the poor people it’s like became object to receive this concept but not make this concept working. So I just want to hear what you think about that, the concept preferential option for the poor. It’s just now I feel among the scholars in academia but far from the poor people.>>Yeah, that’s an excellent question. And of course that’s->>[APPLAUSE]>>That’s always a challenge, and it’s an ongoing challenge. And that’s essentially why I think the practice of accompaniment is essential. I think the point of the notion and of the practice of accompaniment is to insist that the preferential option for the poor is not a preferential option for a class of people. It’s not a preferential option for a concept. It’s a preferential option for poor persons. And that means that unless we engage with, or as Gustavo says, are friends with, poor persons, that it will remain simply an academic concept. Now, the other side of that is that, as theologians, I or Leonardo or any other liberation theologians, have a responsibility to act as kind of a bridge between the community and the academy on the one hand and the larger church I think on the other. For the same reason that Paul acts as a bridge between Haiti and Harvard and Washington etc. The danger, of course, is that a bridge can collapse. But ultimately, I think you’re absolutely right. Ultimately the people to whom we are accountable are the people in the community, the poor, the marginalized. Those are the ones to whom I ultimately, I think, am accountable. So no matter how coherent or ingenious or whatever my theological theories may be, if they don’t respond to the reality and the needs of the people whom I claim to be in solidarity with, Therefore, then they are necessarily fruitless, and hypocritical, and illusory, and I would argue even, idolatrous. So that the notion of accompaniment tries to get at precisely the problem that you’re suggesting. That the preferential option for the poor always has to be a practical option before it can be anything else.>>I think that’s a great question, I’d just say in a way maybe, a physician or a nurse who actually follows the burden of disease, doesn’t really have a choice. You’re really drawn to that intersection of structural violence and personal experience of illness, right? It’s hard, I mean, you can’t be a doctor for poor people from an ivory tower cuz there’s no clinical practice involved, right? So where’d you go by the way, Brazilian guy?>>[LAUGH]>>No. There you are, so.>>Connecticut.>>I don’t->>[LAUGH]>>You’re in your little safe enclosure up there.>>[LAUGH]>>So, in medicine, that’s what clinical practice is about in nursing, I said medicine. And, I feel some sympathy for academics who can go to, and a great deal of admiration for an academic or a theologian who can write from a reserve about poor people, but he or she can’t do that for long without the renewal of service and proximity, right? And you wouldn’t be able to do it in medicine, at all, right? Because you would not be able to understand why people were being, were sick, and how to diagnose them, and how to make them better. So I say I feel some sympathy for those who try. But of course, we’re trying to have more sympathy, a lot more empathy and a lot more solidarity with people who actually are poor and are being punished by poverty, racism, gender inequality, and other social forces that are created by us, humans.>>And I think we’re gonna end there.>>[APPLAUSE]>>And before you all leave, I wanna thank the people that helped make this successful before you all head out. Molly, thank you for starting us off. Robsham’s staff, thank you for making this work with us. Professor Goizueta, thank you for this idea. Thank you to our co-sponsors, and thank you all for coming this evening. [MUSIC]

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