I am reading Mountains Beyond Mountains by Tracy Kidder. Random House Inc. published it in 2003, but excerpts from the book were originally published in the New York Times. It is a New York Times Bestseller and a winner of the Pulitzer Prize.
Howard Hiatt wished to discuss the MDR-treatment project in Peru and thus promote Partners In Health, and such a discussion took place in 1998 at the American Academy of Arts and Sciences in Boston. Remarkably, after treating fifty-three people for about two years, 85% of them were cured of Tuberculosis. Jim Kim, Arata Kochi and Paul Farmer agreed that “Dots-plus” is an effective term to use in reference to the strategy that would treat areas with drug resistance. Kochi enabled those at the meeting to discuss MDR treatment, but there were many arguments and conflicts surrounding the issue of treatment. The biggest problem of MDR treatment is the need for money, and this was discussed in depth until one doctor mentioned that they were there to assist the patient, not assist the patient as long as it is convenient and cost-efficient. The meeting closed with a quote by Margaret Mead.
"Farmer looked away, just a quick glance to the left and right. I'd seen him do this in patients' rooms at the Brigham–look at the patient, then glance up at the TV for a moment, then return, as if disconnecting so as to reconnect fully” (page 158). I wonder why Farmer always looks away from the eyes of his patients and then back again. Perhaps he is frustrated that they are thanking him for something that he can never do perfectly (heal the sick). Perhaps he feels thankful for the privilege to help someone and be the object of their sincere affections. Maybe he uses that moment away from the patient’s gaze to recollect his emotions, which could be stronger than he lets on.
“Excuse me, Ken, but why do you qualify my talk as provocative? I just said we should treat sick people, if we have the technology” (page 147). Farmer is implying that his talk served the purpose of treating sick people with all necessary resources that are available. His speech ignored the possibility of being what the other doctors at the conference called “efficient”. Efficiency is dehumanizing to Farmer, because it entails turning people away, and seeing just their sickness or their quantity. I appreciate that he said this to Ken, because it strengthened the message of the speech; it motivated people to categorize it as more than a “provocative speech.”
“She thought he’d never experienced true depression, a freedom so enviable she almost resented it. ‘I’ve never known despair and I don’t think I ever will,’ he wrote me once. It was as if in seeking out suffering in some of the world’s most desperate locales, he made himself immune to the self-consuming varieties of psychic pain” (page 189). According to Ophelia, Farmer has never experienced all-consuming sadness that kept him from functioning. Farmer, amidst the pain, death, and dying he sees, feels, and works with daily, has hope. Despairing would make his work pointless, for what is striving to help others without some hope? He cannot afford to despair. He is so caught up in the troubles of other lives, that he has no energy to focus on his problems, unless they are associated with his work. His hope frees him, and yet he is a slave to helping others.
This book’s portrayal of the sick and dying is different in several ways than the actions of the sick and dying in my experiences. Most people in my life see doctors as a necessary part of society and life. However, they do not treat doctors with sincere gratitude. If I or a family member gets a checkup, gets vaccinated, or makes an appointment because of an ailment, the happiness associated is more directed to the prospect of being cured, and not the availability of the doctor. People go to doctors to be cured, but not all people have extreme gratitude to the doctors themselves, even in a matter of extreme discomfort of extreme cures. In Haiti, Farmer is sincerely respected and thanked. After a mere day and a half, a Hatian fellow professes to miss Farmer “as the dry, cracked earth misses the rain” (page 183). Hatians pine for their doctor when he is absent. Doctors restore wellness to society, and this wellness is most apparent to the patients in places where it is lacking.
"People go to doctors to be cured, but not all people have extreme gratitude to the doctors themselves, even in a matter of extreme discomfort of extreme cures."
ReplyDeleteThis is a great observation. Consider, for example, some of the issues people have with the medical profession these days. They feel dehumanized as they sit in sterile waiting rooms. They feel disconnected from their caregivers as fewer and fewer people have a lifelong family doctor. They feel cheated by the extremely expensive costs of basic checkups.
But consider also, that this is the business of healthcare.
When you poll most people in medical school, more often than not, the future doctors are motivated by a genuine desire to help others, to benefit communities. But when they reach the profession, they are treated with little thanks. More often than not, they are terrified of medical malpractice suits. Most people think of them as vending machines for prescription pills.
As you said, in places like Haiti, a doctor is still rare and deeply valuable. Their community treats them with gratitude for someone who has come to help, and in turn, the doctors often go above and beyond to provide that help.
My generalizations are getting ahead of me. I think it's valuable to consider how we have managed to dehumanize the doctors as well as the patients.