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Pathologies of Power: Health, Human Rights and the New War on the Poor - Paul Farmer This book is a clear call to action. If you've been following my reviews, you know that I've had an epiphany of sorts from following Dr. Paul Farmer's work. He's the doctor to the poor, the one who cofounded Partners in Health, which treats poor people in nine different countries all over the world, in some of the settings of extreme poverty. They've been working in Haiti for about 25 years, since the early 80s.

His books have raised my awareness of what's actually going on in the world. This is real stuff. It's ongoing, it's actually happening right this minute even, it affects several billion people, it's deeply, deeply wrong, and it's our business to fix it. Paul's analysis has helped me to understand that this is very much my problem. Poverty is the connection, the thing that puts people from all different cultures, in all different places, at high risk for diseases of all types, for violence, for oppression. The story of global health is largely the story of poverty.

Secondly, he has shown me that my relative wealth (I have clean water, nutritious food, decent shelter, warm clothing, education, and access to information) is not independent of their destitution, but in fact that I benefit from the global forces that transfer wealth from the poor to the rich and have done so for centuries. I'm the direct beneficiary of the organized theft that puts these people (my kin and fellow children of God) in a position to be tortured, raped, to fall ill and not receive care, to be malnourished, and kept ignorant. So it's up to me to fix it.

I want to quote for you a passage from his afterword, from his summing up.

The spectacular aggressions I have witnessed are not accidents. Arising from complex social fields, these crimes are predictable, and indeed, ongoing. They are, I have tried to show here, pathologies of power. Looking through piles of notes and articles gathered to complete this book, I am reminded of many stories that are not told in these pages. I did not write about my patient who was the victim of a brutal gang rape inside military headquarters in Port-au-Prince. She told me that one of the most debasing moments of her experience was hearing the army's lawyer, a smartly dressed woman who spoke beautiful English, say on CNN that stories of political rapes were simply not true, that the alleged victims were lying to discredit the Haitian army. To see these and similar claims subsequently taken up by reputable international print media was painful enough for me; I couldn't bear to discuss it with my patient.

Nothing is written in these pages of the thugs who in 1988 torched the church of Saint-Jean Bosco during mass, or, even worse, of the paltry sum it cost the mayor of Port-au-Prince to have them do it. Yes, the mayor (who is no doubt also getting on in years, although he has yet to reach the golden age of Pinochet
(a reference to Pinochet being thought too old for justice. -T) Even though one of my closest friends was among the survivors, and even though I have written about these events, I have never discussed them with this friend, and I never will.

And on and on. These events are added to a long list of things I wish I had not seen, or heard, or smelled. Indeed, staring at the x-ray image of the bullet in Manno's leg
(a reference to a child victim of violence in Haiti who was not helped at all by doctors at the regional hospital in Port-au-Prince. -T) triggers recollection of many expediently forgotten bullets and their forgotten targets. I stop to recall, however briefly: in 1987, sewing up a child's gunshot wounds in the same general hospital from which Manno was just extruded; evaluating the surviving victims of a grenade pitched into a 1990 pro-Aristide rally; knowing what it looks like to watch, from the middle of a traffic jam, a crowd fired upon by automatic weapons, an anonymous ten-year-old boy caught in the crossfire; the death of Chouchou Louis (a torture victim described earlier in the book. -T) in my presence; and the burning alive of secret police, killed by angry crowds. The even worse smells of morgues and prisons and deathbeds crowd my senses.

And the assaultive truths don't stop with the things that I have witnessed, since many of the stories I've heard from others elsewhere have a specific resonance for someone who has worked in Haiti. I think here of the exhumation in Guatemala, with which we did indeed help, and of the one unmarked grave that contained a young man, his wife, and their unborn infant (one bullet was within the fetus). I think of my friend "Julia's" martyred brother -- a teenager, for God's sake -- his body displayed like a hunting trophy; the "disappeared" in Haiti and in Central America; the murder of Father Jean-Marie Vincent by the Haitian military. Father Vincent died, gasping like a fish, on the steps of the rectory.

What do all of these victims have in common? Not language or gender or political views; not religion or race or ethnicity. What they share, all of them, is poverty and, generally, an unwillingness to knuckle under. Pathologies of power damage all concerned -- and who isn't concerned? -- but kill chiefly the poor. These crimes are the symptoms and signs of structural violence. Indeed, when we regard the perpetrators of these crimes from any comfortable reserve, it is important to recall that with our comfort comes a loss of innocence, since we profit from a social and economic order that promises a body count. That is, surely there are direct and causal relationships between a protected minority enjoying great ease and those billions who go without the bare necessities of food, shelter, potable water, and medical services? Pathologies of power are also symptoms of surfeit -- of the excess that I like as much as the next guy.

He goes on to ask a burning question: "is it really useless to complain?"

He goes on to contemplate his own loss of innocence, and to ask from whom he can demand it back.

My own answer to that question, protected as I am from the harsh truths of the depth of violence of poverty, yet from my own position as a survivor of childhood abuse, and the adoptive mom of a son who survived much worse than I... my answer is that Christ, also a victim of torture, had my innocence, that he gave it back to me when I begged him for it. My answer is, like Paul, to dedicate my life to ending poverty.

All I want is for every child born on earth to have love, good care, clean water to drink, adequate nutrition to avoid developmental disabilities, decent housing and bedding, freedom from violence, shoes and clothing, adequate health care, to get good treatment for all treatable diseases, and to have access to the wealth of knowledge, of education, that our modern communication systems afford. I want an end to bigotry, to racism, sexism, classism, jingoism. I want all of us to help one another, to take care of each other and share each other's burdens. That's all I ask. And I think it's the least we can do. The very least.

I don't insist that it be done instantly. (Though really how can we accept the damage to any child that results from delays?) I know that what we don't finish, the next generation will complete for us, along with dealing with whatever new challenges arise for them. I don't have to do it all myself. But it will be done. Make no mistake.

Sekhmet is the Egyptian goddess of protective wrath. She's sacred to mothers everywhere, and she looks after the weak and powerless. Well, Sekhmet is definitely on the move now. She's kicking butt and taking names. She's sort of like Santa, but a lot more wrathful. She's sometimes depicted with a flamethrower, her Flammenwerfer of Ruinous Wrath. Please be aware of her oversight. Be mindful of her FoRW.

Take care that you are not among those who leave undone what should be done, for Sekhmet is watching, and she will know and remember.