Ethnography Review: Pathologies of Power

Ethnography Review
Section AH

Introduction:
The poor are usually the victims in human history, they are the ones who will always be struggling for human rights, raise above poverty and fight against repression from the power and wealthy. Poverty is usually the results from the actions of other human beings, the result of man-made structural violence and the cause of suffrage among the poor and powerless. For this ethnography review, I read Paul Farmer’s  Pathologies of Power: Health, Human Rights, and the New War on the Poor.  I will analysis this ethnography base on strength and weakness of the issues addressed in the book, how this work has contributed to the depiction of a group or community as a whole and these issues will continue to be a global health issues base on the structure of power and inequity of the society Paul Farmer witnessed.

Body:
Health disparities, inequality gap between the rich and poor, structural violence that denies opportunities to those who need most are some of the many concerns that global health and public health encounters each day.  It is problematic from the starts of the century and requires tremendous amount of work and dedication for social changes.  In the book Pathologies of Power: Health, Human Rights, and the New War on the Poor by Paul Farmer addresses many social, economic and political violence against the poor, powerless individuals. The main points that this book also addresses human right, ethics and public health issues in each chapter.  What I like about this book is that is breaks down of the book compose of different issues or problems that are addressed in each chapter with narratives of the poor to demonstrate precisely how their illnesses relate to larger structures of power. Paul Farmer not only break down the issues into chapters but also into two parts, having the first half of the book rely heavily on his own experiences in Latin America and Russia which he witnessed many situation where peasants dealt with extreme structural violence and human rights violations. This part of the book are like his “postscript” that follows those events and describes the declining of health of peasants. The second part of this book inquiries more into human rights theory in light of Farmer’s work in anthropology and medicine. As Paul Farmer stated, “The second half of the book also draws on this experience, but it aims to lay out the framework of a critique of “liberal” views on human rights, since such views rarely serve the interest of the poor,” implies that social justice usually favors those who are powerful and wealthy, but rarely favors the poor.  I think this ethnography stated many interesting and important issues in society and world wide in larger scale. This ethnography, to me, hopes to establish a connections between the general public about anthropologist work in healthcare and medicine to understand the roots of inequity, poverty and illness that relates to the larger structure of power and wealth. Paul Farmer was able to address many issues and problems in different ways and then relates to the larger scale in general of how it affect the poor in terms of hierarchy of suffering, structural violence, comparing charity development in third world countries and concludes with reflections on the implications for changes.

Basic theme of the book:
The first part of the book argues that “social determinants of health outcomes are also, often enough, the social determinants of the distribution of assaults on human dignity,” which implies that the inequity between the human beings with power and wealth to those who have neither, they are often left behind (Farmer 20).  When medicine and policy intertwined, it is inevitable that hierarchy of suffering beings to take shape, for it is impossible to resolve everything at once. Most of the first half of the book address how peasants who were poor poor dealt with the pain of deep poverty which shapes into social issues such as racism or societal down look of social class. The strength of this part of the book is that it would first address the issue by narrating a short story of individuals who were at the moment experience structural violence, and then goes in depth of the how the situations relates to larger social, economic and political violence that worsen poverty in the hemisphere. Those who are poor, hunger and ill will remain the same or worse over time while the powerful, wealthy and healthy continues to thrive in their throne. The examples and the narratives helped strengthen the ethnography as readers are able to visually understand the situation and then analysis it base on the author’s argument. An examples of the narratives of one individual, Acephile, who was born poor and continues to suffering due to her state of poverty. “ You get up in the morning,” observed one young widow with four children, “and it’s the fight for food and wood and water.” If initial struck by the austere beauty of the region’s steep mountains and clement weather, long-term visitors come to see the Central Plateau in much the same manner as its inhabitants do: a chalky and arid land hostile to the best efforts of the peasant farmers who live here. Landlessness is widespread and so, consequently, is hunger?...(Farmer 32). Paul then argues that the reason of her health declining was due to the fact that she is a peasants in Chiapas, the result of poverty but also a historical product of the Spanish colonialism, underdevelopment by the Mexican state, and more recently, destruction of livelihood caused by the NAFTA agreement. Peasant’s lives like Acephile are not only due to poverty itself but due to the political structures that continues to worsen her condition. The narrating also creates a tone or a voice and call from the hopeless which empathize the condition of the poor and powerless. It creates a soft tone to the ethnography as the audience reads the narratives but a very strong, defensive tones for the powerless when Paul argues and address the concerns of poverty and inequity.

Power and Inequity:
One of the chapter addressed the structural violence as  human right issues. ““A Plagues on All Our Houses?” exposes prison epidemics of tuberculosis in Russia, showing that structural violence is again central to determining who is most likely to be imprisoned, who is most likely to be infected and sick once detained, and who is most likely to receive delayed or inappropriate treatment. This largely overlooked epidemic of multitude-resistant tuberculosis will soon be too large to be hidden. The only way to halt what amounts to tuberculosis-as-punishment is to provide prompt and effective treatment to tall prisoners. Even amnesty will be inadequate, if prisoners are released to a dismantled public health system cannot cure them (Farmer 120).” This is an example of a peasant by the name of Sergei, whom struggled to survive and tried to set himself free from poverty by writing fake checks. This small crime has placed him in prison and be waited for trial. During the chaotic of government structure of the fall of the Soviet Unions, he was placed into a crowd, overflow of sick and victims of tuberculosis prisoners which he soon caught the disease himself.  Because he had no wealth or power, his small crime was never brought up to social justice until he eventually fell extremely ill and died.  This demonstrates that the poor are not only unable to have access to health care but also adequate nutrition and living condition to live.  Many of these examples and stories are very practical to demonstrates that without social, economic and political changes, those who are born poor will continue to experience injustice and ethical issues that could be resolved.  It could also allow the general public to acknowledge the root of many global health, public health and social issues are due to structural violence, the destruction of chronic cultures by industrialization and colonialism and the conflict of interest in politics.


Public Health and Possible Solutions:
The right of health is perhaps the least contested social rights and yet, it is possible the solution to both preventable ill-health and human right violations. For global issues, we can see that health advocacy has failed miserably due to politics interest discussed in lectures and the articles such as the What is Global Health.  It address the concerns of health issues and global crisis that were prolonged due to hidden political, social and economic agenda. Paul Farmer linked public health to social justice. With no access to treatment, pneumonia or TB is more lethal than AIDS. These were the issues for the poor. Even when charity groups and organizations were able to give a helping hands to these unfortunate individuals, the help were always second-hand, leftover medicine. This is true. When I go on medical missions to third world nations to give free medical and dental care, the medical material and medication are often donated from companies because it will soon be expired. Often we would try to fundraise enough money to purchase quality medication, but sometimes we also gather and collect with what we can because any help is appreciated by the poor. I can definitely confirm with this point that even charity work does also provide quality care for those who need most.  Just like the film we watched in class about clinic trial on third world nations, the poor and powerless are often second priority and deserves only what’s left. But this isn’t be the case. Health care can be a commodity to be sold or it can be considered a basic social right; it cannot be both. Ergo, equity also is the central challenge for the future of public health. Even Paul Farmers speaks of the “pathogenic role of inequity” and hence of a ‘right to equity’.

Some method that was addressed by Paul Farmers were:
1. To make health and healing the symbolic core of the agenda: He calls for engaging health
professionals in human rights work so as to ensure health for all and to decrease health
inequalities.

2. To make the provision of services central to the agenda: He asks us to listen to the abused
when providing services; to distribute interventions equitably; to closely work with community-
based organizations to improve access. He reminds us that States are best placed to protect the basic rights of poor people; that State failure cannot be rectified by human rights activism by
NGOs; that the search for (economic) sustainability is often at odds with social justice approaches to health; that efficiency cannot trump equity in the field of health and human rights.

3. To establish new research agendas: He thinks we need to examine why some populations
are at risk and others are spared human rights violations. Farmer fittingly reminds us, however,
that research should remain secondary and be designed to improve services and social justice.

4. To assume a broader educational mandate: Do not preach only to the converted, he tells us;
also, do not try to teach lessons to recalcitrant governments and reluctant international
agencies; simply more education will not do for them.

5. To achieve independence from powerful governments and bureaucracies: A central irony
of human rights law, he reminds us, is that it consists largely of appeals to the perpetrators;
collaboration with communities in resisting ongoing violations of human rights is the way to go.
And finally,

6. To secure more resources for health and human rights: States have become less able to
help their citizens attain social and economic rights even though they have most often retained
their ability to violate these rights. It is easy to demand more resources, what is hard is to produce them.

 Conclusion:
Overall, the author concedes his book is principled, but extreme. It is not harsh though; the realities it describes are; the crimes it unveils are predictable and ongoing. What all the victims have in common and share is poverty and an unwillingness to knuckle under. Pathologies of power damage everybody, but kill chiefly the poor. We cannot, therefore, stay in our comfort and
innocence. This ethnography allows readers to understand and see the perspective of anthropologist about global health concerns and ways to address it that are more feasible. It is good that people like us acknowledge the problems but it also equally important to act on it. You have read about the problems of structural violence, you may understand from the perspective of Paul Farmer and my analysis and so now it is your turn to voice and take actions to help those who are repressed by the power and wealthy.


Work Cited

Beaglehole, Robert, and Ruth Bonita. "What Is Global Health?" Global Health Action. CoAction, 2010. Web. 1 Oct. 2012.
<http://globalhealthcenter.umn.edu/documents/whatisglobalhealth.pdf>.

Farmer, Paul. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley: University of California, 2003. Print