This event is a
conversation about the book In the Company of the
Poor by Paul Farmer. And before I talk about our
speakers or about the book, please let me thank First
Church and Rev. Dan Smith for their hospitality here,
for offering to host us here in this great sanctuary. And let me thank my team in
Science, Religion, and Culture, who have been working for weeks
to put this event together. It's really wonderful effort. And it's always a
pleasure and an honor to be working with you. This event is part of our
initiative on religion health in a global, religion and health
in a global context, which is coordinated by Lauren Taylor,
who is monitoring of our event today. Lauren is a Masters
of Divinity candidate and a Presidential Fellow at
the Harvard Divinity School. Her first book, The
American Health Paradox, co-authored with
Elizabeth Bradley, came out in November 2013. The book In the
Company of the Poor invites us, from its title,
and throughout its different chapters, and its
overall message, to think about health
care in relation to liberation theology. In this journey of the
book, liberation theology becomes part of the
new journey where it provides an ethical
grounding for a different type of global health. But also the title of the book,
and every single chapter of if, invite us to ask questions
about the poor-- who the poor are, what can
we think about the poor. After all, liberation theology,
whether in Latin America or in it's different
incarnations, in the black church
in the United States, in Africa, or even in it's
non-Christian incarnations in sub-Saharan Africa
and in the Middle East, in all these different types
of liberation theology, or may I say liberation theologies, it
challenged us to be the poor, to become one with
the suffering, with the downtrodden,
with the marginalized, with those who are marginalized
for economic reasons, for political reasons, for
their sexual orientation, for their gender, for race,
for culture, for all sorts of and types of marginalization. Liberation theologies,
in general, we're also a way not
only of giving priority to these marginalized, but also
a voice of the marginalized, a new discourse, if you
will, coming from down up, a chance for the marginalized
and the downtrodden to say something, for the
voiceless to finally have a voice, to create
a discourse that would express their own
views, their own hopes, and their own problems. If we are to think
about health care in terms of a
liberation health care, how can this health
become also something that is produced by
the quote on quote, the poor, or the marginalized? How can it be
formulated in this way so that it's not only
expressing or coming to them, but it is also produced by
them or, should we say, by us? There are no better people
to answer these questions, and to think with us in these
issues and other issues, than our two speakers today. Paul Farmer, as we all know,
is professor of Social Medicine in the Medical School. His work in global health,
all over the world, is something that probably
every one of us knows. And he is the author,
the co-author of the book that we're discussing today,
In the Company of the Poor. My friend, David
Carrasco, is a professor of Latin American studies
at the Divinity School, a historian of
Mesoamerican religions, and a professor of anthropology. His work, particularly on
questions of race and culture and his discussions that we
had here at the Divinity School with Cornel West,
changed the way we think about race and culture
in the Americas in general. I could go on with
their biographies. But that will consume
the rest of the evening. So we have an extremely short
version of their biographies in extremely small print printed
in the back of your programs. If we go any bigger, we
would run out of space. So have to bear with us. So with this I
leave this podium. And Lauren, you can lead us off. Great. Thank you very much. My mike works. [APPLAUSE] Thank you so much, Ahmed. And thank you all
for being here. It's been an incredibly
exciting few weeks for the Science, Religion,
and Culture program, at Harvard Divinity
School, as we planned and worked with our
partners at Partners in Health. But this event, in
particular also, is incredibly exciting
for me personally. And that's because
both of my passions are represented here
in our two guests. I started my career
in public health. And I did a Masters
in public health and was working in
research before I came to the Divinity School. And when I go back
into health circles, as I've been doing this
fall with the book, I'm often asked,
Divinity School? Did you get lost on
the way to the lab? What are you doing
in Divinity School? But I've always
felt very strongly that there is something
about these two disciplines that really needs to commune
in order, particularly, for global health to
take flight the way I think we would like to see it. Conceptually, I felt
like the Divinity School was a place where
we could really find an ethical grounding
for global health that would make it sustainable
over the long-term. And very pragmatically,
I saw something in the ministerial
skill set that's very interested in the practice
of listening, partnering with vulnerable communities,
acknowledging and affirming suffering that really made me
think that I could do better work, in the field,
by virtue of working on those ministerial skills. I'm going to run through just
a few quick logistics, one of which is that we
are live streaming this conversation this evening. So if you could just
silence your cell phones, If you haven't done so already. That would be really useful. These two gentlemen,
I know, both have incredibly global
reach in their work. And so I expect we have a number
of very interesting and diverse folks tuning in. So I encourage people,
who are watching over at the live stream, to
tweet your questions or comments @SRCatHarvard. And I have my phone up here
and will check it occasionally. And hopefully, we
will take a question from the live streaming audience
when we get to the Q&A portion. My role, for the
evening, is really just to keep an eye on time and
help with the translation process between David and Paul. Although, seeing them at
the reception, I think there will be no concern. There will be plenty
to talk about. And so with that, I
think I will tee up David with the first question. And it's a grand one. What did you think of the book? Should I leave now or--? [LAUGHTER] I don't know what
time in culture and made podiums
that were so small. [LAUGHTER] But it is a great
pleasure for me to be here at First Church
with Professor Ahmed Ragab, and Lauren
Taylor, and of course, Paul Farmer for this discussion
about this wonderful book, In the Company of the Poor,
Conversations with Dr. Paul Farmer and Gustavo Gutierrez. I stand and approach the podium. Because in my tradition,
the Mexican tradition, one stands in the presence
of an honored person. One stands in the presence
of a person recognized for great merit and value. And Paul Farmer
is such a person. And so I stand to speak to
him, and to you, and to us about this book,
which I consider to be a kind of
cruce de caminos, a crossroads
between the thinking and the life of Paul Farmer,
and the thinking and the life of Gustavo Gutierrez. And as I read this cruce de
caminos, and enter into it, I become one of a growing
number of readers. I hope many of you here have it. And it leads me to
learn and question as we go along with this
dialogue that is ignited, once again here tonight,
a dialogue between Paul Farmer-- a doctor-- and the
great priest and liberation theologian, Gustavo Gutierrez. But I'm speaking not
as a theologian nor as a medical doctor. But as an historian of
religions interested in religious experiences, sacred
places, and regressive actions in the lives of
humans, but especially human beings in Latin
America, and especially Latin American people who are here. I'm drawn to the
life experiences, and thinking, and writing of
both Farmer and Gutierrez. And I seek to contribute
five questions to this evening's exchange. First of all, I taught a
course, here at Harvard, in the fall with your
teacher, Arthur Kleinman. The name of that
course was "Quest for Wisdom, Religious, Moral,
and Aesthetic Experiences in the Art of Living." And I see Arthur's touch
in your ideas and writing. Arthur insisted, in this
course, the quest for wisdom, that we were not so
much about wisdom. We were about the quest, the
ordeal of the quest for it. And that quest for wisdom,
according to Arthur Kleinman, the medical anthropologist so
many of us here at Harvard, he insisted that it
meant working effectively with other people in order
to bring good into the world. Arthur stated that
he knew this sounded naive and simple-minded. But he insisted it's very
important for students to think that part
of their goals, of an education at Harvard, is
to know how to work effectively with other people to
bring good into the world. Even though we,
at Harvard, relish in complexity of our data,
the complexity of our theory and interpretations. Matter of fact, you come
to a Harvard classroom, and you won't be in there
20 minutes before somebody says, oh, it's more
complex than that. We got to look at the
complexity of this. And complexity is a good thing. But sometimes, being simple is
as important as being complex. Arthur's insistence
about working effectively to do good in the world forced
me to admit in question, well, it seems to me,
it's very difficult sometimes to know when it is
you're doing good in the world. Even though you claim to
be doing good in the world. This problem, of
not knowing if one is really good in the world,
led me to remember my college summers, which I spent in
the poverty-stricken barrios on the southern side of
the island of Puerto Rico. We worked in sanitation
projects, libraries, and community organizing. And I remember writing back home
to people and in my journal, I'm having the time of
my life with these people in these projects. Working with Tito Cruz,
and Sergio Garcia, and Puerto Rican people
who not only shared with us everything they
had, but also did what they could to protect
us from the dangers that they faced every day. We, students from college, going
from the north to the south. But a crisis came to me when
we returned to the campus as something like heroes. Because we had been
doing good in the world, down there in Puerto Rico. And we had to face
the whole campus. It was a campus-wide assembly. Every student came to hear
of our accomplishments. And I realized I just
couldn't find a way to tell the truth, about what
I had seen and discovered in Puerto Rico, in those
barrios of tremendous poverty. I couldn't bring my
way to, I couldn't find my way to articulate what
it was like to live inside of that poverty. Because I hadn't seen it before. But I was kind of
subbed on stage by the others, who said,
hey, man, you can do it. I didn't know how to talk about
the poverty, the pollution of human opportunity, the ill
health, the sheer vulnerability of the Puerto Ricans in
Ensenada, or Cayey, or Aguirre. I honestly didn't
know how to take off the mask of our success and show
the immensity of the meagerness that we dwelt in
that first summer. And the confusion and
anger, I felt at myself, was compounded by the fact
I didn't understand how this poverty had been created. I didn't know how this
poverty had been structured. I remember the
very first morning I woke up in Puerto Rico. I was living in the sugar cane
shacks with sugar cane cutters. And one of the
members, in the shack, had this terrible attack. And we had to take
him to the hospital. And we carried him out. He was yelling. He kept yelling. He kept yelling, my
leg hurts so bad. My leg hurts so bad. We thought he had some
injury in his leg. And we took him over
to the hospital. And it was really a big mosquito
net, where there was a nurse there. And we asked her, this
man is really sick. He's struggling. Help him out. And she said, well, you
know, el medico viene un dias y un dias no. The doctor comes some days. And he doesn't come
the other days. And we left him
there thinking he had something wrong with his leg. But an hour or two
later, they came and said that Johnny Santos es muerto. Johnny Santos died of
a cerebral hemorrhage, of a brain explosion. And it struck me, how could
I go back and tell this story to my college students,
who wanted to see us as great people of success. And I realized then that knowing
how to do good in the world was so complex and hard. But you, and Partners
in Health, you have done great
good in the world, whether we tell it simple,
or we tell it complex. But here's my first
question, especially for the students who are here,
who look to you and maybe to me somewhat, but certainly
to you as a kind of model, a model for
their future careers, especially those students were
are going to read this book, and get to know
your work better. Tell us two examples-- one
inside a classroom and one outside a classroom--
where you became motivated or gained some
understanding and energy to work effectively with others,
and do good in the world. And when I say
inside a classroom and outside a classroom,
what I'm meaning is you come to a
place like Harvard, and people will work
hard in the classroom. But they'll say, oh, man,
I got my best lessons outside of the classroom. That is not true. It's not true. Don't be sorry about
the good lessons you get inside the classroom. And I'd like to hear him
talk about a good lesson in the classroom and
one out of the classroom that led to this book. The second question,
why this book now? Why this book now? What is the significance
of this book for us? What does it mean
that a doctor has gotten into a
long-term conversation with a liberation theologian,
with the kind of approach to theology and community that
the military units in Latin America, that the Catholic
Church in Latin America and Rome, that the Reagan
administration said, don't pay attention. Don't allow that liberation
theology to have a voice. And here's Paul Farmer, in this
year, forming a relationship, and going public, and saying, I
and Partners in Health, who've done such a profound work in
Rwanda, and Haiti, and Chiapas, I want you to know that
my Partners in Health has been fed by the
theology of liberation. But why this book now? And what does it mean to us? Because this book says that it
wants to, what Paul Farmer says in this book, in an essay called
"Health, Healing, and Social Justice", he says,
"Liberation theology pushes the analysis in two directions. First, to seek the root causes. Second, to elicit the
experiences and views of poor people, and to
incorporate those views into all observations,
judgments, and actions." I thank you, Paul
Farmer, for helping to bring Gustavo
Gutierrez's name, work, and liberation
theology to a wider spiritual-hungry public. Some of us may not know that it
was the Peruvian priest Gustavo Gutierrez, a mestizo-- mixed
Quechuan and Spanish descent-- who coined the term liberation
theology in his 1971 book A Theology of Liberation. And he said, "I come
from a continent in which more than
60% of the population live in a state of poverty. And 82% of them find
themselves in extreme poverty." It was Gustavo Gutierrez who
said, "Poverty is not a fate. It's a condition. Poverty is not a misfortune. It's an injustice. It's the result of
social structures, and mental and
cultural categories. It is linked to the ways in
which society has been built in its various manifestations." Elizabeth Schussler
Fiorenza is here tonight. She knows about this. Harvey Cox is here. He knows about this. This Gustavo Gutierrez, who
military regimes and others turned against, and
identified as dangerous. But you've been
inspired by his hope and his preferential
option for the poor. Why now this book? And what impact is
it going to have? And to what extent
we students are we going to join with
Paul Farmer in this book, and Gustavo, to make sure
that it has an impact, and this message
goes out from here? So that's my second question. Why [INAUDIBLE]? [LAUGHTER] Number three, and
I'll move through this so we can hear from Paul. [LAUGHTER] This book seems, to me, to
be two books intermingled-- his essays written
as a man of faith, and your essays written
as a man of medicine. My reading is that you're trying
to do a work of translation, a new translation of
several texts and processes, including liberation theology
into the work of Partners for Health. Along the way, you and
Gustavo Gutierrez's attempt to develop quote, "A
comprehensive commitment to healing the world." But to do this, you work
to give new meanings to words traditionally captured
by conservative Catholic lexicon. Conversion is used
a lot in this book, a word that usually
meant, also, attacking indigenous ways of living. You use evangelization,
which often led to the byproduct of
destroying indigenous cultures. But you don't mean that. There's a lot in this
book about spirituality. It use to mean focus on
things from another world. So I want to do
two things for us. Tell us what you
mean by at least one of these words in your secular
medical work with the poor. And secondly, it seems to me
that this work of translation, like all translations,
is incomplete. I'm not persuaded yet that you
and Gustavo have sufficiently translated the
word "spirituality" into medical practice. But we want to
know what you mean. So that the next
generation of people can further the translation,
develop the translation further. The fourth question may be
a little more challenging. [LAUGHTER] You describe Gustavo Gutierrez-- That's [INAUDIBLE]. [LAUGHTER] OK, thank you. That's not what I expected. Are you ready to go? [LAUGHTER] You describe Gustavo Gutierrez
and his theology of liberation is about hope. But I read these essays
to show that he's as much a man of faith. And in the Catholic
Christian world, that's not the same as hope. And in fact, faith in
Gustavo Gutierrez's teaching is what ignites
hope into action. Allow me to quote
him on page 31. And the essay is called
"Saying and Showing the Poor that God Loves You". He says, Gustavo Gutierrez
says, "Jesus bears witness to the Kingdom of God
through His words and deeds. And the healing of the sick has
a prominent role in His work. Jesus healed the leper, the
paralyzed, the blind, the deaf, and many others who
suffered disease. "All of this was a
message," says Gutierrez. As the Acts of
the Apostles says, "Jesus passed through
the world doing good. And Jesus not only
healed the sick, but He allowed the
sick to participate in their own healing. Very often, Jesus told them,
"Your faith has saved you." But my dear brother here, he
doesn't mention faith too much in his book. And I don't think you mention
the word God too much either. And that's all right. Though you do talk
about God talk. And so I guess I'm doing
a little God talk here. For Gustavo Gutierrez, God and
Jesus are not only the models, They are the center
of his enterprise. I'm not asking you here to talk
of your own personal faith. But where are God and
Jesus in the word, in the work of
Partners in Health. This seems, to me, a pertinent
question given tonight's theme and where we are after all. Finally, what do you see
as the specific future for the Partners
in Health energized by a revival of
liberation theology? And what do you
hope for the future of liberation theology made
manifest in Partners in Health? And in the case of your
work in Chiapas, Mexico, Chiapas is the poorest and
Mexico's most indigenous state, where Partners in
Health will be treating people. Those indigenous people,
they have larger cosmologies than Catholicism. They have larger cosmologies
than what you even have in other parts of Mexico. What's the future? Let me put it this way. You have an ongoing
project there now. I'm very grateful
to be part of it by helping with teaching
some of these students who are working there. I'm pleased to be a
part of that project. But I'm reminded of the
great essay on the Chiapas and the bishop of
Chiapas, Samuel Reese, by John Womack in his great
book Rebellion in Chiapas. And I'm coming to the end. Womack recounts that the
bishop, the great Bishop Ruiz, who did so much in
Chiapas, said, "I went there to convert the Indians. And they converted me." And one of the key
moments in this conversion was when a group
of Indian wise men confronted him on the
church's work among them. They presented him with
three tough questions. What happened was
the church said we want to find out
how good we're doing [INAUDIBLE] indigenous people. So let's do a study. And let's [INAUDIBLE] all
the people themselves. And the people,
the Indians came. And the came and
said, OK, now we're going to tell you how
you've done with us. We have three questions
for you, dear Bishop. The first question is
does the Bishop's God want to save our bodies
as well as our souls? Number two, they said,
if the work of God is like a seed that
is found everywhere, and already a seed of
salvation, can we not assume that these
seeds are to be found where we live in the
mountains and the forests? Therefore why should we come to
your centers and your church? Why don't you come out
there where we are? Because where Partners
in Health is going. The bishop did not know what
I know about this question, that for the Indians, when they
speak of seeds in the mountain, they really are speaking of
their ancestorss-- mountains. But the question, the
third question, Paul, is the one I have for you. The [INAUDIBLE]
Indians asked him, and they could be talking about
you and your medical folk, quote, "You have lived among
us and shared our lives. "We regard you as our
brothers and sisters. Is it your desire
to be our brothers and sisters for all time? So Paul Farmer, how long
do we go on together in our accompaniment
with the poor? What do you see
as the next steps that you and we
must take together? What will you tell
the audience here about what must be done next? Thank you. [APPLAUSE] Thank you. Well, I was hoping for a
light, breezy conversation. [LAUGHTER] Thank you, David. I didn't take any notes. I may have to turn
to Lauren for help. But I certainly
would like to start the conversation, the dialogue
or with others here as well. I feel like the
easiest way to start, which is something I need to
do-- it's sort of like sitting next to Martin Luther King Jr.,
and then, being asked to talk-- is to think a little bit
about your first question first about things one can
learn in a classroom, or again through reading, or
books, and things that you can learn outside
of the classroom as well. And when I was
working on this book, I had occasion to think back
to both those questions. 31 years ago, I was
lucky enough to, in between college and medical
school, to go to Haiti. And it changed my life. But I went there prepared. And I don't say that
with any great pride. I just have met so
many people in Haiti or-- go right through the
list-- who are not prepared, who have not tried to prepare. And what I meant by
prepared is I certainly knew about liberation
theology by then, having gone to college
between 1978 and 1982. This was a very difficult
time, which we know well in Central America. And one of the experiences
I had after having really rejected the Catholic
faith that I grew up with, was wondering why it was that
in Central America, in places like El Salvador,
Honduras, Nicaragua, people were willing to put
their lives on the line, and that in order to promote
dignity and social justice, and an end to
oppressive regimes. That was one
question, pretty basic for any citizen of the
United States, I think. Unfortunately, not questions
that we posed as much as we should have back then. And I remember
the day, actually, that Archbishop
Romero was murdered. And I just couldn't believe
that it would have happened during a mass as
he was saying it, and not understanding
what was at stake. And that's really why I
started reading the liberation theologians, the curiosity
about what was going on in Central America. And I can't say I
read them very deeply. I never took a class, like the
kind of class you teach here. So my experience
in the classroom was really in anthropology. Took my first class
in anthropology as a college student. This is at Duke University. And it just, somehow, seemed to
lead me to ask questions about, as one is supposed
to do taking classes, ask questions about how poverty
worked in the modern world, to go from a
setting of affluence and ease to just a couple of
hours away to see farm workers. Most Latino, but
many from Haiti, to see farm workers
laboring under conditions that, in 1981,
were termed slavery by the US justice system. So the US justice
system actually tried some growers, farm growers, on
slavery charges in that year. It was my junior year of college
in the state of North Carolina. And it just seemed
to me, right then, because of things that
I learned in a classroom or in a university, that
the world opened up for me. And that's why I teach. It's why I teach not
just medical students and physicians, or
teach with my colleagues in places like Haiti, and
Rwanda, and elsewhere. But that's why I
teach at the college. And whenever I
can, talk to people who were my age when I saw
the world open up before me. And that's intellectually. Because I didn't go anywhere. I didn't go more
than a few hours away from the campus, or my
home state of Florida, or my adopted state
a Massachusetts until after I went to college. And I share that
often with students, say, don't disdain what you
can learn in a classroom or from a book. The path that I'm on now,
along with many, many thousands of other people, and I'm
talking about the path of pragmatic solidarity
with Partners in Health is, to some extent,
the path that was laid before me in a university. In any case, that experience,
I would elevate it, and did in thinking
about this book, and how I could
contribute to it when writing it alongside of
someone who I admired so much and thought of as a hero. When you may meet
Gustavo Gutierrez, and there are a number of his
friends here in the audience, he's a very unimposing
kind of fellow by choice, not by his choice necessarily,
also by God's choice. He's kind of small. I'm very regretful, I'm very
regretful that in the book, I called him Yoda. And they didn't take that out. Yeah. [LAUGHTER] It's too late now. Anyway, it was in an
interview and not in a chapter that I wrote. He won't mind. No. No, he won't mind. He's good sense of humor. But he, in reflecting
a little bit about why I felt so
strongly, and you ask me these questions personally. And so I'm answering
them personally. Because when I turn to another
question about spirituality, about which I know little
but have some things to say, I will reflect on the asocial
nature, the asocial way we have of discussing spiritually all,
spirituality all too often in, again, I'll say in
the United States. But I haven't studied
this formally anywhere. But back to Gutierrez and
writing in concert with him. I felt that I had a lot more
reflecting to do than he did, and not just because he
was, he's older than I am. But because he
thought so much more about these first
order questions of doing good in the world. And that was very humbling to
me just in the last few years. I've spent my life thinking
about doing good in the world. And I felt that on every issue,
every topic they came up, I had been nowhere near
as thoughtful as he. And that was also humbling. And that's what would
lead me to say things that I learned outside of
a, give an example of things that I learned outside
of the classroom. And I'll link two
things together. One of them was, to
use your term, just the immensity of the meagerness. That was your
expression, I believe. That was it, yeah. Yeah. And it beautifully captures
what I saw in that first year after leaving college before
going to medical school. I had read, I said
I was prepared. But prepared in some
ways and not others. The immensity of
the meagerness of was available to people living
in extreme poverty, which of course, I've since
seen all over the world, including to my shock
in Chiapas, Mexico where I saw places that
were really almost every bit as poor as a poor
village in Haiti. I saw places in
South Africa that were just as poor as some of
the places I'd seen in Malawi. And of course, I saw
marginalized people just as marginalized in prisons,
in Russia, and the United States. But that first year, the
immensity of the meagerness almost overwhelmed me. And when I say overwhelmed,
I don't mean in a good way. I mean in a very bad way. In a way that I've seen happen
to others to make me retreat to a place where some of that
immensity might be diminished, forgotten, relativized. And one of the
reasons I didn't are people that I met
in Haiti, including my wife, although she
doesn't like it when I say that was 31 years ago. But also the, and we're still
working with the same people now, to this day. So there's something,
I think, to be said for enduring all these years. I met the people with
whom I would later form, I don't even like using
first person here. We would form together Partners
in Help all in that first year. Amazing. But that 1983, but the
fear of that immensity was a lot for me. --me. And one of the ways that
I learned something good outside the classroom was not
to be a spectator to poverty, although I knew by then
that I was only that, very little more. And I learned that the hard
way at someone else's expense of seeing people, young
people my age die. But back to what you can learn
in a book or take from a book, it was really
writings by Gutierrez, in those first years, that
convinced me that this was a fight worth engaging in. Now, I hate to parse that
as a classroom experience and something
outside of classroom. Because, of course, it was
in some ways integrated. But the example,
one of the examples that I'd given not
willingly in this book, along with the earthquake, which
again a number of my colleagues are here from Haiti, from
Chiapas, actually from Rwanda. And this is, they
didn't come all the way to hear me speak at this
church, as beautiful as it is. But rather, we're
here for a meeting. Yeah. And it's not that easy
to write and reflect on extreme suffering. Again, Arthur
Kleinman, as you said, was a wonderful
mentor in that way. And to bring a little bit of
levity into the discussion, because there hasn't
been much yet. And I once was in Texas giving
a talk at a medical school. And this is not too long ago. And this young man's kid,
I would say, came up to me and said, oh, Paul Farmer. And he held out his hand. And I thought he was
going to say, really love your work or something. He said, I thought you'd
be a grumpy old man. [LAUGHTER] And I said, really? Why? And he said, because
I've read your books. And I said, OK. [LAUGHTER] In any case, the levity part
is by 1986, spring of 1986, I had my first job as a teaching
assistant to Arthur Kleinman. And he said, well, why don't
we do a course together? I learned a lot
from him not just from his writing
and his teaching, but his collegial ways. Why don't we design
a course together? And I said, really? Well, I've never
designed one before. But that sounds great. He said, you take it. And let's not do a medical
anthropology course. Let's think about suffering. And-- Yeah, that's-- I even knew the word theodyssey. I have my friend the theologian,
Jennie Block, is here. She can tell you I did know
the word theodyssey back then. And so we did. We designed a course, which
had a really catchy title. The Harvard students
just flocked to it-- Varieties of Human Suffering. Yeah. [LAUGHTER] I'm sure you can look it up on
the course catalog of not very successful courses. Now, I mean, actually about 20
years later, he taught again. Yeah. But going between
classroom and non-classroom is very bracing experience. And that also taught me that
we can do better complementing what we can read and
learn through action. Well, what's interesting
about this first response that in your case, you're
born in Massachusetts. You're down in North Carolina. But it's two Latinos who
really have an impact here. They're not all. But you have Archbishop
Romero, who was assassinated. And then, you have Gustavo
Gutierrez providing with this kind of model. So it's very interesting to see. Now we got a third one
lining up to influence me. Yeah. [LAUGHTER] I'm talking about
Francis not David. Because he's already
influenced me. [LAUGHTER] Yeah. No, I mean, that struck me. I was very, I was surprised
when there was some interest. I got a call from a journalist
writing for the National Catholic Reporter. And maybe, I would get a call
from Infectious Disease Weekly or-- I have some friends from the
New England Journal of Medicine who came tonight,
which moved me greatly. But the National Catholic
Reporter, not my bag. And, I mean, it is my bag. But the interview is,
an interview with them. And they asked me because, I
mean, Father Gustavo's story, with the Catholic Church
is it's own detail. And just as I don't
venture very willingly into discussions of faith or
spirituality, but I will try. And I thought I did pretty well. You did good. Even though you said
I hadn't finished the translation, which is true. Father Gustavo is a priest. He's a part of that church. He's a Dominican, as you know,
and as my Dominican friend reminds me regularly. He's a Dominican, you know. Yes, he is. [LAUGHTER] He's a Dominican. But I would say that
between Vatican II and now, let's just
say he hasn't always had cozy relationships
with those in charge. And one of the first things
that the Pope did, the new Pope, I have to tell
occasional stories so it doesn't seem to weighty. So-- Yes. Did you hear the
one about the Pope? No, I won't do that. [LAUGHTER] I was in a car, in Haiti, going
between a teaching hospital. Actually, Ahmed encouraged me to
talk about a teaching hospital. And I will. That'll, maybe,
work it's way in. Between a teaching
hospital and the airport, this is all
post-earthquake obviously. And I was on the phone. And there were three people
in the car-- a driver who I knew quite well
from central Haiti, and someone who
I've known for 15, 20 years who falls in the
popular movement in Haiti that has undergone so many ups, and
downs, and difficult turns. Anyway, I was on the phone
speaking in English to someone at Partners in Health. And late for a meeting. And I hung up the phone. And the guy in the
backseat was, said, did you hear the Pope resigned? And I said, who? Dr. Pope? Because there's a
Dr. Pope in Haiti. And he said, no, the Pope. And I said, the Pope in Rome? He said, yes. I said, has that
ever happened before? And he said, yeah,
about 677 years ago. [LAUGHTER] So that's how out of it
I am in terms of the, knowing about the
Catholic Church. But what I will
say about this is after Father Gustavo was invited
back-- I shouldn't say back. But it was invited to Rome,
it made the, it was of note. It was of note. To people who followed
the Latin American Church. I heard about it. Yeah, yeah. It did. And so of all people, I got
asked to do an interview. And I said, oh, sure. I'll do it. I was teaching here
at Harvard College in between the medical
school and the college. And stood there and
took the interview. And I realized, I'm
totally in over my head. He said, what do you
think this rapprochement between liberation theology
and the Vatican might mean for the church? And I said, I want to
say, I have no idea. Yeah. [LAUGHTER] But I did say something
that I believe in. I said I don't know. I'm not a historian
of the church, or a sociologist,
or a theologian. But I do think it should come to
mean something for the secular world-- understanding
structural violence, how poverty is perpetuated, how
racial discrimination, gender inequality come to get
in our bodies, and then our social bodies, how to
make a preferential option with the board. What would that mean? Why shouldn't every foundation,
or hospital, or school, or people trying to do
good in the world, back to Arthur's book, we have to
understand questions like that. And that's the,
it's not that I'm trying to skirt questions
of faith and spirituality. It's just that I'm writing
with a theologian, who knows so much more about
these things than I do. And so that's the
main reason, I hope, modesty that led me to stick to
the third question you asked, and the fourth one, which
is, how did these ideas come to inform the work of
Partners in Health, which is fundamentally a
secular organization, but which is trying to
do good in the world? And like you said,
Partners in Health is rooted in these ideas. Yes. And these ideas take root in us. I mean, you don't propagate
an idea by imposing it. I would say the church in Rome
had better have learned that. You take, ideas take root
by the power that they can, the imagination
they can inspire. In any case, I will go
back to the questions of faith and spirituality
if you force me to. I was hoping Lauren or someone
might intervene about now-- I have another question for you. --or Ahmed. I'm kidding. I'm not-- You can go there. Well, I was going to
ask, as a student, I thought that what David
said about our efforts to do good in the world
is so quintessential, not only for Divinity
School students but for all Harvard
students at this moment. And yet accompaniment,
as you say, is such an elastic term with
such personal connotations about physical presence. And I know that's what ministry
is about, in many cases, at the Divinity School. It's not all that it's about. But it's rooted in that
personal interaction. But what would
you say about, how do we know when we've
done good in the world? How do we measure that? Because I know that you
have real reservations about how we measure good in the
world, now, in global health. But what schematic or
framework would you put forth in the place
of cost effectiveness, research, or straight
utilitarianism that's really based in the foundations
of liberation theology and accompaniment
that you talk about? Well, all three of you--
Lauren, Ahmed, and David-- have mentioned, I think, that
liberation theology provides an ethical justification
for this work, again, doing good in the world. Now, by, with what right would
we ever mock an idea like that? That it's somehow naive to do,
trying to do good in the world? I mean, that sort of
idea, that it's not the most important thing we
can do, even in a university-- Even in the university. --makes me wonder what's
wrong with some people, in the university, who would
denigrate the idea of doing good in the world is naive. That strikes me as
perverse or worse. I don't have any real
objection, though, to measuring, attempting to
measure good in the world. And indeed, any attempt to
understand effectiveness of an intervention
or it's cost, we talk about this all
the time, not only in a medical school
or a hospital, but also in the
work we do together. And this book, actually,
is a better chance, than I've ever had before, to
really pick apart the objection that we were making to
not just to using solely in economic justification
for doing good in the world. That is you do
good in the world. So the world does good for you. You do good in the
world so that things are more good for you,
or those close to you, or those you can see. Those justifications are
interesting and dominant. But there are plenty of
others that you encounter, I have no doubt, more
commonly in some parts of this university than others. What I try to do, and
others have been helpful, obviously, in guiding
me was to say not only is not that the only way
to measure something, but why are we so confident
about measuring cost? Why are we so confident about
measuring effectiveness? The history of
medicine, certainly, is one long error report
on both of those matters. [LAUGHTER] And turns out, we didn't know
how to measure effectiveness. And we didn't know
how to measure cost. Now, forget about price. All right, price
you can measure. Because it is an arbitrary
designation, right, and deep link from cost. And cost, again,
the obvious thing. Just to go back, I was
trying not to give story after story of some of
those lessons learned outside of the classroom, which
were too difficult to recount. But if as in my, not my
first year going to Haiti. But again, these are
people we know personally. I remember an awful, I think
about it a lot, an awful. One of my co-workers, a young
woman about my age-- this is back in the '80s-- who had
manic depressive disorder. She was bipolar. And she would go off
on these bouts of mania and be brought back
with medications that were not available
to her in central Haiti. There'd have to be
some practically divine intervention, someone
going to Port-au-Prince and getting an antipsychotic. That was the drugs that
were available then. And maybe or maybe not she
would come back down to earth quickly. I became good friends with her,
and friends with her family-- her mother, her
brothers, her father. And during one of
these episodes, she use to work with us. She worked in medical
records in this first clinic that we built, again, that
my Haitian colleagues built in 1984. And I'm going back
to your question. Don't worry. You'll get there. And she was pregnant,
had a child. And right after she
was born, after he was born-- it was a boy--
she became ill with a fever, and had, basically, what's
called peripheral sepsis. And she died of it. And she died in
pain and anxiety. And then, I saw a lot of
things, not just the immensity of the meagerness. But as the days
wore on and, then, the months, I learned something
about effectiveness and cost. How do we know how much
it costs when someone dies in or around childbirth? Were we so sure how to value? It turns out that
her infant lived. He's a grown man now. Just got an email
from him if you can believe how things change. But how do you measure cost? And again, to dismiss that as
a naive question or not one worth asking,
because obviously we could do a much more
sophisticated job measuring cost and effectiveness,
is something that I never found to be true. It's a great goal
trying to measure cost. It's a great goal trying
to measure effectiveness. But inculcating some
humility about both endeavors is also something I
learned, or reinforced, by reading Gutierrez. So back to measurement
and global health, I think there are good ways
to measure global health. For example, chalk
up one for failure in the case of that young woman. And, that is, measure
maternal mortality. Measure infant mortality. Measure child mortality. These all have
technical definitions, as you know from
your writing as well. Measure suffering, morbidity. Measure, try and
measure all the time. Just don't be overly confident
that we can assess something like the burden of disease,
or how much it costs to neglect it among the poor. I've never been convinced
by those arguments that we can say,
well, it costs x, y, or z to treat AIDS in Africa. And even that then a next
line that this is how much would be saved by
saving those lives. What is the untallied cost of
those early debts on what is? And these questions,
the cost of inaction, is a project through
Jim [? Cammon ?] and people from
Partners in Health were involved in those days when
we realized that we were not going to win an argument
about cost effectiveness unless we could make people
understand true cost. Now, that's a longer
answer than, it's certainly a longer answer than I've ever
given in a church about cost effectiveness, where
one isn't always obliged to make such
arguments, right? Yeah. It's the, again, the secular
world where I found this, find this imposed. And not just by economists
and policymakers. My students ask me
that all the time. I taught your class yesterday. Yep. And that was the first question. How is this sustainable? Building a teaching hospital in
central Haiti in the same town, by the way, where
this young woman died from not having a
hospital, and where two other of our co-workers died. These are kids my age,
who never made 30. Because they didn't
have hospitals. Let me ask you a question that
I get from listening to you. I think, where do you
get the staying power to stay in these communities? You're talking about 30 years
later, stuff is going on. I'm thinking about
our colleagues in cultural anthropology,
some great teachers, wonderful friends of mine. They go down. And they do three or
four years of field work. And they come back. And they make a career. And they kind of keep
their field work up. But they don't necessarily get
down into those communities. Where's that come from for you? This you sustain
this involvement. You didn't go down
for five years, do something, come
back, and become. You've stuck with it. That just allows me to quote
Father Gustavo in the book. There's an interview at the end. And the editor of the book
is here, Jennie Block. And she said to me, my
favorite part of the book-- and I was hoping she'd say,
chapter 5, which you wrote. But no. [LAUGHTER] I mean, this really long-- Yeah, on "Time of Cholera". Yeah. Yeah, yeah. She said, no, the interview. And the last words that Gustavo
says, he says, the question, I think, was actually asked by
another liberation theologian. Said, what, this is
your last day teaching. We were teaching together. And if you had one message that
you could give undergraduates in this class today-- because
they were mostly college students-- what would it be? And I said something and a
dime, probably along the lines of what you asked me. What are things you can? I said something like, look, you
can learn a lot in a classroom [INAUDIBLE] Notre Dame,
where Father Gustavo teaches. And I may have the paragraphs
wrong, so don't correct me. It's OK. No bones. Yeah. [LAUGHTER] And he said, well,
the first thing I would teach them is that the
first person is not "I am." And in most languages,
they'll tell you the first person is "I am",
second person, "you are" or "he is", et cetera. And he said it's "you
are" is the first person. Did I get it right? You got it right, man. Right there. And that's the answer to your
question about staying power, too, is it's "we are". The reason that we're
still there is it's a "we". It's whether we're talking
about 10 years in Rwanda, or 30 years in Haiti, we're,
there's a lot of my colleagues right over there. I work with terrific people. Yeah. And they're committed
to the cause. And the cause, as
laid out in that book, they may or may not be
Catholics or Christians. Or they may be
completely secular. They believe in a
preferential option for the poor and fighting
for it in attacking structural violence together. That's the main reason. Well, it comes very
clearly in the book. So I mean, that message
comes through beautifully. And another reason is because
back to Lauren's question, things are getting better. We just tracked
some of the progress being made, human progress. Yes, there are
enormous problems. But you can't tell me
that infant mortality, which again, I think these
pedestrian sounding measures are important. Infant mortality in
Haiti is much less than it was 25 years ago. And we can make
claims of causality about that even in the
face of a major cholera epidemic that reverses
some of our work. All right, we know that
there is improvement. I mean, I-- Yes, it is. I told Ahmed I would mention
that of teaching hospitals. To see a teaching
hospital in central Haiti, that's the largest
solar-powered hospital in the developing world today,
where I can know that when [INAUDIBLE]. This was the poorest country
in the face of the earth. And everyone was
ready to declare it a failed state, a
basket case, a disaster, no hope of recovery. But now, Rwanda is meeting
all the development goals, especially the
health-related development goals in the so-called
Millennium Development Goals. Infant mortality has
plummeted to a convergence with the rest of the world. Forget about the rest of Africa. These are the steepest declines
in mortality ever recorded in human history in any place. So you ask, how do
you stick with it? You stick with it. And you get results. You have to make the
right interventions with the right people. --on that investment
to use crass economic language is great. And there are lots
of other reasons too. I mean, I like this work. And I don't prefer no
electricity to electricity. Or I'm not, I don't have
any of those tendencies. I like-- [LAUGHTER] I can't even sleep
without a fan. All right? But so when you say
down with the people, yes, I will live in
squatter settlement. But I'd like to
put in electricity. Yeah, yeah, yeah. I'm not in-- [INAUDIBLE] I'm just getting warmed up now. I know. Well, good, you're
warmed up for the people. If we can just get a mike. So Alex, standing
right over there, is going to be our mike stand. And if folks want to
create a line behind her, we can start doing that. And I can ask one more question. It's the moderator's privilege. Maybe you can talk
just a little bit in terms of connecting
the dots in terms of, what does accompaniment
look like, operationalized, on the ground, in
Rwanda that has an impact, then, on declines
in maternal mortality? Yeah. The rather wry and uncharitable
joke, made at Partners in Health, is we use
the term accompaniment so loosely that it could mean
just showing someone where the bathroom is in the office. But it means something
different than that. And like I said, my co-workers,
some of my co-workers from Rwanda are here. Operationally, it
means understanding that it's not about, OK, I'll
put it in grandiose terms. It's not about our own
quest for personal efficacy as people coming in to a very
disruptive place, Rwanda. We were not there in the '90s. But 10 years ago coming
in and finding colleagues. Maybe they grew up in a village. And maybe they didn't have
an advanced degree or even a high school degree. Or maybe they were
dying of AIDS. But thinking of
them as colleagues, especially when they're better. Because they're on
the right medicines. Again, that's the
kind of effectiveness, critical thinking about
effectiveness we need. Bringing in, giving
people a chance to do good in the world
in their own world, Rwandan professionals. Or training them,
saying, OK, well, there aren't many doctors. I mean, in Rwanda,
there's plenty of cancer but no oncologists. Or how do you take those
kind of challenges seriously? I mean, first is
you have to think it's going to be long-term. And that the, when
accompaniment is over, however you've handled it
programmatically, they'll let you know. All right? That's another part
of the question too, when have you done
good in the world? Asking people in
a place like that, have we done good in
the world, might get you an answer you don't like. But it's probably not
a bad process to ask. In any case,
programmatically, you'd be, you'd say, OK, we're here
to provide services to the poor. And again, it's never been that
difficult in my experience. And Gustavo has written
more about this than I have, identifying who the poor are. Because they usually
just tell you. In Haiti, for
example, that there's a overlap between the poor
and the term "the people". But they mean the poor. That term, "the people",
means the poor usually, [FOREIGN LANGUAGE]. And same in Lima in
my experience, which is not a poor city, and
not even a poor country. But they're the poor in Lima
will tell you exactly who they are and where they live. Back to the programmatic
part, what if you said we were here to
deliver services. But we're not, we're going to
use a some jargon much beloved in foundations these days. We're going to
leverage our service delivery training local people,
building local capacity. That's a programmatic
part of accompaniment. And what's more,
knowing, as we do, that there's a lot of myths and
mystifications about poverty and its impact on
health and well being, but also the ability to break
a cycle of poverty and disease. There's a lot of myths and
mystifications about it. You need to generate
new knowledge. And that sounds, it
sounds like saying, well-- And when I
say new knowledge, I mean you can call it research. You can call it illumination. You can call it epiphany. You can call it
whatever you want. It's you're generating
knowledge by doing something that hasn't been done before. And again, not because of
quest for personal efficacy so much as we desperately
need this kind of information. And there's no one who
doubts that we need this kind of capacity building. Now, what does that look like
on a grand societal level? I mean, to me grand
is a whole country. It looks like what's really
happening right now in Rwanda, where there's lots of
investment, as I said, in the low-hanging
fruit of public health. But now, if life expectancy is
doubled in the last 15 years, when mortality from
these illnesses I mentioned-- AIDS,
tuberculosis, malaria-- plummets, what happens? What do we see emerge
as the ranking problems? And you see, you do need trauma
surgeons, and cancer care, and treatment for
major mental illness. And building that
capacity locally, along with your colleagues,
is the work again at this next generation. It's not that you're
done doing good in that world, or the world. It's that there are more tasks. And that strikes me as a
long-winded but appropriate view of accompaniment. It's not over because
we say it's over, like a contract in law. All right? A project in a NGO with
a beginning and an end, and a funding cycle,
and a budget, that's not how accompaniment works. How many students are here? Let me see. How many people here are
students at one of the Schools? Let's put your hands up here. OK. So somebody here must have
a question, as a student, for this man. [INAUDIBLE] Yeah, he's a student. I know that one. [LAUGHTER] [INAUDIBLE] And the second part of
it is a little bit more directed toward Paul. It has to do with
your fifth question that you put the Paul,
which is about the future of the role of liberation
theology and medicine. Please recall, and you
mentioned this study, that liberation
theology was attacked not just by the Vatican. But it was attacked
by the Vatican. People were silenced. People were excommunicated. Yes. It was also attacked
by the elites in Latin America,
including the military, and by the United States foreign
policy establishment, which explicitly noted this is a
danger to American interests in Latin America, in
the Rockefeller Report, for example, after if he
went down and visited. So here we have,
perhaps, a rebirth of a movement that many people
had written the obituary for. Liberation theology
was dead and gone. And now, thank God, with
Pope Francis, who was greatly influenced by this,
and you could tell this by his first Pastoral Statement,
and by many of the things that he's doing and saying. We have that. We have this book. We have this conversation. And it gives me a little hope
that maybe those obituaries were a little premature. So I wanted to get your
speculation on that. Is surely these people
who are endangered, that feel themselves endangered
by liberation theology, are going to be feeling
themselves endangered by its rebirth as well. Because it still poses a
serious threat to many of things they hold dear. Now, my question for you,
Paul, is a little shorter, which is the underlying
principle of liberation theology, the preferential
option for the poor method, you started in theology. You started reading again
theology, Bible, church, ethics, all those things from
the perspective of the poor, the outsiders, the
people who had not been part of this conversation,
who hadn't been listened to. We had done the theology
and brought it to them as a message. Now, I wanted to ask you
to imagine a little bit, you've hinted to this in
a couple things you've said this evening. What about the poor, actually,
making an input into, let's say medical education, or
what the practice of medicine's about, or global medicine's is? Can you imagine how it might
change if it weren't just a service being
brought to the poor, but by those people being
enlisted in the agenda and in the perspective of
the whole medical work? Thank you very much again. And I hope we hear more from
both of you this evening and in the future. Deep questions. Real quickly, just is great
to have Harvey Cox here. I don't if any of
you recently saw he wrote an article answering
his own question in The Nation. And it's absolutely-- I learned
a lot from that article. He went to Rome, got a chance
to talk with people there, and has really deciphered, as
much as anybody in the world, the whole history of liberation
theology, its ups and downs, and has now been
able to see that we are at a time of
tantalizing hope here. Part of the problem
is, of course, that the Rome and
the papacy, they have such influence over the
way that the Catholic community, in large, embraces these
theological innovations, these theological statements. I mean, the Catholic tradition
has been here how long? 1,500 years. You'd think that liberation
theology would have been here at least 1,000 years ago
and not seen, in the 1970s, as some sort of danger. Actually, Paul's on top of this. Because here in Note 6, in
a terrific chapter he writes called Health, Healing,
and Social Justice, he picks this up. Let me read it to you. "There are other clues
that liberation theology might have something to offer
the healing professions. For one, the more
destructive forces hate it. In 1982, for example, advisers
to US President Ronald Reagan argued that quote, 'American
foreign policy must begin to counterattack and not
just react against liberation theology.' "That's quoted from the
Santa Fe Document, a Reagan administration working paper." So you get a sense of
why I'm asking Paul that second question. I think this is such a
remarkable partnership that he and Gustavo
Gutierrez has formed. But we got to give Paul
a lot of credit here. Because he's got this
other chapter in here that really lays out a way
to make liberation theology a kind of guide for new
types of innovations, both in theology but also
in medical treatment. He's got a chapter
here, Conversion in the Time of
Cholera-- A Reflection on Structural Violence
and Social Change. But he's also got
this other chapter where the subtitle is Insights
from Liberation Theology. You wouldn't even have
theologians writing that, you see, except for
some of the people, as I say, Elizabeth Schussler
Fiorenza, and Harvey Cox, and people like that. This is a great moment. And I'm very grateful to
be sharing it with you. Thank you, David. And Harvey, let me
just say before I turn to the second question that
it won't surprise you to learn, and again, it not the most
comfortable topic to discuss. Although, I've tried
to write about it. It won't surprise
you to learn that being drawn to liberation
theology in a country where a dictatorship was
being unseated by it, and to some extent, led
to a certain familiarity with the impact, the reaction,
the reactionary forces that you mentioned, and to
knowing people, who were killed in
those years, in Haiti. And there were some
spectacular crimes against the church, the
liberation church in Haiti, as you know. And so I'm also very
interested in preventing or not seeing, not that I would give
myself any capacity to prevent, that to never seeing that again. And it's enlightenment idea, but
not a bad one, that laying out, again, the utility
of these ideas, for doing good in the world,
is not only, as David said, exactly what is called for,
obviously enough, 1,500 years ago and more, but
something that one has to, at least I have to believe. You could say,
well, wait a second. Why would you not want
to do these things, make a preferential option
of the poor, making, to understand
structural violence, and to practice accompaniment. And I know the answer. I once said to my friend, the
theologian, who by the way tells me that, eh, Christianity,
all the good stuff happened in the first 400 years. [LAUGHTER] But asking, well,
why would someone want to hurt a
liberation theologian. And she looked at me
like, are you kidding? Don't you remember Jesus? Anyway, back to the
second question. Partners in Health and
many of our partners have, in fact, permitted just
that-- to bring people living in poverty, who
still call themselves the poor, into our work
and, also, to listen to their lived experience
of poverty and illness to change the work further,
to change the work plans, and the budgets back to
the word that comes up all the time in our work. Right? And I was lucky enough
to be able to give some examples in there. That is when something fails
the poor, instead of calling it the failure of the poor to
comply or adhere to our, the way we, let's say
prescribe a medicine or offer a service,
how about we ask them what we did wrong in serving
them or failing to serve them? And I'd say those two
parts of the work, again, which could be
laid, out in great detail, how we structure
certain programs. I'm talking about
clinical programs. Serve the poor,
how we understand the importance of
removing barriers to good health,
which we've called these barriers
structural violence. A friend of mine, who's a
surgeon is here in the room, in the church tonight. And even in the
operating room, what we found is that for patients
to get well after a procedure, we needed to pay attention
to the experience of poverty on either preventing them
from getting to us in time, or preventing them from falling
some important prescription, quite literally. And there's no field of
medicine where that's not true that I can see, no field
of clinical medicine. The other part, bringing
poor people into the work. I think I'm proud
of what we've done. In Haiti, especially,
70% of the employees of this massive hospital
are from central Haiti. Fantastic, yeah. And 70% of the entire
workforce of Partners in Health are community health
workers, the vast majority of whom have never had a job,
any kind of formal job before. And we learn from them
in our work all the time. But we also try to transform
those conditions with them. So it sounds like
sloganeering in a lot of even anything I could write. I would feel it might sound
that way, or romanticizing what people without a lot of
formal training and chances could do. But it's not been
our experience. It's been our experience that
it improves the quality of care, both by incorporating them
as co-workers and colleagues but, also, by
listening to how they would have us change our care. Is there more questions? And I just want to, sorry David. OK. I just want to
highlight how radical an idea that is in
medicine and global health. And that was a
real resonance that came through for me in the
book, with liberation theology. This idea that you're trying to
subvert a dominant worldview. And that is not easy work. And it gains you a lot
of enemies along the way. I want get to one more question. Good evening. My name is Mario Melendez. I'm a first year MD student
at Boston University School of Theology. And Dr. Farmer, I'm going
to put you on the spot. Right. You're from BU? Yes. You're not allowed in here. I know I need to go back there. [LAUGHTER] Sanctuary. I'm going to put
you on the spot. And brother, if you want
to answer as well, millions of people, not just around
the world, but in this country have no access to
affordable health care, to compassionate,
decent care, even after the very provisions
of the Affordable Care Act. Access to compassionate,
decent care is still a dream. So my question is
among the many things that you see in your analysis
coming both from liberation theology, from your work,
and your work in medicine, what do you think is
one, one of the steps that must taken to
make sure that everyone has access to decent,
compassionate, affordable health care? That's a question. That's a great question. Can I cheat and say two? [LAUGHTER] I'll allow it. You'll allow it, Lauren? If you're hit by a car, and
you need trauma care, right? So I'm not going, I don't
want to forget that. Or if you have
acute leukemia, you need chemotherapy in
a hospital, right? One of the biggest problems that
we face in the United States and in many of the
places we've worked is that we have almost
nothing in the way of community-based care, of
community health workers. So the model, the lessons we
learned, back to Harvey Cox's question, the lessons we
learned in Haiti and Rwanda, in a place where there were
no or very few physicians or nurses in rural
Rwanda or rural Haiti, was that community
health workers, when they had the right backup,
could do the job better. And I wish we had that
in the United States. I wish we had that people
living with multiple illnesses, elderly, or young had
access to more convenient and care near their
homes, and did not have to go through the
difficult process of getting here and there for
their fractured care. But if I had to
choose one thing, it's going to sound
very undramatic perhaps. But it would be insurance. It would be a safety net. Not a safety net with big
gaping holes that gets ripped ever wider in any
kind of economic downturn. And you wrote about
this in your book, right, where if there's
any recession or problem, the first thing
to go out the door is compassionate expert
health care that's accessible. And there are
exceptions to that. But they're very rare. The United States
now, Great Britain, any kind of economic
contractures is followed by a contracture
of social services for poor people. And that's not just health care. It's education, food security,
heating security, et cetera. And I'm thinking about the
United States, I think, as you can tell. So the idea of
universal coverage, or UHC it's even
being called sometime, right, universal health
care, is very powerful now in global health
circles, more powerful than it is right now, here. It's very, and I think
that's a good thing. Because if we in any way
sign on to that aspiration to protect people
from the effects of catastrophic illness,
the economic effects or their personal
effects, then we will protect not just
millions of people but, probably, many hundreds
of millions of people. And there will be problems
with any insurance system. It is sure. But just that idea
of saying, you should not have to die
because you're poor or are about to be poor if you're
sick, and aren't poor, but have no insurance. That's the leading cause,
catastrophic illness is the leading cause of
destitution in many countries in the world, rich and poor. United States,
catastrophic illness is a major cause
of impoverishment of American families. So again, I wish I could say
something really memorable, and jazzy, and David-esque. But I think that we need better
ways of protecting people from the slings and arrows
of outrageous fortune. And we might as well call
that better safety nets and better insurance. David, any thoughts? [INAUDIBLE] Anybody else? Oh, one more question? I think there are several more. Yeah, yes, he would. I know. [INAUDIBLE] Yeah, a line here. Yeah. Let's get the questions, yeah. So I am also a student at Boston
University School of Theology. So hang with us here. So my question is
for those of us who are looking at becoming
interfaith religious leaders in the next couple
of years, going through these programs, what
is the most important advice or recommendation that you
can give to us who are looking at going out into the world
and serving communities to look at these problems? Well, I think that Gustavo's
comment on the first person is really "you are" and
not "I am" is really about, it's about humility. And it's easy to say, right,
and far harder to practice. All right, I mean, we
even celebrate notions in, as a liberal piety of
cultural competence. But it's not a
very helpful notion in my experience, the idea
that as a graduate student, for example, you could really
become culturally competent in a place, you're
calling it communities. And I'm not exactly
sure which communities you're talking about. But many of the
places where I work, I've not found it possible
to be culturally competent. But you can be culturally, you
could have cultural humility. And I think no matter
what your field, or what your area of study,
or if you're in pastoral work, it's all, obviously, called
for, right, much more directly to be humble, and think about
doing good in the world, not as some joke that no
sophisticated person would attempt, but rather the
ultimate goal of your work. I think those are very
helpful if mundane sounding bits of advice. And I got very different advice. But it was complemented
by some of the wisdom that I mentioned reading in
these books that helped me. And then, the idea of
some long-term commitment, which we've called
accompaniment here. And I suppose there are
events and processes were short-term commitments will do. But I just don't see
as many of those. Certainly, the kind
of problems that we've described, whether in
a prison in Russia, or a squatter
settlement in Haiti require long-term commitments
to address effectively, as would food and security or
a medical system that makes no sense in the United States. Those are long-term commitments. And the other is
the one David gave us is don't think there
are things that you, there are lots of things
you can learn in a book are in a classroom. Out of respect
for people's time, because we are running
over, I'm going to draw this to a close for now. And try and move
Paul to the back, where he and Jennie,
who is also here as a co-author to the
book, will sign and happily chat with anyone else who has
questions that are ongoing. Just [INAUDIBLE] David? Last word, of course. [LAUGHTER] Who am I to stop you? Don't let him kid
you about jazzy. This man can write beautifully. I don't know If you've
seen his book of speeches that he's given,
graduation talks. It's a marvelous book
to heal the world. And some of those
chapters are not only entertaining and informative. But they move, they
move the reader. And it'd move me
sometimes to tears. Because of the kind
of humanity that is coming out of Paul's writing. I just want to lead you one
little paragraph that ends the first chapter of the book. It's called A Doctor's
Tribute to Gustavo Gutierrez. And I think it's really
kind of the heart of what this accompaniment is here. And I think it's
an appropriate way to bring my comments
to a close, is to give the last
word to Paul Farmer. He writes, "As long as poverty
and inequality persist, as long as people are wounded,
and imprisoned, and despised, we humans will need
accompaniment-- practical, spiritual,
intellectual. "It is for this reason,
and for many others, that I am grateful
for Father Gustavo's presence on this wounded,
but beautiful, Earth." That's Paul Farmer. [APPLAUSE] Thank you. Thank you. [APPLAUSE] Thank you, darling. Thank you.
