LP Spring 2018 - 13

SPRING 2018

To make a long story short: PIH ultimately
decided, because of my age (61), to withdraw
their offer to assign me to work in an Ebola
Treatment Unit for two months. However,
they eventually recruited me to join their
team in Malawi, where I spent 18 months as
Medical Director of Lisungwi Community
Hospital in rural Neno District. While there,
I worked closely with the Ministry of Health
in the poorest district in one of the world's
poorest countries.
PIH partners with ministries of health in
nine countries around the world, providing
resources that aim to raise the standard of care
in some of the poorest countries in the world.
It does so out of a conviction that if health care
is a human right, then ultimately it is up to
governments to guarantee that right. Its mission
statement explains: "Our mission is to provide
a preferential option for the poor in health
care. By establishing long-term relationships
with sister organizations based in settings of
poverty, Partners in Health strives to achieve
two overarching goals: to bring the benefits of
modern medical science to those most in need
of them, and to serve as an antidote to despair."
In Malawi, I worked with one Malawi
doctor and seven clinical officers, providing
medical care to about 70,000 people. We saw
tropical diseases like malaria, schistosomiasis,
and malnutrition as well as HIV and all its
complications, tuberculosis, and anemia.
We also encountered a surprising amount of
hypertension, diabetes, cancer, heart failure,
and stroke. The foundation of our work
was the hundreds of "village health workers,"
minimally trained and often-illiterate villagers
who helped us to seek out and find those most
in need. They were particularly helpful in
ensuring that those on HIV or TB treatment
remained engaged in their treatment regimen,
allowing us to achieve outcomes with our 7500
HIV patients that were comparable to those
in many urban settings in the U.S.1
When I was asked by the editorial board
to write about my experience of "medical
missions," I found myself questioning that
term-despite the fact that at an earlier time
in my career, I had worked at a Mission Hospital in rural Kenya (Friends Lugulu Mission
Hospital, 1991-94). The term "mission" carries

Admitting an infant with malaria to the pediatric ward

for me the connotation that we from the developed West somehow bring something that is
otherwise missing from these places (whether
that is knowledge, medical technology, or the
Gospel). However, my own experience from
two stints in Africa is that I received and learned
far more than I gave or taught.
PIH co-founder Paul Farmer asks: "How is
suffering, including that caused by sickness, best
explained? And how is it to be addressed?" In
reflecting on the second question, he discerns
three broad approaches: charity, development,
and social justice models. Charity, though a
powerful and unquestionably positive motive,
too often tends to "regard those needing
charity as intrinsically inferior." It also "too
frequently consists of second hand, castoff
services-leftover medicine-doled out in
piecemeal fashion." Finally, "a preferential
option for the poor is all too often absent from
charity medicine," with a resulting neglect of
the structural and systemic causes of poverty
and disease.2
The development model assumes that progress and economic development are inevitable
and will automatically bring improvements
in health. This mindset can easily slide into
victim blaming, attributing the suffering of
the poor to their own "backwardness" or lack
of development, while ignoring structural
causes. The huge gap between rich and poor

LANCASTER

13

PHYSICIAN

within all countries also presents a challenge to
this approach. Even as development improves
the condition of the wealthy elite, it may have
little impact on the poor majority.
That leaves a social justice approach, which
starts with the assumption that access to
health care is a basic human right. Poverty and
oppression pose the most important obstacles
to health, and therefore a "preferential option
for the poor" is necessary for the delivery of
equitable health care. Those who work from
a social justice paradigm tend to be motivated
by not only indignation (because "the world
is not as it should be") but also humility and
penitence (recognizing their own role in the
structural roots of suffering).3 Those working
from this new paradigm will bring with them
virtues of listening,4 accompaniment, and
solidarity with those whom they serve.
The distinctions between these three
models are not absolute, but perhaps can be
illustrated by the debate 20 years ago over how
best to address the HIV pandemic in Africa.5
By 2000, effective treatment for HIV was
widely available in the developed world-
but virtually unobtainable in Africa, home
to 70 percent of persons living with AIDS.
Charity medicine tended to concentrate on
offering palliative treatment for complications
Continued on page 14



Table of Contents for the Digital Edition of LP Spring 2018

LP Spring 2018 - 1
LP Spring 2018 - 2
LP Spring 2018 - 3
LP Spring 2018 - 4
LP Spring 2018 - 5
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LP Spring 2018 - 48
https://www.nxtbook.com/hoffmann/Lancaster_Physician/LPFall21
https://www.nxtbook.com/hoffmann/Lancaster_Physician/LPSummer21
https://www.nxtbook.com/hoffmann/Lancaster_Physician/LPSpring21
https://www.nxtbook.com/hoffmann/Lancaster_Physician/LPWinter21
https://www.nxtbook.com/hoffmann/Lancaster_Physician/LPFall20
https://www.nxtbook.com/hoffmann/Lancaster_Physician/LancasterPhysicianSummer2020
https://www.nxtbook.com/hoffmann/Lancaster_Physician/LPSpring20
https://www.nxtbook.com/hoffmann/Lancaster_Physician/LPWinter20
https://www.nxtbook.com/hoffmann/Lancaster_Physician/LPFall19
https://www.nxtbook.com/hoffmann/Lancaster_Physician/LPSummer19
https://www.nxtbook.com/hoffmann/Lancaster_Physician/LPSpring2019
https://www.nxtbook.com/hoffmann/Lancaster_Physician/LPWinter2019
https://www.nxtbook.com/hoffmann/Lancaster_Physician/LPFall2018
https://www.nxtbook.com/hoffmann/Lancaster_Physician/LPSummer2018
https://www.nxtbook.com/hoffmann/Lancaster_Physician/LPSpring18
https://www.nxtbook.com/hoffmann/Lancaster_Physician/LPWinter18
https://www.nxtbook.com/hoffmann/Lancaster_Physician/Fall2017
https://www.nxtbook.com/hoffmann/Lancaster_Physician/Summer2017
https://www.nxtbook.com/hoffmann/Lancaster_Physician/LPSpring17
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