“Addressing the needs of the poor is built upon the insistence to not avert your gaze from suffering.” I was struck by these words uttered by Dr. Jim Yong Kim in a webinar on global health and social justice on October 20, 2020. Tabitha Johnson, director of the Sundance Foundation was speaking with Partners in Health (PIH) co-founders Dr. Paul Farmer, Dr. Jim Yong Kim, and Ophelia Dahl about the documentary Bending the Arc. The film focuses on their collaborative journey to ensure that everyone has access to needed health care regardless of where they live or their circumstances.
The path is marked by failures. In their conversation Dr. Kim noted that the story of Partners in Health is not a victory narrative. They each talked about the failures they’ve experienced and what they learned from them. Dr. Kim noted, “If you’re truly going to stand with the poor, the most important thing is to admit that you have failed.” Then, he added, “you have to continue to renew your commitment to standing with the poor.” Working to ensure health access and equity requires that we never give up. Theirs is a narrative of persistence.
We need to work our way through the web of complexity one step at a time. All too often, Ophelia Dahl, Chair of the PIH board, noted, “We use complex as an excuse to not address the problem;” to turn away from the problem. No one wants to be told that delivering care to them and their loved ones is too complex or unsustainable.
The key is working with the people. We learn from people on the ground exactly what challenges they face and what they most need and want. This is what ethnographers and anthropologists do best. We partner with communities and, as PIH has done, engage and employ locals to solve the problems. Outsiders can partner with locals to empower them, to raise their voices up, and ensure that they are heard and included.
Social pathogens create fertile ground for viral pathogens. Dr. Paul Farmer noted that viral pathogens collide with social pathogens in ways that disproportionately impact black, brown, and poor communities. Social inequities (based on race, income, gender, sexuality, religion, etc.) enable a viral pathogen to take hold. Unless we address these social inequities, the social vulnerabilities will remain long after a virus has been eradicated, providing fertile ground for the next health crisis.
Partnering to build local infrastructure is essential. One of the most important lessons the team learned was that they needed to partner with the public sector to deliver sustainable healthcare. They emphasized that we need robust public health systems to avert future crises. Building health infrastructure is key to inoculating communities against future health threats.
We cannot afford to keep on cycling through patterns of panic and neglect. When a healthcare crisis hits, just like it has with COVID-19, we must see this as an opportunity. Our response should be more than just an effort to address a specific disease, rather we must seize the opportunity to build functioning healthcare systems that will remain in place to address current and future health needs.
We won’t get “herd immunity,” rather we’ll get “herd culling.” Discourse on the COVID-19 pandemic at times invokes this Darwinian notion of the survival of the fittest. Essential workers, those caring for the sick, are most at risk. If we fail to implement measures to protect everyone from infection, we are sacrificing healthcare workers; we are seeing them as expendable.
We are all vulnerable. Even in a resource-rich, wealthy nation like the United States, we are vulnerable to the vicissitudes of political will. Unless healthcare is universal, there will always be a segment of the population that is vulnerable. We need to focus on the social inequities in the USA as well as elsewhere. Like the founders of PIH, we need to recognize our failures and ensure that we do the work to needed to bend the arc toward justice.