27 February - 5 March
MODULE IV: UNDERSTANDING UN-'NATURAL' DISASTERS
February 27/March 1: The Case of Haiti
Film: The Quake (60m)
CA pp.266-70 - anthropology and medical rights: the right to work of paul farmer
• Haiti, a country of some seven and a half million people, is the poorest country in the western
hemisphere, with 80% of the population living in poverty
• Young pregnant women die with malaria bc cant afford inexpensive equipment needed for blood
• It is critical to appreciate the role of vodou,a religion that combines traditional catholicism with traditional
african beliefs, in the life of most Haitians
• Liberation theology: a powerful rebuke to the hiding away of poverty
• Farmer was attracted to the activism of liberation theology because it was driven by a need to
accomplish something concrete in the lives of the pro and was characterized by what farmer calls
“pragmatic solidarity” with the communities that it sought to assist
• Liberation theology argued for giving the poor, not equal treatment, but preferential treatment
• A minor error in one setting of power and privilege could have an enormous impact on the poor in
• Farmers’ structural violence: actions of remote government or international agencies that result in denial
to the poor of basic rights of food, shelter or livelihood
• P.268 - health as a human right
• Farmer became convinced that health is a basic human right and that medical workers, along with
social scientist, are uniquely situated both in temperament and profession to address the problems of
structural violence and to engage with the poor in the spirit of pragmatic solidarity
• Denied adequate health care and food is a human right
• Theres a daily struggle for food, drugs lab supplies and even heat and electricity
• Prisoners are dying because of ineffective treatment, a clear violation of article 25
• Everyone has a right to share in scientific advancements and its benefits
Farmer points out that people are dying, not because there are no effective treatments;
• People are dying because they or the agencies responsible for their care lack the money to pay for that
• Untreatable became a euphemism for too expensive
• World wide 32% of all deaths are caused by infectious disease, but in the poor countries disease s
responsible for 42% of all deaths, compared to 1.2% in industrial countries
• Once we have defined health asa human right and recognized the structural violence that either creates
conditions for disease or denies the afflicted access to medicine we can accomplish:
• First they can put the human rights violations into the global contexts that identify the structural causes
of the abuse
• Social inequalities based on race or ethnicity, gender, religious creed and above all, social class are the
motor force behind most human violations
• Violence against individuals is usually embedded in entrenched structural violence
• We need a strategy to confront structural violence
The problem is that traditional government and non governmental agencies are unnecessarily restricted
in addressing rights issues
• Independent groups such as first world universities, hospitals, churches and health care professionals
can best serve coal communities
• If healing and health care can become the symbolic core of a human rights agenda, we can tap into an
almost universal concern for the sick, while at the same time involving person in medicine, public health
and the natural and social sciences • P.270
• The focus on health offers a critical new dimension to human rights work and is largely untapped vein of
resources, passion and good will
Organizations donating money to drugs and drug treatments help
Farmer, Paul. 2003. On Suffering and Structural Violence. Chapter 1 of Pathologies of
Power. Available online here: http://www.ucpress.edu/excerpt.php?
• Growth of GNP or of industrial incomes can, of course, be very important as means to
expanding the freedoms enjoyed by the members of the society.
• But freedoms depend also on other determinants, such as social and economic
arrangements (for example, facilities for education and health care) as well as political
and civil rights (for example, the liberty to participate in public discussion and scrutiny).
• extreme suffering: premature and painful illnesses, say, as well as torture and rape.
• More insidious assaults on dignity, such as institutionalized racism and gender
inequality, are also acknowledged by most to cause great and unjust injury.
• Haiti The biggest problem, of course, is unimaginable poverty, as a long succession of
dictatorial governments has been more engaged in pillaging than in protecting the rights
of workers, even on paper.
• In only three countries on earth was suffering judged to be more extreme than that
endured in Haiti; each of these three countries was in the midst of an internationally
recognized civil war.
• Suffering is certainly a recurrent and expected condition in Haiti's Central Plateau, where
everyday life has felt, often enough, like war. "
• ﬁght for food and wood and water.
Landlessness is widespread and so, consequently, is hunger.
• Life expectancy at birth is less than ﬁfty years, in large part because as many as two of
every ten infants die before their ﬁrst birthday. Tuberculosis and AIDS are the leading
causes of death among adults; among children, diarrheal disease, measles, and tetanus
ravage the undernourished. 7
• In rural Haiti, entrenched poverty made the soldiers—the region's only salaried men—
ever so much more attractive.
• Acéphie and her daughter, also infected with the virus
• Chouchou childhood. It was brief and harsh, like most in rural Haiti.
• Like many in rural Haiti, Chouchou was distressed to hear that power had been handed
to the military, led by hardened duvaliéristes. It was this army that the U.S. government
termed "Haiti's best bet for democracy." (Hardly a disinterested judgment: the United
States had created the modern Haitian army in 1916.) In the eighteen months following
Duvalier's departure, more than $200 million in U.S. aid passed through the hands of
• Like most rural Haitians, Chouchou and Chantal welcomed Aristide's election with great
joy. For the ﬁrst time, the poor—Haiti's overwhelming majority, formerly silent—felt they
had someone representing their interests in the presidential palace.
• Military Anger was soon followed by sadness, then fear, as the country's repressive
machinery, which had been held at bay during the seven months of Aristide's tenure,
was speedily reactivated under the patronage of the army.
• In rural Haiti, any scrape with the law (that is, the military) led to a certain blacklisting.
• Although I am not a forensic pathologist, my guess is that the proximate cause of his
death was pulmonary hemorrhage
• The women I interviewed were straightforward about the nonvoluntary aspect of their
sexual activity: in their opinions, poverty had forced them into unfavorable unions. 13
Under such conditions, one wonders what to make of the notion of "consensual sex."
• International human rights groups estimate that more than three thousand Haitians
were killed in the year after the September 1991 coup that overthrew Haiti's ﬁrst democratically elected government. --Almost all were civilians who, like Chouchou, fell
into the hands of the military or paramilitary forces
• In Haiti, AIDS and political violence are two leading causes of death among young
• these afflictions are not the result of accident or a force majeure; they are the
consequence, direct or indirect, of human agency.
These grim biographies suggest that the social and economic forces that have helped to
shape the AIDS epidemic are, in every sense, the same forces that led to Chouchou's
death and to the larger repression in which it was eclipsed.
• victims of structural violence
• For many, including most of my patients and informants, choices both large and small
are limited by racism, sexism, political violence, and grinding poverty.
• The suffering of individuals whose lives and struggles recall our own tends to move us;
the suffering of those who are "remote," whether because of geography or culture, is
often less affecting.
• Second, the sheer weight of