Pathologies of Power: Health, Human Rights, and The New War on the Poor by Paul Farmer

Author:Paul Farmer [Farmer, Paul]
Language: eng
Format: epub
Published: 2002-11-26T18:47:35+00:00

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CHAPTER 9

RETHINKING HEALTH

AND HUMAN RIGHTS

TIME FOR A PARADIGM SHIFT

As the global market economy pulverized traditional societies and moralities and drew every corner of the planet into a single economic machine, human rights emerged as the secu lar creed that the new global middle class needed in order to justify their domination of the new cosmopolitan order.

Kenneth Anderson, formerly of Human Rights Watch From the perspective of a preferential option for the poor, the right to health care, housing, decent work, protection against hunger, and other economic, social, and cultural necessities are as important as civil and political rights or more so.

Leigh Binford, The El Mozote Massacre Medicine and its allied health sciences have for too long been only pe ripherally involved in work on human rights. Fifty years ago, the door to greater involvement was opened by Article 25 of the Universal Dec laration of Human Rights, which underlined social and economic rights:

“Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, hous ing, and medical care and necessary social services, and the right to se curity in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”1

But the intervening decades have seen little progress in the efforts to secure social and economic rights, even though we can point with some pride to gains in civil or political rights. These distinctions are crucial, as a visit to a Russian prison makes clear.

In the cramped, crammed detention centers where hundreds of thou sands of Russian detainees await due process, many fall ill with tubercu losis. Convicted prisoners who are diagnosed with tuberculosis are sent to one of more than fifty “TB colonies,” several of which I’ve described in earlier chapters. I bring up these colonies again in order to illustrate 213

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One Physician’s Perspective the difference between civil rights and social and economic rights. Imag ine a Siberian prison in which the cells are as cramped as cattle cars, the fetid air thick with tubercle bacilli. Imagine a cell in which most of the prisoners are coughing and all are said to have active tuberculosis. Let the mean age of the inmates be less than thirty years. Finally, imagine that many of these young men are receiving ineffective treatment for their dis ease—which, given drug toxicity, is worse than receiving a placebo—even though they are the beneficiaries of directly observed therapy with first line antituberculous agents, delivered (however ambivalently) by Euro pean humanitarian organizations and their Russian colleagues.

If this seems hard to imagine, it shouldn’t be; I have seen this situa tion in several prisons. As this book goes to press, most of these prison ers are still receiving directly observed doses of medications that cannot cure them. For many of these prisoners, the therapy is ineffective because the strains of tuberculosis that are epidemic within the prisons are re sistant to the drugs being administered.

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