Paul Farmer Interview (page: 2 / 9) Founder, Partners in Health	Print Interview

When you arrived in Central Plateau of Haiti, they didn't have a blood bank. There had been no immunizations.

Paul Farmer: No, it didn't have a blood bank. Maybe it did on paper, but if you went, there was no blood.

Get the Flash Player to see this video. It's hard to have a blood bank without blood. It's hard to have a blood bank without electricity and lab techs, et cetera. But again, it's easy to make that diagnosis, and easy to rule against institutions, including the Red Cross. But it's much better to start working with them to build blood banks, and that takes a lot of time. But it's certainly not impossible. (If we can) put someone on the moon, we can certainly put in better blood banking. And that didn't happen. I think it happens, again, with persistence. It's not some innovation, or the really entrepreneurial thing. This is the point I'll make tonight in my comments, is the really entrepreneurial thing is for someone just to stick it out and serve the poor. Then you learn things. Now you don't want to keep re-inventing the wheel. So if we learn something in Haiti that's useful in Boston, we need to make sure and share that information. If we learn something in Rwanda that's useful in Haiti, we need to get it back there. And that's another problem, I think, in development work and NGO work, is there's a lack of coordination and sharing of information, experience. But again, these are not problems that are insuperable. That's why you guys have your web site, so you can reach out to lots of people who you're not actually ever gonna meet. We need to harness those technologies as well.

[ Key to Success ] Perseverance

The bottom line was -- as in many places in the world -- you'd go to some place, and there are these basic infrastructure needs that are unmet. What are the basic services that everybody agrees on? School, water, food, security, medical care. Most people agree on those. If you're gonna live in the 20th century, to say nothing of the 21st, you need those kind of basics, and you know you have to build them.

Was it on your first trip to Haiti that you learned what the building of the Péligre Dam had done to the people of Cange and the Central Plateau?

Paul Farmer: Yeah. Even now, it's still an evolving kind of understanding. I'll tell you what I mean. When I was 23, I went to the squatter settlement that was formed when the valley was flooded by a hydroelectric dam. So that's one way of experiencing an infrastructure project. I was reading about the Tennessee Valley Authority, actually, of all places. Here in Cape Town, yesterday, I'm reading a book about FDR.

Get the Flash Player to see this video. I studied a little bit about the TVA, as it's called, when I was writing my first book about that part of Haiti. But the purpose of that infrastructure project in the Tennessee Valley was a poverty alleviation project, and to generate cheaper power in Alabama, Tennessee and the American Southeast. And that was the stated purpose of that dam, the Péligre Dam. It was to control the flood waters down river, and later to generate electrical power. Now remember what happened in Haiti last year -- so this is 26 years later -- was terrible floods. Four hurricanes hit Haiti, and some of the areas where we've worked, the real problem was flood control with the dams. So 26 years later, I'm thinking, "Wow, it's still very important to have flood control if people in these flood plains are gonna be protected." And guess what Haiti needs more of? Electrical power. So I'm only saying all this because I'm not against hydroelectric dams, but when I was 23, I got to see what poor planning of a development project meant to poor people. So it was poorly planned in terms of what would happen to the people in the flooded valley, and they're the ones who introduced me to -- the people living there -- they were the ones talking to me about what this development project meant for them.

Get the Flash Player to see this video. Someone asked me once, "Do you have something against dams?" I said, "What are you talking about?" and it's just that the first look that I had, as a young American, at a big infrastructure project was through the eyes of people who had lost their land. And I think that's a very valuable way to look at a major infrastructure project, you know, through the eyes of the people whose lives are disrupted. Now the Tennessee Valley Authority -- I don't want to sound pedantic, or like a professor, but you know, a lot of people were displaced by that project too. But it led to rural electrification and lots of good things for poor people. I think people looking back at the TVA, there's always gonna be critics of any major project. But I think it probably was a net positive for development in the 30s and '40s and beyond.

Whether or not we can say that about the dam you're talking about, I'm not so sure, but we still need better flood control and more electrical power in Haiti.

Those people had no say about whether the dam would be built or not, whether they would have to move or not. What does that lack of empowerment do to the psyche of a community?

Paul Farmer: Well, I know what it does to the psyche of a community, or at least I've seen it. So when you're a peasant farmer, and you lose your land, then you lose the means of supporting your family. That's very destructive. To go from being able to work to support your family to being a squatter -- a landless peasant -- is a terrible and destructive thing. I don't think anybody would disagree with that.

Get the Flash Player to see this video. The question with a lot of these projects is, "Are there ways of bringing benefits like electricity, flood control, water to large numbers of people without disrupting them?" I'm sure the answer to that must be yes, and whether or not that was done there is still an open question. I think it wasn't. Now when you talk about human ecosystems, don't forget that Haiti is -- in many ways -- was created. It's an artificial creation. The people who call themselves Haitians were kidnapped in West Africa and dragged over across the Atlantic in chains. The natives of that country disappeared before the 17th, 18th century. So the ecosystem in Haiti has always been disrupted, as is true in a lot of the Caribbean. So I'm not sure exactly how to use that term effectively there. By the time that the valley that I lived in was flooded, it was also a creation, after the Haitian revolution. People fled up to the hills. They worked the land themselves, so they were creating a new ecosystem in a sense -- what you call human ecosystem -- and that was disrupted again by this flooding of the valley.

Would you rather the Péligre Dam had not been built?

Paul Farmer: I think the answer to that, for me, is no. I don't feel that way.

Get the Flash Player to see this video. Going back to the Tennessee Valley Authority, TVA, I may get the numbers wrong, but something along these lines. Yes, 15,000 people were displaced. I'm sure that it wasn't done well, but think how many millions of people got electrical power -- cheap electrical power -- compared to what was available before from private utility companies. So I think, and I would like to look back at what I wrote when I was in my 20s, writing about -- even about TVA in my Ph.D. thesis, for example. You know, I'd like to look back, and I will look back at it now that you bring it up, because I'm not so sure I was that fair to the TVA, and there are many other major infrastructure projects around the world that are, by the way, now very hotly contested, and now there is actually -- there are movements against these big infrastructure projects. I wouldn't want us to have Luddite approaches to technology and infrastructure projects. We need electricity, roads. We need green fuels. We need all those things. We need clean power. So I think we need to keep pushing forward on finding solutions to these technological problems. But we need them to be solutions that are not disruptive ecologically. We need them to be solutions that are not destructive socially. And I also think it's fair to ask, "Well, how is this gonna affect really poor people?"

So if we could do better on that front, I wouldn't be opposed to building a dam. I'm not even opposed to that dam. It's just that I happened to have learned about it from the people who lost their land. It's not about the dam. It's about the way that those people were treated. I might add, and I have added many times in print, that they also did not get electricity or water, the people I knew. They had neither of those things. So it's a hydroelectric dam, and you'd think the people who lost their land would at least get hydro and electric, and they didn't. It took decades for them to get electricity.

Why didn't they get any benefits from the building of the dam?

Paul Farmer: They were poor, that's why. They were poor. They didn't have much of a voice. The electricity was going off to the city, and they didn't have the power to get the power. I think it's good for me to read about the TVA again, 26 years later, and to look at other perspectives on what can be done -- a decent, well-thought-out infrastructure that's actually designed to help poor people. We can do that.

From Haiti, you went to Harvard and got two degrees, medicine and medical anthropology. Was that option unique to Harvard?

Paul Farmer: No, it wasn't unique to Harvard but there weren't many programs that had M.D.-Ph.D. programs in that field. It's two different degrees: your medical degree and a Ph.D., and there are probably a dozen or more universities in the United States that have those programs. Maybe it's more, but there weren't many back in 1983-84. I started in 1984 at Harvard.

Paul Farmer Interview, Page: 1   2   3   4   5   6   7   8   9