The Art of Being Human A Textbook for Cultural Anthropology Textbook Lesson 10 The Art of Being Human

Lesson Ten The Art of Being Human MI ' we world we world it or ' ix road toward realizing potential . It ix road to . 336 THERE ARE NO ACCIDENTS In 1983 , a young anthropology graduate from Duke University named Paul Farmer set off for Haiti . He had done research on Haitian migrant workers at Duke and become deeply interested in their home country . He wanted to become a doctor and an and thought he might sample a bit of both by going to Haiti and volunteering in health clinics . there , he boarded a bus with a new friend , Ophelia . Ophelia , the daughter of movie star Patricia Neal and author , was just 18 at the time , and looking for a calling in life . As they navigated the rough , unkempt roads of Haiti , Paul leaned out the window and waved happily to all who greeted them , which Ophelia found nerdy but beautifully innocent and charming . Then they came upon an overturned bus on the road . Mangos destined for the market were scattered everywhere as people about making sense of what had just happened . A woman lay lifeless , with a strip of cardboard covering her body . Paul went stone silent . Ophelia tried to comfort him by saying , It just an accident . But Farmer was seeing big like an . He saw that the neglected road was no accident . The 337

worn shocks of the bus were no accident . The overloading of the bus with peasants going to market with their mangoes was no accident . These were all a result of poverty , and Farmer could see through this poverty the past 400 years of history in Haiti . He saw the 17 century slave colony of France , the brutal and bloody fight for independence , the French demand that Haiti pay back 21 billion for their lost property ( the slaves who were now the citizens of Haiti being asked to pay for themselves ) and the environmental collapse that came from trying to pay those debts . So when he saw the woman who was riding in a bus over a road to sell mangos in a Third market , lying dead on the side of the road , he turned to Ophelia and responded , It is never an accident ' This peculiar view of the world , that there are no pure accidents , is also an empowering one . Paul Farmer and Ophelia would soon recruit the young Jim Kim to their cause and set out to provide the best healthcare possible to the world poor . Thirty years later , their efforts would be celebrated as the friendship that changed the world . And it all started by applying the anthropological perspective of seeing your own seeing , seeing small , seeing big , and seeing it all to realize that there are no pure accidents . If the message building from the preceding chapters was We make the world , the message of this trio has been , We can do better . TOUT MOUN SE MOUN During one of his first trips to Haiti , Farmer shadowed an American doctor . He was enamored with his competence , talent , and care , and saw him as a great role model . But he was soon disenchanted to find out that this American doctor had no intention of staying in Haiti . I an American , and I going home , the doctor said . Farmer kept pondering the conversation and on those words , I an American , wondering how it is that we come to classify ourselves into these exclusive categories , thus limiting our responsibilities and allegiances to others . 338

That night , a pregnant woman suffering from severe malaria came in and crashed into a coma . She needed a blood transfusion , but the only place to get blood was far away in the capital city , and the blood would cost money . Farmer ran around the hospital gathering money and came up with fifteen dollars . The sister took the money and set off for the city , but returned empty handed . She did not have enough money for the bus and the blood . The woman , a mother of five , died . The sister was distraught , sobbing and crying . Through her tears Farmer heard her say , You ca even get a blood transfusion if you poor . And then she kept repeating , Tom mom re mow . Tout Mom re . are all human beings . re . Driven by such words , Farmer dedicated himself to serving all humans as humans . He turned his attention to those who had been most neglected by the world . He set off for in the central highlands of Haiti , the poorest of the poor in the poorest country in the Western hemisphere STRUCTURAL VIOLENCE was the perfect place for Paul Farmer From the mountain road entering , there is a beautiful vista of an expansive blue lake framed by the steep . But Farmer , who could see that same scene through the eyes of local Haitians , with the benefit of an anthropological lens to see the bigger picture , saw that this was no simple beautiful mountain lake . It was , despite the deceptive calm and tranquility of the mountain lake , one of the many reasons for the extensive poverty of , and it was no accident . The lake was artificially created by a dam project led by the Army Corps of Engineers to provide irrigation and power to Haiti . However , the recipients of the water and power were not the poor of Haiti , but and the Haitian elite living downstream . 339

The lake swallowed up the best farm land of and destroyed people homes . Farmer called the people who had to evacuate the valley the water refugees , and they were some of the most poor and destitute in a country full of the poor and destitute Instead of farming in the valley the river ran through , the people were forced onto the steep where water would not hold . They tried to farm , which led to devastating erosion . Pushed beyond malnutrition toward famine , virtually everything green was consumed and used up , so that today is a shocking glimpse into a world that has suffered true environmental devastation . Paul Farmer frequently writes and speaks about the dam near as an example of structural power and the structural violence that can result . THE ANTHROPOLOGIST WITHIN Farmer enrolled in a at Harvard that allowed him to pursue a degree in anthropology while simultaneously earning his doctorate in medicine . He knew that if he was going to serve the world poor , he would need the perspective to understand the broader cultural environment and issues impacting their health outcomes . Throughout his training , he continued to spend most of his time in Haiti . His professors were not against it , as he was providing important medical care to people who needed it , and it proved to be a fruitful place to apply what he was learning in graduate school . His work had a profound influence on anthropology In one of his first essays , The Anthropologist Within , he argued that the traditional manner of practicing anthropology as an impartial observer made him feel restricted in his ability to help solve the many problems surrounding him in Haiti . Since that article was written in the early , anthropologist have become much more active in their work , and are more likely to actively participate in providing 340

solutions to local problems rather than standing idly by as impartial observers . But Farmer was struggling to make a big impact in He needed money to complete his vision of building a free hospital providing outstanding medical care to the poor . His essay caught the eye of Tom White , the owner of a construction company in Boston who was interested in donating money to feed the poor in Haiti . In fact , he planned to away every last dollar of his substantial fortune before he died . In Paul Farmer , he thought he had found someone who could make sure his money was well spent . With the first million donated by White , Paul Farmer established Partners in . The plan was not to simply support Paul Farmer in Haiti , but instead to create partners in health by training community health workers throughout rural areas of Haiti . FOR THE As the three friends Farmer , Kim , and set about crafting the core goals for Partners in Health , they continually caine back to the idea of for the , short for preferred option for the poor . The preferred option refers to the idea that poor people should not just get the bare essentials of healthcare , but they should receive the same preferred options that the wealthy receive . Tom re mom we are all human beings drove every aspect of their operating philosophy . While this might seem like an obvious and uncontroversial goal , it ran against the operating consensus of other development professionals , as well as the top global aid organizations such as the World Health Organization . The standard consensus at the time was organized around the idea of cost effectiveness . Instead of providing the preferred option the scarce resources available to development projects should be used to maximize benefits to the most people . 341

for the opened up a serious controversy . Imagine a fairly common scenario that one might face in rural Haiti or any other impoverished area . A patient has a complicated case of that will cost or more to cure . Ordinary cases of cost just 200 to cure . Do you cure the one for or do you cure 25 ordinary cases for the same amount ?

The principle of cost effectiveness would suggest that you cure the 25 , not the one . But Farmer , Kim and were taking a longer view . They so strongly believed that the highest quality healthcare should be available to all that they decided to go down that long , hard , unexplored path of providing the best for everyone , in hopes that they might be able to attract more money , lower costs , and ultimately save even more lives than they could by following the traditional model of cost effectiveness . THE STRUCTURAL POWER OF MEDICINE The key barrier to for the was the cost of medicine . When they first decided to try to treat the most complicated cases of , the treatment drugs could cost as much as for just one patient . such high prices , the Health Organization ( would not recommend the drugs , since it goes against the of cost effectiveness . And since the WHO would not recommend the drugs , generic manufacturers would not produce them These three factors create an interlocking triad in which prices are high , so the VVHO will not recommend it , so will not produce it , so prices stay high a vicious cycle that continues as people all over the world continue to die while drugs are readily available that could save their lives Jim Kim took the lead on trying to break through this vicious cycle that kept prices so high . As he did , he kept encountering a prevailing supporting myth for why the drugs were not being made more available Poor people are poor because they are stupid and They are lazy , so they do not deserve the drugs . Their lives are 342

limit not as highly valued as those of the wealthy . And they are stupid and will likely misuse the drugs , build resistance to the drugs , and cause further harm . The WHO and development professionals who held these views were not as prejudiced as you might think . They formed their opinions based on experience . They came into their careers idealistic and full of hope , but constantly found their carefully crafted plans fell apart in practice , and treating was especially difficult . To properly treat , the patient must take the proper drugs and keep taking them after the symptoms have cleared in order to ensure that the does not recur or get passed on to others . Unfortunately , when people do not complete the drug sequence , the can develop resistance to the cheap drugs , and an outbreak of resistant can take hold . Paul Farmer saw the same patterns , but he refused to blame the patients . Instead , he studied them anthropologically and developed a new prescription for . His new prescription was not just for drugs , but also for regular visits from community health workers who would travel throughout rural areas to check up on the patients and make sure they were taking all of their drugs . And as a third element , he even prescribed money a cash stipend so that they could pay for good food and childcare while they were sick His studies had shown that the poor were not stupid , they were simply constrained and forced to make bad decisions while they were sick in order to make ends meet . A small cash stipend of just was enough to let them rest properly and pay for help until they were fully recovered . The success rates before Farmer intervention were dismal . Afterward , the success rate soared to nearly 100 percent . When he published the results , it became a model for others all over the world . With their success , they decided to push harder against the structural power that was keeping the drugs for more complicated forms of so high , and launched a project in the shanty towns outside of Lima , Peru where there was an outbreak of Resistant ( Farmer held to his same prescription drugs , 343

regular visits , and a cash stipend The problem was that the drugs were per patient . The World Health Organization and other development professionals pushed back . It was not cost effective to treat people for each . It was not sustainable . Tom mom re mum , Farmer thought , and they set off to find a way . With their background in anthropology , Farmer and Kim know that price is a social construction . There is no inherent quality of the drugs themselves that make them worth So they set about changing the structure to lower the cost . Jim Kim , with his passion for policy and transforming bureaucratic structures , threw himself into the problem . He had to find a way to convince generic manufacturers to produce the drugs , which would create competition and drive down the cost . But the WHO not recommend the drugs due to their high cost , and because of their concerns about poor people and poor not having the knowledge and resources to properly administer the drugs . To convince the WHO , Kim promised them that Partners in Health would set up a Green Light Committee to create standards and require training to ensure that the drugs would be administered responsibly . With the WHO on board , Kim went to the generic manufacturers , who agreed to make the drugs . Prices fell 97 . lives were saved . It was an amazing feat Jim Kim was trained as a medical doctor and hoped that one day he would save here he had just saved lives without even touching a human body . He simply recognized a configuration of structural power that was causing great structural violence , and changed the structure . AIDS IN AFRICA By 2001 , their money was running out . Tom White was determined to die without a dollar to his name , and he was nearing his end . They had created an effective treatment for that was 344

spreading throughout the world , and they were having great success treating AIDS in Haiti at a time when much of the world thought that treating AIDS among poor people would not be cost effective or sustainable . At that time , thirty million people in Africa had AIDS , and only of them were receiving treatment . The Partners in Health model was working in Haiti , in circumstances similar to those in many African countries . This made people hopeful , and The Global Fund to fight AIDS was launched , raising millions of dollars to combat AIDS . The Gates Foundation followed soon after this with a 45 million initiative . Paul Farmer joined Agnes in Kenya to set up a system that followed the same prescription Farmer had always preferred the proper drugs , by health workers , and a cash stipend to cover expenses while sick . many still saw the treatment ( and especially the stipend ) as radical , the results were proven time and time again . The program in Kenya worked , and it showed people throughout the entire system that we could go after AIDS in Africa . The WHO was brought on board , the generic manufacturers started producing the drugs , and the cost of treatment plummeted . drugs can extend life for many years , President of the United States George Bush announced in his State of the Union address later that year , And the cost of those drugs has dropped from year to under year , which places a tremendous possibility within our grasp Ladies and Gentlemen , seldom has history given an opportunity to do so much for so many . He proceeded to ask Congress to dedicate 15 billion over the next five years to turn the tide against AIDS in the most nations of Africa and the Caribbean . His request was greeted by a jubilant standing ovation , delivered from both sides of the political aisle . Jim Kim , Paul Farmer , and Ophelia were astonished . In just twenty years of deeply dedicated service to their calling , they moved from working and struggling outside the system to being insiders . A 345

few years later , Jim Kim was appointed by Barack Obama as the new President of the Bank , an opportunity to use tremendous wealth and power to bring better health and to the world . LEARN MORE I Mountains Beyond Mountains The Quest of Paul Farmer , by Tracy Kidder ' Bending the Arc A Friendship that Changed the . Documentary Film . 346

IF PAUL FARMER IS THE MODEL , WE GOLDEN At Partners in Health headquarters there is a sign that says , If Paul Farmer is the model , we are golden . But golden is on a piece of paper taped over another word , screwed ( or rather , a synonym of screwed starting with ) It is a favorite saying of Jim Kim . he meant was that nobody can hope to be just like Paul Farmer He is incredibly intelligent and with natural gifts for medicine and anthropology . It would do us no good to hold ourselves up to that high of a standard . Instead , we can learn from Paul Farmer ( and Jim Kim and Ophelia ) that seemingly impossible problems can be solved . can discover that we make the world and that we can do better . In a recent commencement address at the University of Management , comedian Jim reminded us that the dynamics of fear and love operate in every moment of our life . Fear is going to be a major player in your life , he said , but you get to decide how much . You can spend your whole life imagining ghosts , worrying about your pathway to the future , but all there will ever be is happening here , and the decisions we make in this moment , which are based in either love or fear . 347

Perhaps we have all caught a little glimpse of what lies down the road of the hero path . We have had moments of hope where fear fades away . For a brief moment , we have that sense of connection , clarity , and conviction that allowed Martin Luther King to say in his final speech , We got some difficult days ahead , but it really matter to me now , because I been to the mountaintop . I seen the Promised Land . He was , by that time , living beyond fear and beyond even the most basic desire to preserve his own life . He was living for something much greater than himself . I may not get there with you , he told the overflowing crowd . But I want you to know tonight , that we , as a people , will get to the Promised Land . For that moment , we feel that sense of connection that the heroes who have come before us talk about . Most of us will not lead a movement like Martin Luther King . We will not lead a revolution like Gandhi , or end apartheid like Nelson . But we will all have to face millions of decisions , some mundane and others momentous , and each time we will do so out of fear or love . To find out how these decisions play out in everyday life , and how the lessons of this class might help in those decisions , I reached out to alumni of this class and asked them to share with me their own heroic journeys through life . I received letters back from all over the world They were now engaged in every kind of career you could all over the world , applying the mindset , methods , and goals of anthropology to a wide range of problems . One had been paid by Virgin Records to travel across the United States in an studying how young people listen to music . Another was working with Facebook on what to do with social media profiles after people die . were living abroad in places like Dubai , South Africa , Iraq , Afghanistan , and Vietnam . Some were working on global health care while others held military leadership positions in combat zones . Others had settled into jobs in the United States in a 348

wide range of careers including game design , clinical psychology , advertising , and business . All of them had stories to tell about how the art of seeing or how communication , empathy , and thoughtfulness had been essential to their careers , but I was especially struck by how many of them had found these ideas so essential in helping them in their everyday lives . Indeed , it was their letters that inspired me to write this book . One shared her journey out of fear toward true love and how anthropology helped her understand her journey . She realized that she had fallen into an abusive relationship because she feared being alone . It was my default to love myself through the eyes of men , she recalled . I treated relationships as a safety net , holding me high above a pool of insecurity . It was like a spider web , she said , and she was like a fly , stuck there on my own accord smack in the middle while a spider consumed me . She ended up in an extremely abusive relationship . I lost hold of myself and ended up where I had been leading myself all along , existing as an object for him . She realized that the core of her fear that led to these poor decisions was the fear of being alone and unloved . She went to a very rural area for several months where she was forced to live with her loneliness . There she found that she was not afraid . She felt free to love herself , which freed her to love others rather than to simply be consumed by them . Another former student shared how he had battled against the dynamics of fear and hate , and how he came to discover these dynamics through the anthropological perspective . He fell in love with a girl who had been in an abusive relationship . One night he had a dream , and in the dream he could see ships burning on a lake . I watched a burning ship that represented her old boyfriend , who had abused her , sailing past other ships , catching them each on fire . Those ships would sail on and set fire to more ships , and so on . I watched as his ship pull alongside her and lit her on fire . They pulled up to me on my island and began shooting fire at me , and it 349

seemed to me like it was the most important thing in the world that I not catch on fire , that I do topple . Do people who are hurting spread the pain to others in an attempt to elicit empathy ?

he wondered . And does this create a cycle of hurting that spreads like a fire , like burning ships bumping into one another on a lake ?

He resolved to not allow himself to get burned , but she burned him . He tried to withstand the pain and let it dissipate so he would not spread the fire , but it only inside of him , ready to ignite into a inferno at any moment . She could see it inside of him . She did think we could stay together , he said , and so , I told her that I would see her that evening . I was going to fight my demon . He rode his bike out to the lake where they had together for the first time , and laid down on top of a hill . A massive thunderstorm moved in . I was scared , he recalled . That thing could really kill me nothing , God seemed to whisper . But then the winds calmed and the sky opened up as he gazed up at the stars . It really was the balance of infinity staring me in the face , he remembers . The moon seemed so close . The stars became joined by strands of light , forming a beautiful web . The sky fell then rose , zooming towards me and retreating like the lungs of an animal . And this is when he had his revelation I somehow ended up kneeling back on my blanket , and the world collapsed inside of me . I saw myself . I knew myself . It was terrifying . I held myself before me , suspended in the air above me . Every piece of my identity was evident . Every fabric of construction , every pride , stubborn impulse , and conceited motivation . Each piece of my ego swirled together and formed me , suspended in the air beside the full moon . I was hugging myself in a child pose and I remember crying out , almost screaming as I saw myself like never before . In horror . In awe . I saw me . I saw the pieces of me 350

limit I that were destroying me . I knew and understood . I also saw her . I saw hurt and love . I took these things , these destructive aspects of myself which I had been too proud to recognize before , which was producing the pain within myself , and let them float into that yawning abyss above me . They were not bound by gravity , but by my ego . I spent the entire night on that hill . I learned that that my was not coming from without , but from within myself , due to pride and stubbornness . I was able to let them go . It was painful and terrifying to look so deeply into myself , but I found that the source of my pain was within myself , not within her . That night on the hill wrestling with myself was one of the most intense experiences of my life , but it worked . currently in the healthiest , most fulfilling relationship that I can . If I had placed the blame on the world around me and bolstered myself on my own ego , I would have collapsed , our relationship would have collapsed . we would have set fire to more ships . As it is , we are able to pass our joy and loving relationship to others every day . He ended his letter by recounting the lessons of anthropology that have become a part of his everyday life , his way of being the best human he can be His ability to see big and see small allow him to empathize with others , and also to understand himself , the inner forces that drive him , and where they come from . I would not be with her today if I had not made the basics of anthropology an integral part of my life , my identity , and my way of thinking about the world 351

A HERO GUIDE TO EVERYDAY LIFE by Dean Class of 2012 FedEx Courier I began college with lofty , idealistic hopes and dreams about who I wanted to be , and how I wanted to change the world I think at one point , I convinced myself I wanted to be President of the United States . I do not regret those ambitions , but a little over halfway through college I began to realize ( literally , make real ) two things . The depth , breadth , and diversity of the tedious mess the world is in . How I , personally , am a blatant , contributing part of the problem . I want to be certain that this is not seen as hopelessness , so I will clarify that these were very positive , grounding , and educational realizations even if they felt kind of crappy at the time . Sure , at the time , it was not fun to see how I not only had no real power to change the world in all the idealistic ways I thought I did , but was actually participating in reinforcing all the corrupt , irresponsible ways people and our planet are being treated . That downer , however , was very brief Through lessons learned in cultural anthropology and in life , and through my own desire , I began to discover a deeper , awareness I may not have the power to change the world , but I have all the power to change and be responsible for myself and my own life . Gandhi said it best , in regard to being the change we wish to see in the world , when he stated , If we could change 352

limit ourselves , the tendencies in the world would also change . As a man changes his own nature , so does the attitude of the world change towards him . We need not wait to see what others do . I began to learn through my experience in cultural anthropology that my willingness to change myself might be simultaneously the ONLY and BEST thing I can offer the world that challenging myself to be a healthy , responsible human might not only be incredibly to me , but also to those around me that the world is just a of its people , of me that healthy , responsible individuals can create a healthy , responsible world . The power part of this realization was that it applies to me , at all times , where I am at , and as I am ! I did ( and do ) need to have a lot of money , or incredible of soft power , or an amazing ability to move millions with my words , or be the President of the United States I can work on myself at any time , and choose to learn and grow and live and give responsibly in every aspect of my life , and in any given circumstance . In fact , I am the ONLY one who has the power to do that in my life . From this realization came decisions , some rather hard and personal ones , which were ( and continue to be ) met with considerable criticism , even from those I was close to . However , the I have gained from these decisions have been deep and personal and profoundly meaningful . Through working on growing in relationships , finances , physical health , and other areas of my own life , I have met people and discovered opportunities and done things I never would have dreamed I be able to in the past . I was able to pay off my student loans , which turned out to be one of the most difficult , empowering , and educational endeavors I ever faced ( even more than , dare I say , getting my degree )

I have chosen to embark on a program that has helped me heal myself and outgrow cluster migraines , stomach ulcers , depression , and other debilitating illness , which was even more difficult and profound than student loans . I have chosen to travel and challenge myself and place myself in uncomfortable territory to learn and grow and experience myself and the world . I have been able to share my music at venues around Denver , and challenge myself to be vulnerable with music in front of people in new ways . This only scratches the surface for me , but these and many other decisions gifts can be attributed to that realization I gained through my experience at , and most of all with lessons in cultural anthropology . These decisions are not monumental . They are not going to upset any corrupt establishments , or end hunger , or create peace among the nations , or abolish modern forms of slavery , or create economic equality , or reverse the degradation of our beautiful planet and its resources . At least , I have a very hard time any correlation between these things and the decisions I have made . Singing cover songs in a Denver brewery does exactly exude heroism . I just a normal guy . I live a normal ( pretty mundane , from a surface view ) life . I am merely a human , learning how I can be the best ( however flawed ) human I can be , and make the most out of my life . However , if I can help anyone around me , or anyone who allows me to share this with them , to discover within themselves the courage , freedom , creativity , empowerment , and love I have discovered by choosing to take back my life and take responsibility for who I am , I would like to . I would like to , because it is the most meaningful ( yet somewhat terrifying ) experience I have had .

I would like to , because I my life means more to me than I ever thought possible , thanks to the decisions I made and the people from Whom I learned . I would like to , because these decisions continue to shape me into a healthier , more open person whose effect on the world will be at least a little more positive . I would like to , because there is something redemptive about the raw , beauty of everyday human life .

356 Challenge Ten Your Manifesto Your challenge is to reflect on What you have learned in this class and manifesto for your life . This document should outline a Vision for your highest goals for yourself , your future , and for how you will contribute to life on earth In addition to the manifesto , post a collage of the work you have done in this class on , or post a photo or work of original art that captures your Vision for who you want to be or how you Want to contribute to the World . Your manifesto should include ) Your life goals ( What problems do you Want to address in your life or the world ?

Your ideas , ideals , beliefs , and values ( do these problems matter to you and to the world ?

Your View of the World , past , present , and future . Why your goals and Vision for the future matter . What are the consequences of failure ?

Key lessons learned from this class ( How will these lessons and insights help you in your quest ?

How your goals , ideas , values , and Vision have been changed , or questioned in this class . Go to for more inspiration , and a helpful worksheet to get you started . 357