More than 30 years ago, Dr. Paul Farmer and Dr. Jim Yong Kim travelled to Haiti to provide care for the poor and underserved. The lessons they learned about public health, poverty and social justice can be applied in the U.S. today, as the Covid-19 pandemic accelerates, ravaging low-income communities across the country.
In 1983, Farmer and Kim, along with activist Ophelia Dahl, went to Haiti to bring high-quality medical care to rural Haitians. A new film, called “Bending the Arc,” depicts their story and the challenges they faced setting up health clinics in remote parts of the country. Through their failures, the group realized they had to change the way they were delivering care. They began to train Haitian villagers as healthcare workers and developed a successful community-based care delivery model. The model has since been applied in other countries, including Peru and Rwanda.
Farmer and Kim, who later created Boston-based nonprofit Partners In Health, believe that there is knowledge to be drawn from their experiences abroad for the U.S. healthcare system.
One lesson they learned is that public health experts have a “frustrating” tendency of having low aspirations for the poor and are very nihilistic about the likelihood of improving their health and circumstances, Kim said at a virtual panel discussion for the movie.
“The thing that I couldn’t believe was that [nihilism] kicked in here in the United States once Covid started,” he said. “We couldn’t believe that public health experts in the United States were giving up on things that, for example, are well in place in Rwanda, are well in place in Korea, in Hong Kong, in Taiwan, in China — well in place in lots of places that have been successful at suppressing the virus. We just gave up.”
And the people who are suffering the most as a result are the poor, the Native Americans, Black people and other communities of color, he added.
Public health crises involving infectious diseases tend to follow a panic-neglect cycle. The U.S., still in the panic phase, appears to be attacking the Covid-19 problem with fiscal stimulus and just hoping for a vaccine, Kim said.
What the country needs to do is invest in public health and the proven strategies of testing, contact tracing and supported isolation — where those who need to isolate are given the resources they require — because even when there is a vaccine, on-the-ground public health strategies will be necessary to distribute it, he added.
“I hope I’m wrong, but what I think we may [see] is — if the vaccine is successful, we’ll go right back to neglect,” Kim said. “We won’t build the public health systems [we need].”
The panic-neglect cycle needs to be broken, Farmer said, and there is a chance to do it now amid the Covid-19 pandemic.
Strengthening the public health response to the pandemic, for example, can help address inequities related to social determinants of health, like job loss. In Navajo Nation, a number of the new recruits for contact tracing jobs are from the casino industry, which has seen closures and layoffs amid the pandemic, Farmer said.
Further, community support, similar to the model developed in Haiti, is needed as the pandemic rages on. Kim and Farmer’s nonprofit found that about 20% of the people they got in touch with via contact tracing needed resources, like food, to help them isolate properly. So the nonprofit started hiring resource managers to assist those in need, Kim said. This had the added benefit of creating jobs.
In addition, contact tracing and supported isolation was successful in places like West Africa during the Ebola epidemic, and they can be effective in the U.S. now. Some of what we have learned in one place can also be useful in another, Farmer said.
“We’re facing a once-in-a-century — if we are lucky — a once-in-a-century pandemic,” he said. “It has resulted in a massive disarray that all of you can see and feel, and with 250,000 dead, you can bet a lot of people are feeling this in a very personal way. Now we’re saying: here’s how to transform the illness care system into a healthcare system that does not neglect the critically ill and injured, but there is a lot more [we can do] to make us healthier overall.”
Photo credit: Bruce Bennett, Getty Images