Bending the Arc of History Toward Justice

Early one morning in 1896, Cecil Rhodes, the South African politician, visited Earl Grey in his room at Government House in Bulawayo "to congratulate him on his good luck in having been born an Englishman." Grey, who had recently arrived in what is now Zimbabwe as Administrator, responded first to some inquiries: "Grey, how old are you?" ("Forty-four"); "You've no incurable disease, I believe?" ("No, thank God"). "You've arrived at the age of forty-four," said Rhodes, "you have no disease which as far as you know is certain to kill you, and you are an Englishman. Why! You have drawn two of the greatest prizes in the lottery of life!"

Good fortune is still in short supply in Africa, in Haiti and in parts of Peru; these regions appear at the bottom in many rankings of health conditions and life chances. These are also the places where Paul Farmer—an anthropologist, physician, and teacher at Harvard University—has tasked medicine with bending "the arc of history toward justice." The power of modern medicine becomes visible most clearly when even small doses are applied in settings where none were available before. For Farmer, these dazzling moments occurred in the 1980s in Haiti when clinicians at a makeshift clinic in Cange saved a girl who had tetanus and when he shared his inhaler with a young man and saved him from almost certain death because of asthma.

For years, Farmer has delivered commencement speeches at universities in the United States to students who have received a much larger helping of good fortune than people in Haiti. To Repair the World presents over a dozen of these speeches. Many have long prefatory sections, aimed perhaps at building rapport with the listeners, through references to past commencement speakers and to people in the audience; some readers will find the preambles funny; others will want to move straight to the heart of the matter, which in each case is a plea to correct the imbalance between health care needs and services.

Many of Farmer's other books and writings are academic in tone; To Repair the World is more conversational. Farmer illustrates his arguments with an impressive array of examples, largely drawn from his travels and clinical work. The most moving stories come from Rwanda, where Farmer finds spirituality in an "unlovely place," the nation's largest prison, and where he talks with a young man who lost most of his relatives during the genocide and who not only met his brother's killer but also forgave him "right there and then" when the murderer said he was sorry and explained "that the government had made him do it."

"Whenever you are in doubt or when the self becomes too much for you, apply the following test," Mahatma Gandhi told his disciples, "Recall the face of the poorest and the weakest man you may have seen, and ask yourself if the step you contemplate is going to be of any use to him. Will he gain anything by it? Will it restore him to a control over his own life and destiny?" For those who labor to repair the world, Farmer's book can act as a corrective when Gandhi's directive appears to lose strength and the image of the most powerless starts to fade.

Karunesh Tuli is a Pasadena-based public health consultant. He helps non-governmental organizations with health projects in Asia and Africa.