An Ode to Paul Farmer

Matthew 15:21-28

Jesus left that place and went away to the district of Tyre and Sidon. Just then a Canaanite woman from that region came out and started shouting, “Have mercy on me, Lord, Son of David; my daughter is tormented by a demon.” But he did not answer her at all. And his disciples came and urged him, saying, “Send her away, for she keeps shouting after us.” He answered, “I was sent only to the lost sheep of the house of Israel.” But she came and knelt before him, saying, “Lord, help me.” He answered, “It is not fair to take the children’s food and throw it to the dogs.” She said, “Yes, Lord, yet even the dogs eat the crumbs that fall from their masters’ table.” Then Jesus answered her, “Woman, great is your faith! Let it be done for you as you wish.” And her daughter was healed instantly.

            When I take people to Africa, there are a series of books I recommend.  King Leopold’s Ghost is a serious account of how colonization robbed a continent of wealth, murdered millions.  Before you go to Africa it is good to see where all the money went, where the looting of Africa can be found. Extreme poverty is not a lack of development.

            A bit nicer story is Three Cups of Tea.  If you are going to wade into places like sub-Saharan Africa you need to listen before anything else.  Learn to listen to people.  Three Cups of Tea is a good listening exercise. Better to have a good question than be sure of an answer. 

            Don’t Let us Go to the Dogs Tonight is a coming of age story that gives you an image of what it means to grow up as an Expat as to does The Poisonwood Bible.  There are very good books about David Livingston and his famous visitor, Henry Stanley.  David Livingston’s grave in Westminster Abbey pleading for the “open sore” of Africa could be enough reading for the well-intended. 

            There are other books, academic ones, heartbreaking books on Rwanda, or slavery and the Portuguese.  I wish there were books written about Africa that are happy or capture its beauty.  I guess the brokenness sells more. 

            My habit is to put a large stack a of books in front of people getting ready to travel and say, “take what interests you.”  But then I hand everyone a copy of Mountains Beyond Mountains.  “This book,” I say, “you must read.  This one is very helpful and will prepare your heart.” 

            Mountains Beyond Mountains is an account of Paul Farmer. Paul Farmer was a medical student at Harvard.  He was also a doctoral candidate in epidemiology.  He was doing both at the same time.  Midway through his programs, Farmer got into trouble with the dean because he wasn’t attending classes or lectures.  Farmer decided he would open a rural clinic in Haiti while he was in two doctoral programs.  The dean suggested that being in a different country running a free health clinic was not advisable.  Farmer convinced him that if he maintained excellent scores on his exams he should be excused from lectures. 

            He was and he did complete the degrees while at the same time running the rural clinic.  I don’t have a lot of heroes, but Paul Farmer is one.  His life is a great introduction to population health.  Population health is a question, what do you do when the needs of the people are greater than the resources to heal them?  How do you prioritize, ration; how do you choose who will live and who will die?

            A rural clinic in Haiti— population health is the question you ask every day.  I encourage people to read the life of Paul Farmer before they go to Malawi because sub-Saharan Africa is a perpetual health crisis. 

            Reading Mountains Beyond Mountains prepares you for the mind-bending heartbreaking need you can’t solve.  It’s not a lack of expensive drugs; in Malawi it’s the lack of Tylenol that makes a difference between life and death.  It’s not the $2000 deductible causing injustice in healthcare; its fifty cents worth of acetaminophen to lower the fever and keep malaria at bay.  It’s not the 50-million-dollar hospital wing that cannot be built in a poor neighborhood; it’s the dollar bed net in the village home that is too costly.

            More than a million people die in sub-Saharan Africa every year because they lack a dollar and fifty cents.  It seems impossible, unbelievable.  But it is. The life of Paul Farmer in the book Mountains Beyond Mountains puts you into this truth, this world where a billion people live and die in a way you just can’t justify.

            The book is a warning.  When you step into a crisis where it seems anything would help, you need to tread lightly, slowly, and with great caution. It may seem it can’t get any worse, but it can.  Good intention, a broken heart: dangerous things for people in extreme poverty.

            I saw this in a rural clinic on the lakeshore of Malawi.  It was an outbuilding of a church by a school where kids could get basic meds, moms could get supplements for their babies, front line diagnosis or triage could be done.  One year when I visited this clinic it was filled to the brim with trunks, many trunks of meds from the US.  They were AIDS drugs, the cocktail we developed to keep the infection at bay. 

            These meds were no longer good in the US, so they were shipped to rural clinics in sub-Saharan Africa.  And the US not only shipped drugs, but they also sent money to administer the cocktail.  It was a tricky drug to administer, and you needed healthcare professionals to monitor the patient— how they responded, what dosage should be given.

            Good thing.  Right?  In the US the percentage of people with AIDS never reached a 10^th of one percent; in Malawi the infection rate was 13%, not adjusted for cohort.  If ever there was a place in need of these drugs, this is it. But they hired all the healthcare professional to do this good work and they were drawn away from other needs.  This helped the AIDS crisis, but it created a crisis in malaria and dysentery and malnutrition.  The numbers skyrocketed. Saving some caused more people to die.

            Population health is asking how do you not create a crisis trying to solve one?  Paul Farmer was a great light in the world trying to illumine and ask these questions.  His life was a sacrifice, a gift to the world, to ask: how can we help and not hurt?  He died this week at the age of 62. 

            Our reading today from Matthew is part of a series.  The series is the opening of the gospel, the invitation to the world to follow Jesus.  Gennesaret, the Canaanite woman’s daughter, the Roman colony outside of Tiberius, feeding the four thousand: the boundary of the messiah giving way.  What was for the Jews is now for the Gentiles. The gift to a few was being shared.

            If you read these passages, you will hear revolution, profound change undoing an order. 

            Jesus will tell the quality assurance committee from Jerusalem, the Pharisees and Sadducees who came to assess him, the tradition meant to save people actually brings death.  Your confidence is false.  You wanted to save a few, but you are hurting all. If you want to be right, you have to be wrong. 

            You will have to turn this upside down.  You are looking at this as something for a few when God’s love is for all.  Jesus said, the Canaanite woman is an example to follow.  Great is her faith.  The woman who is nothing to you is everything to me. Great is her faith.

            You can’t speak this way to authority, to the entitled and privileged, to power and not expect power to strike back.  There are reasons why prophets die.  Jesus tells his disciples the Chief Priest and the scribes are going to put me to death.  And he was right.

            Traveling to Africa, to Malawi, to rural villages where an entire generation was lost to AIDS, where families lose children quite often to maladies very easily treated, when you stand in the midst of the feeding stations and see the orphans get their bowl of gruel for the day, you need someone like Paul Farmer in your corner.  Someone who lived asking the question in our passage, how is mercy for everyone and not just a few?

            The Canaanite woman is an example of faith because she gave her life away carrying for the least.  Her daughter was one of the least.  Her faith came from the desire to save the discarded.  She let go of all the excuses and justifications you make for greed.  Even dogs eat the crumbs. Her daughter was not one of the elect, the few, the chosen.  How is it she too finds healing?

            Every day of her life she saw the need for mercy.  Her daughter was a healthcare crisis each day. She saw the heartbreak— the heartbreak where you know without question one dollar saves a life, makes a difference. One dollar, just the crumbs.

            Our reading today is a light.  It is a light right now.  Right now there is a global question, a moment to wonder.  Do we care what happens in the Ukraine? 

            Consider the Ukraine in light of the Canaanite Woman’s daughter.  Is this a moment of indifference?  Not my problem.  Not my people. Not my fight.  Why should I care, Jesus asks?

            Jesus asks the mother, “why should I care for your daughter?”

            In population health there are a lot of hard questions.  How do you treat tuberculosis when it becomes drug resistant?  How do you care for the food insecure in a culture without connection to food security?  When do you choose between keeping the hospital running and not running it into the ground of human suffering?  It’s tough.  Big questions.  Big questions, though, find answers in humble places.

            Our reading today, the Canaanite woman and her daughter, is a kind of guide, a light in the darkness.  It’s a principle: You love the least.  You begin at the bottom, not the top.  You refuse to be indifferent.   

            You and I both know that a crisis thousands of miles away, a crisis born of centuries, is not ours to solve.  No one is going to call us and say, “how do we navigate the violence in the Ukraine?”  It’s not a problem for us to solve; it is a moment for us to care. 

            That is what Paul Farmer was, is, to me.  When you find yourself in the midst of the crisis of the world: care.  Don’t be indifferent to the suffering, to the brokenness.  Care.  That is the beauty of the Canaanite woman and her faith.  Jesus asks, why should I care?  Her response is such a Paul Farmer like response: you care because that is the place to start.  You care because such is the way of being human.  Start with being human.

            When you read the gospels and listen to the stories of Jesus healing people, there is a hard truth that lingers: why didn’t he end suffering for all?  Jesus healed a few people in a remote place 2000 years ago.  What does that really have to do with us?  When you look at this from a global perspective, from a historical perspective, it’s easy to say, “what difference did this really make?” The tenacious woman’s daughter was healed.  That’s great. Dogs eat crumbs.  Okay.

            This doesn’t really make much of a difference until you equate faith with care, believing with sacrifice, loving the least.  That’s the dynamic of the story; it’s the way Paul Farmer lived.  You care.

            People thousands of miles away are caught in the grip of greed and power and violence.  What is that to me?  I can’t fix that.  What if life truly begins to change, the kingdom of God truly comes to us on earth as it is in heaven, simply when we care, when belief is simply care?  What if our love truly begins to grow when we love the least?

            That’s why I gave people the book Mountains Beyond Mountains.  I wanted them to be ready for what happens to you when you really start to care, when you start with the least, when your heart is broken in a village with hungry kids.  You need to find a place to begin to make sense, to understand. You want to fix it, to make it all right, but you know you can’t.  When you sit with Paul Farmer you realize he didn’t save the world; he didn’t right every wrong.  He cared.  He showed the place where you start to find your way of being human.  You care.  Amen.