Discussion: On Humility and Working With People, pt 1

September 13, 2006 at 7:19 pm (Michael's Posts)

I have begun reading a book that has long been on my list, Mountains Beyond Mountains. I saw Dr Farmer speak at Brown in front of an awed crowd of my friends and classmates (and many of this blog’s contributors, I might add). The experience followed a reading of some of Farmer’s work in courses and a discussion with a professor about Farmer’s personality. I should add that this professor had mixed things to say about the good doctor. Details of what that impression was built on have since escaped me, but the impression stuck because I was of a single mind about Dr Farmer. I was impressed. No, I was floored, KOed. And I thoroughly disbelieved that my professor was criticizing him.

When I saw him speak at Brown, I loved most of what he had to say; it resonated with my beliefs and goals perfectly.  But something struck me. I couldn’t quite put my finger on it, but something about his manner rubbed me the wrong way.  I waited in the long line of bright-eyed optimists to shake his hand and say hello afterwards. In his eyes, there two gleams: a great optimistic drive in life accompanied by something else.

So now I am reading the account of Tracy Kidder’s time with Dr Farmer. There are parts that remind me of that other thing I saw in his eyes that evening. But only vaguely. And then Kidder said something that connected the dots:

” In any case, he seemed to think I knew exactly what he meant, and I realized, with some irritation, that I didn’t dare say anything just then, for fear of disappointing him.” (Kidder, 44, italics mine)
There are great personalities in this world that one feels awed by simply by virtue of who they are and what they do. To many people, Farmer is certainly one of these. But there seems to be an edge of arrogance to him, something trying to convince everyone that he really knows better than they do.
But his arrogance is complicated. He’s extremely proud of himself for working with those who are downtrodden. Far from humble, Farmer seems to drive forth with an undercurrent of egotism. Certainly, in his work with patients, he appears attentive and unbelievably generous and good. But to his American guest, he sports this like a trophy. This seems paradoxical in some sense. And it makes me want to shout, “Paul, I know you do good stuff. But not everyone else is wrong all the time for not doing what you do! It’s insulting to act that way.”

My impression of the man may change as I read the book, but that isn’t the point.

This post is about something more than my reaction to Dr Farmer’s apparent arrogance (real or imagined). It’s about how we are going about our work in the world. People Farmer works with call him a god. It seems like that got to his head. What is the role of the ego, if any, in our work in the world. Farmer is fighting great forces of inequality and possibly that assurance/arrogance is used to pierce the protectice layer of complacency that so many Westerners have. But could it also drive people away? Is one risking the silencing of dialogue (as Farmer’s arrogance silenced Kidder in the quoted passage)? And if so, is one silencing change?

In the spirit of this question, I suggest a dialogue. Farmer’s egotism is not really the question, but merely the springboard to a greater question of how we should approach this work and a big example that many of us are familiar with that we can compare our own motivations to.
-Michael Soule-



  1. sstolper said,

    I have never met Paul Farmer before. Nor have I heard his voice or read his work. I have only read Mountains Beyond Mountains. I think the book was great. I think Paul Farmer is great.

    From my personal experiences, when someone does something differently than the rest of a community, it is inherently insulting. I’m excluding, of course, the areas of life where we accept multiple different practices and acknowledge that we don’t know the answers.

    In the world of global health, I think there might be a lot of established norms of how to deal with infectious disease. Paul Farmer disregards these norms a lot – he spends lots of money, quickly, on small groups of patients; he goes against World Health Organization-accepted procedure; and he insists on using his powers in the field, not in the conference room, where most people think he’d be best. It’s only natural that people who have been following protocol would feel insulted when he more or less says, “I think I can do it better.” I really believe that this, and not the idea that he is actually doing things wrong, is why people sometimes don’t like Paul Farmer.

    Yeah, he is definitely proud and outspoken. But he’d piss people off anyways, just because of all the press and adulation he gets for doing things differently. I’m okay with it. I think he’s doing an excellent job. How many people has he galvanized with his writing, his speaking, his story? It’s possible that he focuses too much on the individual. But I have three things to say about that: one, I am not convinced that any other method would have been as successful as Farmer’s in Peru and Haiti (let me know if I’m dead wrong); two, maybe Farmer has figured out that direct interaction with the individuals themselves is the best way to motivate oneself; and three, he’s not perfect, but relative to the rest of the world he’s doing a pretty good job.

  2. msoule said,

    I think you’re right. As I read on in Mountains Beyond Mountains, I am coming to see that my initial reaction to his arrogance was the ego-driven, knee-jerk reaction that make a lot of people in high places not like him at first. I felt belittled and put down by his seemingly endless energy and zealousness. He put me out by making me feel like what I did and thought was nowhere near as good as it had to be to come up to his standards.

    As I read on, like the head of the Russian TB program, i came to like him more and more. His self-righteousness came across as a rallying cry for the poor instead of a self-congratulatory litany as I read about his extreme commitment to people, his patients. As I read, I realized that I had pinpointed in my post what his attitude might be useful for: cutting through the excuses and bullshit that keep the people he advocates for from getting what they need (in his mind, what they deserve). It’s about time someone had that attitude about the poor and followed up on it in the meticulous, amazing fashion he does. And the fact that when he is with his patients, none of that attitude seems to transfer. Kidder’s accounts of his bedside manner seem to have no trace of the egotism that powerful doctors are at times afflicted with.

    So maybe it’s a tool. And it seems like a good one.
    But my original caveat still stands, I think: how do we balance this attitude with the careful awareness that we are not serving our own egos, but rather the people stricken with illness. It is easy to let the whole enterprise come off like an ego trip (like Farmer seemed to come off immediately to me) and let it become a crusade for My Cause. What Farmer never forgets is his people in Haiti and this keeps him from falling into that trap of self-centeredness.
    This may be the reason that so many solutions come up with in boardrooms have so little to do with the reality on the ground. It’s a lot of Big Guys’ Good Ideas, but they’re not good clinicians, so they don’t work out. It’s like economic decisions made for the poor that don’t work because they are based on a Good Idea, not Reality. Coming back to Farmer, his connection to Reality allows him to go into the boardrooms and say, “I can do it better” and actually DO it better.
    I know my original post came off as a little Anti-Farmer (and maybe I was feeling that way when I wrote it), but I am more with Sam on this one now as I have read on.
    Rock on, Dr Farmer.

  3. misarita said,

    Oh, Paul Farmer. This man has probably caused more fights in my life than any single other person that I’ve never met.

    I’m always torn. He has almost single handedly changed the health care system in Haiti. Clearly he knows a lot that I don’t.

    But I agree with Michael’s first impression–I’ve never been able to wash my hands of the sense that he has more than a slight ego trip that is the driving force behind is work. Does it matter if the outcome is so positive? Yes and no. For the immediate benefit of those that he helps, no. But if we’re going to change the paradigm that the world values some people more than others, that it is OK that people live under squalid conditions as long as they are far removed from those of us who are more comfortable, then I think that we need to have some pretty delicate changes in the way that we conceptualize and deliver the right to health care. I don’t think that it can be done with arrogance–it needs to be done with an attitude of respect and service to ALL sides involved. It needs to win people over on the side of the privileged so that they will be inclined to help, not alienate them.

    I also have always had the sense that Dr. Farmer places all the blame for Haiti’s challenges on the outside world. “Look at how much they’ve been oppressed. We owe them everything.” I would never want to deny the damages that international politics has played in the way Haiti is currently. But I do believe that people must take responsibility for change if it to be sustainable. I have a friend who spent 6 months in Haiti. His impression was that the biggest problem that is currently facing Haiti is the massive apathy of the average citizen. Can you blame them? When you live under a system where you get no results for your effort, you learn to stop trying. To me, this problem needs to be addressed as well. Dr. Farmer’s focus on how Haiti has been wronged may be missing the mark in this sense–while it is true, it matters less than how to inspire people to be their own advocates.

  4. msoule said,

    Get ready, I’m going to sound like a true Brunonian economic radical. Just bear with me.

    One of my reactions to what Sarah is saying is, “Very true.” People do need to take hold of their own destinies and they cannot simply let someone else do all the work for them. Otherwise, we risk removing the drive from the people. That’s not the point. We’re there to help them, not make them dependent.

    However, there is the stark political economic truth that Haiti (as many of the other countries in the “developing world”) had its blood sucked from it systematically by powerful Western nations. It is hard to look around in India and imagine that when the British showed up in the 1700s, it was a land coveted for its riches. Not only was it coveted, it was raped and pillaged and drained of its wealth. Where did all the money go? Towards the industrialization of England, that famous age when Western Economies began to Rise Above. But they didn’t do it on their own. They had help and lots of it: the wealth of the Southern Hemisphere. One might even say, if one felt truly radical, that European economies became dependent on that wealth. If you’re sceptical, have a look at the book “King Leopold’s Ghost” and witness the scene where the European powers divvy up Africa into colonies. As if there is no one living there and using that wealth already. Truly shocking and deeply saddening.

    So while I agree that there needs to be encouragement to take hold of one’s destiny, there also must be awareness that truly, we do owe these people our comforts. They were not always poor. Before they were brought under the heel of European economies, they were not poor. Certainly now, they are still being oppressed by the US as Haitian political movements that recognize the plight of the poor are subverted by the US. So while Farmer’s arrogance is off-putting and really makes us defensive of our own positions, it ought not to. His crusade to bring resources back to the now-impoverished countries is bold and it challenges us. He is striving to put a bit of the energy that we’ve taken out back in, striving to re-balance the power. We should be inspired, not defensive.

    I think this talk of “sustainability” is good, but it is far too early on the scene. It seems a liberal excuse for not reappropriating the resources. A project is deemed “not sustainable” if it requires too many outside resources. But the resources in the community are limited by such factors as basic health and nutrition, and so the projects that can be of the most benefit are not undertaken because the resources do not exist inside the community. Herein lies the quandary: have the most benefit OR have much less but “sustainable” benefit. Since we have the power to have the most benefit, it seems unethical not to.

    Definitely we can’t hold their hands once they have the power to walk, but right now, that’s not the case. Let’s cross that bridge when we get to it.

  5. Wiki Lover said,

    Well with wiki i noticed there is a danger of…..

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: