Molly Short RN

July 24, 2020

NSG 469

Population Health

 Paul Farmer finds ways of connecting with people whose backgrounds are vastly different from
his own. How does he do this? On page 20 the book says that “It usually takes him an hour to
make his way through the courtyard”. This is because Farmer stops to visit and help the Haitian
people on the way to see his patients. The book said that close to a million peasant farmers
relied on Dr Farmer and his team at Zanmi Lasante for care. He would not allow anyone to be
turned away if they could not pay. Haitian colleagues had wanted every patient to pay what
was equivalent to 80 cents for care, Dr Farmer had agreed that all patients except woman,
children, the destitute or the seriously ill would have to pay for care. (pg 21 Kidder)

 Are his methods something to which we can all aspire?  Why or why not? Absolutely I think that
we all could learn lessons from Dr Farmer. Just because a patient is unable to pay that does not
mean that they should not receive care.

 What lessons can you learn from him to apply to your own nursing practice? Cite specific
examples from the book. On page 208 Farmer stated that “someone needed to have a revolt on
the Haitians behalf”. Then stated that it “would be regarded as a total joke.” In todays practice
we as nurses need to stand up for our client’s rights and not worry about looking like a joke in
front of people.

 What is the “epi-divide” and how does the incidence of TB fall along that divide?   According to
Farmer the “epi divide” is a simple epidemiological map based on what makes people sick, what
kills them, and in what numbers and in what ages. The map is coded in two colors one standing
for populations that tend to die in their seventies, mainly from illness that seem to be inevitable
accompaniments to the aging of the body. The other color stands for the groups of people who
on average die ten and even forty years earlier, often from violence and hunger and infectious
disease that medical science knows how to prevent and to treat, if not always to cure. (page 124
Kidder)

 Also, Farmer designed a study to find out whether there was a correlation between his Haitian
patients’ belief in sorcery as the cause of TB and their recovery from that disease through
medical treatment. What did he discover about the relative importance of cultural beliefs
among his impoverished patients and their material circumstances? Most all the patients when
asked believed that TB came from sorcery. But this fact was irrelevant when the study results
were reviewed the group that got not only the free treatment, they also received other services
including visits from a community health worker and monthly cash stipends. This group was
cured. The group that only received the free treatment only 48% were cured. (p 34 Kidder)

  Do you think that this discovery might have broad application – for instance, to situations in the
U.S.? Yes, I do I think it proves that patients need more than just medication to be cured or
 treated for a medical condition. To have better chances of survival patients need also need
supportive care. They need to be followed up with to be sure they have enough money for
food, childcare and transportation. The treatment can’t be centered around the illness it has to
be centered around the whole persons wellbeing.

 Kidder points out that Farmer is dissatisfied with the current distribution of money and medicine
in the world.  Consider the following:

 How specifically has this book influenced your understanding of worldwide health disparities,
both in the U.S. and around the world? I was aware that there are health disparities in the
world and in the U.S. But, having them explained in such detail really made realize the depth of
the disparities. For example, people are concerned about the lack of needed personal
protective equipment during the COVID 19 pandemic, in some countries the people have no PPE
ever and are cleaning wounds with dirty water. I think that puts things in perspective.

 What is your opinion of the distribution of these forms of wealth? Forms of wealth being the
medical treatment, equipment and clean water, I believe that all persons deserve clean water
and equal medical treatment. It should not depend on the amount of money that a person has
as to whether or not they are able to receive high quality treatment.

 What would you change if you could? I would find a way to raise the money for everyone in the
world to have equal high-quality medical care. I think that governments of all country’s should
work together to ensure that they all have they same information and support one another to
ensure quality health care is provided for all.

 What role, if any, would you as a nurse play in beginning to rectify this vast disparity? Be an
advocate for my patients standing up for their rights and ensuring that they get the care that
they deserve.

 In your opinion, is there a moral imperative to change the way that things are currently
distributed both in the U.S. and around the world? An idea is to have more fundraising events
to assist with medical care. There could also be universal health care all, so that everyone can
have equal medical care. There also needs to be away to get needed vaccines in all countries.
The leaders need to get together and share the medical information and discoveries, so that all
the countries have the same information and that the information is up to date.

 How will this influence your nursing practice stateside and/or abroad? I will continue to
advocate for my patients and put their needs first. Continue to educate people on the needs of
other countries.

 Mountains Beyond Mountains is written by a white man from the United States about another
white man from the United States who seeks to improve the lives of poor people of color in Haiti
and other parts of the so-called Third World.  What issues and assumptions regarding race, class,
and nationality in relation to service and activism are raised, both implicitly and explicitly, by the
book? Be specific. How might your thoughts on this question relate to your nursing practice here
in the U.S., when you consider your care of patients who might differ from you in one or all of
 those ways? When Dr Farmer first arrived in Haiti, the native Haitians would yell “blan, blan”
meaning white when they saw him. In my opinion, this was calling him out as a tourist. Once
the people of Haiti realized that he was there to help them, they no longer did called him that. I
feel that this is a foreign white man helping native Haitians and a key component of this help
should be education and training so the natives can help themselves. This goes back to the
saying “give a man a fish, you feed him for a day. Teach a man to fish, he can be fed for a
lifetime.” I believe that education and resources are the keys to patients’ success no matter the
race. This is the same for people of the U.S. They need to be better educated and resources
provided in underserved areas in order to be capable of taking better care of themselves
medically and financially.

References

Kidder, Tracy. Mountains Beyond Mountains (p. 21). Random House Publishing Group. Kindle Edition