International Health Issues and
Personal Experiences
Reflections on Social Justice, Working
Collaboratively, and Teaching by
James Beebe
Interest in international health
 Issues illustrated by the work of Paul
Farmer
 Origins in Peace Corps Experience
 Related to:
Commitment to social justice
Passion for working collaboratively across
national and cultural boundaries
Love for teaching
 Relevance of Rapid Assessment
PAUL FARMER
PAUL FARMER
Pathologies of Power
PAUL FARMER
Pathologies of Power
 “This is an angry and a hopeful book.
It has both passion and authority.”
 “He combines an unflinching moral
stance--that the poor deserve health
care just as much as the rich do--with
scientific expertise and boundless
dedication.”
 “illuminates the pathologies of a
world economy that has lost its soul”
PAUL FARMER
“superb physician, a penetrating
anthropologist, and a prophet of social
justice”
PAUL FARMER
Multi-drug resistant tuberculosis, AIDS ,
and human rights violations
PAUL FARMER
Reporter: With so much suffering, is
it sometimes hard to maintain a
positive outlook?
Paul Farmer: Very difficult. It’s
important to see the little victories,
which are not so little to those who
are served by these projects.
PAUL FARMER
Two issues with Paul Farmer
 Assumption that medical care is
provided by MDs and no discussion of
the role of others providers of
primary health care.
 Assumption that the traditional
approach of anthropologists, including
long field work, is the only approach,
with apologies for using more rapid
approaches.
PEACE CORPS
VOLUNTEER
Peace Corps, Public School
Castillejos, Zambales, Philippines
Peace Corps
Teaching, Bontoc Community College
Peace Corps
Planting rice, harvesting the 2nd try
Peace Corps
Developing curriculum materials
Peace Corps
Even though only a Peace Corps
Volunteer for four and a half years,
the experience has had a significant
impact on who I am and who I am in
the process of becoming.
Peace Corps
Experiences with on health issues




Stupid Deaths and Angels
Cholera Vaccinations and Tradeoffs
Rabies and Rural Reality
Infections and the Environment
International Health
Interest based on three factors:
 Commitment to social justice
 Passion for working
collaboratively across national
and cultural boundaries
 Love for teaching
COMMITMENT TO
SOCIAL JUSTICE
COMMITMENT TO SOCIAL JUSTICE
My belief: Justice not Compassion
 Motivation for action should not be
based on compassion
 Compassion implies action is optional
 Those who believe that charity is the
answer often regard those needing
charity as intrinsically inferior
COMMITMENT TO SOCIAL JUSTICE
According to Paul Farmer
There is an enormous difference
between seeing people as the victims
of innate shortcomings and
seeing them as the victims of
structural violence.
COMMITMENT TO SOCIAL JUSTICE
Health as a fundamental human right
 I agree with Paul Farmer that health
is a fundamental human right.
 Farmer contrasts this with a
perspective that health is a desirable
outcome to be attained through the
purchase of the right goods and
services.
 “The commodification of medicine
invariably punishes the vulnerable.”
COMMITMENT TO SOCIAL JUSTICE
I join Paul Farmer in concluding:
 Social justice requires a preferential
option for the poor.
 Conditions of the poor are not only
unacceptable but are the result of
structural violence that is humanmade.
 Working for social justice requires
working with the poor as they
struggle to change their situation.
PASSION FOR WORKING
COLLABORATIVELY
ACROSS NATIONAL
AND CULTURAL
BOUNDARIES
WORKING COLLABORATIVELY,
Dissertation research on farmers
Barrio Gugo, Calumpit, Bulacan, Philippines
WORKING COLLABORATIVELY, Gugo
Dissertation research on farmers
WORKING COLLABORATIVELY, Gugo
Dissertation research on farmers
WORKING COLLABORATIVELY, Gugo
Dissertation research on farmers
WORKING COLLABORATIVELY, Gugo
Dissertation research on farmers
WORKING COLLABORATIVELY, Gugo
Dissertation research on farmers
WORKING COLLABORATIVELY, Gugo
Dissertation research on farmers
WORKING COLLABORATIVELY, GUGO
Experiences with health issues
 ORT and small but significant
innovation
 TB and the ability to sustain
treatment
 Pneumonia and access to medical
care
WORKING COLLABORATIVELY
Umm Hijliij Breimya, El Obeid, Northern
Kordofan, Sudan
WORKING COLLABORATIVELY, UMM HIJLIIJ
Rapid Assessment
WORKING COLLABORATIVELY, UMM HIJLIIJ
Rapid Assessment
WORKING COLLABORATIVELY, UMM HIJLIIJ
Rapid Assessment
WORKING COLLABORATIVELY, UMM HIJLIIJ
Rapid Assessment
WORKING COLLABORATIVELY, UMM HIJLIIJ
Rapid Assessment
WORKING COLLABORATIVELY, UMM HIJLIIJ
Rapid Assessment
WORKING COLLABORATIVELY, SUDAN
Experiences with health issues




Malaria and the limits of prevention
Ebola Fever and accidental exposure
Schistosomiasis and culture
Hepatitis and the difficulty of
diagnosis
Rapid Assessment
Process RAP
James Beebe
Gonzaga University
2005
RAP
RAP is intensive, team-based
ethnographic inquiry using
triangulation and iterative data
analysis and additional data collection
to quickly develop a preliminary
understanding of a situation from the
insider’s perspective.
Results can be produced in
•
as few as four day,
• but usually requires several
weeks.
The RAP team should seek out
•
•
•
•
the poorer,
less articulate,
more upset, and
those least like the members
of the RAP team.
Stories NOT Answers
The goal is to get the
insiders to tell their stories
and NOT answer the
questions of the outsiders.
Successful RAP
•
•
•
Members of the RAP team need to
recognize:
They don’t know enough to ask questions,
They don’t know enough to provide the
answers, but
They do know enough to want to empower
others to solve their own problems.
Iterative Analysis and
Additional Data Collection
Time is divided between
• blocks used for collecting information
and
• blocks when the team does data
analysis and considers changes in
the next round of data collection.
RAPID ASSESSMENT PROCESS:
An Introduction (2001)
http://www.rapidassessment.net