How did you become involved with international development and health care?
Like most 19-year-olds, I couldn’t have told you why I knew I wanted to be a doctor in college. I liked biochemistry, and that’s one of the things you do if you want to be a doctor. And then I took a class called “medical anthropology” because it had “medical” in it. I had no idea what that was, and I loved the material, the projects we did, the papers. So I really did decide I wanted to be a doctor-anthropologist. You’re not always right when you make those guesses as a college student.
How do you combine medicine and anthropology in your work?
Anthropology is about restoring context and being humbled by what you don’t know. In any human endeavor, you create the boundaries of your social world. I kind of attack the idea of cultural competence as illusory. For me, cultural humility is much more important. If you cultivate cultural humility — which anthropology can help you do — you can really have an impact.
How connected are poverty and health care?
A Duke study by an economist surveyed 17 countries. In 16 of the 17, the leading cause of falling from poverty into destitution was catastrophic illness. If that’s the way it works, that means that not only are we failing the poor, we’re creating more poverty without adequate health care safety nets.
I'm making a completely pedestrian claim, that just serving the unserved is innovative.
What are we missing in the U.S. when it comes to health care?
We’re not doing a good job on primary care. Say you have a chronic condition or two. The chances of you getting community-based care for your disease at home or anywhere convenient to your home are very small for the vast majority of the country. For poor people with chronic diseases, that can be very devastating — it’s hard to fill your prescriptions; it’s hard to get to the clinic; and you end up in a hospital when you shouldn’t be.
What do we get right?
Some of the best tertiary hospitals I’ve seen in the world are here. We also have the best research machinery. And it’s largely federally funded. The National Institutes of Health is to me the jewel in the crown of the U.S. When we fund research, that means we get to be the innovators. We also have great students who want to be doctors. Some of the best students who could do anything they wanted are still choosing medicine.
What has been unique about the Partners in Health model in places like Haiti and Rwanda?
Go to a rural area that’s poor. It ain’t a crowded social field. There are not a lot of people lined up to help the destitute sick. So basically I’m making a completely pedestrian claim — that just serving the unserved is innovative.
What keeps you hopeful in the face of growing inequalities?
These are not insolvable problems. They require bold initiatives, but I’ve seen some work. Most of our work is extremely gratifying. You see some sad things, obviously. What keeps me going is it works — you apply the staff, the stuff, build the space you need, get the systems right, and people get better.
What role can people outside the medical profession play?
You don’t have to be a doctor or a nurse to be involved in global health. What we’re looking for is broad-based support for the notion of health equity, which is a crucially important issue in this country and elsewhere. I think this is a human question. It’s not a professional question.