Doctor teaches a divinity school about corporal works of mercy

It is an interesting commentary on the state of the church when the most well-attended event in Yale Divinity School's recent history is a lecture not by a minister or theologian, but by a physician.

On April 26, Dr. Paul Farmer, chairman of Harvard Medical School's Department of Global Health and Social Medicine, addressed the Divinity School community on "The Corporal Works of Mercy and the 21st-century Struggle Against Poverty."

He is uniquely qualified to comment on the topic. In the last three decades, Farmer has traveled to Haiti's squatter settlements, Peru's slums, Siberia's prisons and Rwanda's impoverished rural villages to provide medical care to some of the poorest and most oppressed populations in the world.

In 1987, Farmer co-founded Partners in Health, a nonprofit organization that brings the benefits of modern medicine to those most in need and works to alleviate the crushing economic and social burdens of poverty that exacerbate disease.

I wasn't able to attend the Farmer event because of a speaking engagement, but watching the live stream over the Internet and hearing accounts of the event from friends and former colleagues, I felt compelled to reflect on it.

Because as interesting as Farmer was to listen to, equally as interesting was who came to listen to him.

Almost 500 people packed into the Divinity School's Marquand Chapel and two overflow rooms. Not only was the crowd intergenerational, it was also deeply ecumenical. The chapel was filled with mainline Protestants and non-Christians, evangelicals and non-believers, fully habited nuns and very progressive Catholics.

All came to listen to a man who seems to live out a vision of "church" longed for by many ministers, theologians and laypeople. Unlike most of us who espouse the preferential option for the poor, Farmer and his partners have actually made this ideal a living reality.

According to NCR columnist Jesuit Fr. John Dear, who befriended Farmer when they were undergraduates at Duke, the night of Oscar Romero's assassination was a turning point in Farmer's life. In a 2008 column, Dear reminisced about attending small prayer vigil with Farmer to honor the slain Salvadoran archbishop.

"It was the first time he realized that Christianity meant siding with the poor, advocating for the poor, speaking out on behalf of the poor, and abolishing poverty itself," Dear writes.

According to Tracy Kidder's biography of Farmer, Mountains Beyond Mountains, Farmer's interest in Haiti was inspired by a Belgian nun, Sr. Julianna DeWolf, who was working with the United Farm Workers not far from the Duke campus.

"Through Sister Juliana, he came to know many farm workers, including a number of Haitian migrants," Kidder writes. "Farmer was fascinated by their stories and began to learn everything he could about Haiti, studying the Creole language, interviewing migrant workers and reading scores of books about the island nation's tragic history."

Farmer took these lessons with him as a first-year medical student in Haiti.

"I never understood why it was important to think about the corporal works of mercy until I went to Haiti," he told the crowd.

But it was a lack of mercy that first motivated Farmer. In his first assignment in Haiti, he witnessed poor people paying for inadequate care and ineffective medicines.

"It was a total nightmare," Farmer said. "I didn't even know how to talk about it."

In 1983, Farmer traveled to another part of Haiti called Cange, where the construction of a dam had forced residents to settle on a barren hillside. The site was notorious for its high levels of illness and death. It became one of Farmer's greatest teachers.

"The best place you could ever start to work in public health is in a squatters' settlement of landless peasants," he said.

By 1985, Farmer helped to establish Clinique Bon Sauveur in Cange. What began as a two-room facility developed, room by room, into a full-fledged hospital. The clinic came at a crucial moment. By 1986, AIDS began to emerge in the Haitian slums.

By treating his Haitian patients, Farmer became an expert in drug-resistant tuberculosis. His knowledge led him to the prisons of Siberia, where doctors were overwhelmed with inmates afflicted by TB. "Visit the prisoners" is one of the corporal works of mercy that taught Farmer one of his most important medical lessons.

Farmer noted that his method of learning medicine paralleled the ideas of Gustavo Gutierrez, the liberation theologian he befriended while working with the sick in Peru. Gutierrez taught Farmer that learning theology should "lead you into the slums and squatter settlements and prisons and back waters."

"I owe a great debt to liberation theology. It taught me the lessons I didn't understand as a child going to church," said Farmer, who was raised by a Catholic mother and an atheist father.

Websites listing Farmer's most popular saying typically place this quote at the top of the list: "Conventional Catholicism does not appeal to me." Yet it is liberation theology that has most grounded Farmer's commitment to bringing social justice to public health.

"The preferential option for the poor is so radical compared to any ideology. It says not only should you take care of the poor, you should take better care of the poor. I have never seen that really applied in medicine or public health anywhere."

Farmer says throughout his career, he has constantly heard the refrain, "If it costs a lot, it's too much for the poor." Most health care decisions are based on cost-effectiveness "without a critical understanding of cost or effectiveness," he said.

"I learned a lot about the corporal works of mercy in Haiti, but I believe these lessons are applicable in the U.S. In the shadows of the great teaching hospitals like Harvard, you'll find people living in poverty," Farmer said. "You always find that diseases run together with social pathologies. In Haiti, it's hunger; in Russia, its alcoholism; in the U.S., it's homelessness. But in every case, what I see is that we are way too quick to give up on people who are marginalized by poverty."

Farmer's desire to "apply liberation theology to medicine" is perhaps best summed up on PIH's website, which reads, "Our mission is both medical and moral. It is based on solidarity, rather than charity alone."

Twenty-five years after its founding, PIH continues to provide excellent, comprehensive medical care to the world's most desolate regions. Today, they have 11,000 employees working in 49 health centers in 11 countries. Farmer says none of this work would be possible without partnerships, particularly with community health workers.

"My co-workers would never and have never used the term 'corporal works of mercy' " for what we do, Farmer said. And yet, without being religious, Farmer and his colleagues have managed to become the incarnation of the Gospel values in ways that surpass many Christian communities. One wonders how many PIH workers are aware of the impact that Oscar Romero, Gustavo Gutierrez and Sr. Julianna DeWolf had on the work they do today.

Partners in Health offers a vision of what "church" could look like when a community shifts away from the doctrines of exclusion and obedience and, instead, commits itself to the teachings of solidarity and compassion.

During a time of deep divisiveness between liberals and conservatives, traditional and progressive Catholics, and evangelicals and nonbelievers, the fact that one lecturer could draw members from all of these communities into one chapel is a testimony to the enduring, unifying power of mercy.

[Jamie L. Manson received her Master of Divinity degree from Yale Divinity School, where she studied Catholic theology and sexual ethics. Her columns for NCR earned her a first prize Catholic Press Association award for Best Column/Regular Commentary in 2010.]