1. On what points/issues do Garrett and Farmer agree? On which do they disagree?
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Generally speaking, Farmer seems to be more optimistic about the current health situation than Garrett. The two agree on many issues, disagree on a few, but mostly Farmer's paper is an expansion of Garrett's ideas rather than a rebuttal.
ReplyDeleteGarrett tells us that doctors are not efficiently distributing medication. She gave the example of Guinea-Bissau where supplies are stored and often wasted.
Farmer says it is not the doctor's job to distribute- that should fall on the "accompagnateurs". He says more than doctors and nurses need to be trained in order to provide efficient medical care.
Garrett argues against Clinton's idea that as the HIV/AIDS situation improves other diseases will improve too. She gives the example of Haiti, where, even as the HIV/AIDS rates improved, "every other health indicator" went backwards. In short, she says aids money distraction from other diseases.
Farmer admits that AIDS not only disease we need to work on, but it leading infectious cause of death in adults and therefor needs the most urgent attention. He claims there is no proof of substantial prevalence rates of other diseases, at least not in Haiti. In addition, Farmer says the Global Fund budget for Haiti was in fact spent on general health issues anyway, just as Garrett thinks best.
On the whole, I read Farmer to be fairly accepting of Garrett's thoughts, even lauding he for drawing our attention to several points such as the need for local infrastructure where aid work is being done ad cooperation between charities.
Agree
ReplyDelete·HIV/AIDS is not the only problem, nor is it completely separate from other problems.
·Aid organizations too often “stovepipe” donations to specific diseases. Both authors agree that “it is simply not possible to have vertical programs in poor, rural areas, because people in those areas typically suffer from more than one disease at a time”. (158) Improving global health requires a comprehensive healthcare system that includes clean water, prevention of disease, and medical facilities that are capable of treating a variety of problems.
·Both Farmer and Garrett agree that “those of us concerned about global health must…make a careful analysis of how the global health outcome gap came to be any why it continues to worsen in spite of many well-intentioned efforts to reverse it.” (159)
Disagree
·Responding to Garrett’s claim that HIV funding in Haiti has caused the country to go backwards on every other health indicator, Farmer says that a correlation has not been proved and, even if it had, political unrest was probably the culprit. In her rebuttal, Garrett seems to agree that political upheaval was at fault. This seems to be a problem of semantics more than anything else; both writers agree that stovepiping of funds hurts overall health outcomes and both (eventually) agree that political upheaval is the reason that Haiti’s health indicators have plummeted.
·Farmer believes that Haiti is the exception to the rule that Garrett originally presents.
·Farmer notes that funds that were donated specifically to fight AIDS in Haiti can be used to improve the broader healthcare situation, which of course is a more effective method to combat the disease. This avoids the stovepiping effect that Garrett deplored and would likely improve Garrett’s success indicators of maternal health and life expectancy.
·To Garrett’s claim that the influx foreign funding could have negative effects on a country (such as new programs hiring all the local doctors), Farmer says that negative effects of funding are entirely preventable and only occur when aid programs are poorly designed. However, Garrett and Farmer agree that the best designed programs reflect the interests of the patients, not those of the donors.
·As could be expected from someone so entrenched in healthcare systems in developing countries, Farmer believes that the problems that Garrett describes do not apply to all programs. Farmer values Garrett’s critique but warns that it should be directed only at the poorly designed programs “lest casual observers incorrectly conclude that good results cannot be achieved, when in fact they can”. (159)
Paul Farmer and Laurie Garrett seem to agree on most things; even when they butt heads, Farmer usually supports Garrett's main point but has problems with a bad example or dismissal of issues he deems important. Farmer takes little offense at Garrett's article, considering he has dedicated his life to a health care program in what she considers and wholly flawed and inefficient system. Both authors concur that skewed distribution of funds, stovepiping, etc., serve to cripple health efforts.
ReplyDeleteFarmer writes a bit more optimistically about the public health situation than Garrett. He wants to acknowledge to successes of extant functional programs, and disputes Garrett's universal application of her analysis of the health community's inefficacy; because, of course, his program Partners In Health has changed countless lives in Haiti and has begun to reform the modern approach to global health. Garrett and Farmer both support a 'holistic' approach to health care, and the employment of local people as 'accompagnateurs.' However, Garrett proposes to include franchises and businesses as part of the plan, to employ local sand produce/distribute drugs.
Re: the 'Haitian paradox,' it seems that Farmer has succeeded in changing Garrett's opinion. That Haiti boasts one of the best HIV/AIDS treatment programs which has decreased infection rates dramatically yet is a country which has been lowering its average standard of life in most aspects is indisputable. Garrett infers a causality and exaggerates the possible connection in order to negate Bill Clinton's theory that HIV/AIDS programs could 'end up helping all other health initiatives.' In his response, after correcting a technicality (Garrett's claim that Haiti has gone backward on 'EVERY other health indicator'), Farmer suggests that Garrett has judged too readily and that Clinton's claim is indeed true. He argues that the 'Haitian paradox' does not disprove Clinton's theory because Haiti's deterioration in health was likely liked to the 2004 political upheaval, not an HIV-only approach to health aid. When Garrett replies, she concedes to Farmer's argument, citing 'political instability' as a valid reason for Haiti's decline. She neglects to respond to Farmer's subsequent support of Clinton's theory and claim that, within a system like Haiti, increased AIDS funds CAN improve general health. In summary, both Garrett and Farmer agree that the stovepiping of funds is inefficient, but while the former uses Haiti as an example of the caustic effects of a vertical approach to health care, the latter attributes Haiti's problems to a different cause and suggests that, with careful planning, vertical approaches can be smoothed out ('horizontalized') to best benefit poor countries.
Anna Ruth
Farmer admittedly agrees with most of Garret’s critique of the global health system that she brought up in her article “The Challenge of Global Health”. He agrees that stovepiping, the uneven distribution of funds, the massive amount of unorganized NGO’s, corruption, and money thrown into a unstable economy causes serious problems. He applauds Garrett for bringing up these points, but his problem with the article is that it puts a bad light on all health organizations, not just the dysfunctional ones. He concluded his essay by saying, “Garrett’s critique is welcome as a part of that analysis, but is should be directed primarily at the badly designed programs—lest casual observers incorrectly conclude that good results cannot be achieved, when in fact they can” (Farmer 159). Farmer does not think that putting money into the health care system is always a bad thing, that there are ways in the current world of global health where good work is being done. Farmer believes that his program, Partner’s in Health, is an exception to Garrett’s model of dysfunctional health care. “Our experiences at PIH, however, suggest that while her general thesis is right, Haiti is not a good example to support it” (Farmer 157).
ReplyDeleteFarmer believes that in Haiti focusing on HIV/AIDS, a critique that Garrett made in her first article, has been working. At PIH in Africa he has put ninety five percent African workers in his facilities, and believes that his approach to HIV/AIDS care is well rounded. Garrett’s main point in her first article was that more attention should be placed on maternal care and life expectancy. Farmer directly responds by saying his HIV work in Haiti has helped these factors. “Even if we measure, as she suggests, by maternal mortality and life expectancy at birth… we see that funds nominally slated for AIDS may be used to reduce maternal mortality and increase life expectancy” (Famer 158). He believes that he has found a way to work around stovepiping and vertical programs, “PIH learned to do this decades ago” (Farmer 158).
Garrett’s opens her response to Farmer by calling Farmer a hero and commending him for his efforts to bring funding to global health. She concedes a bit of her arguments to Farmer, saying that PIH has done a good job of employing locals and accompagnateurs. Overall she agreed that PIH was doing a better job than most, but it still needed more, and everywhere else in public health needed a more radical change. She brings back the point from her first article that even in Haiti with PIH all other areas in health besides HIV is deteriorating. She agrees with Farmer by saying, “Farmer is right to question whether there is a cause-and-effect relationship between the two and to ask what role political instability has played in lowering life expectancy” (Garrett 161), and then she moves beyond him back into her old critiques, “still, the paradox exists” (Garrett 161). She concludes by agreeing with Farmer that results can be achieved, but that the real problems remain, the corruption is still there whether Farmer likes it or not.
The only significant disagreements between the opinions of Laurie Garrett and Paul Farmer stem from the fundamental difference in their approaches to the problem which the "marvelous momentum for health assistance" poses to the global healthcare community. Dr. Farmer approaches the issue from the standpoint that the aid so-far is largely encouraging and, though he recognizes the fact that there are cases where it has indeed not helped and the aid given has not been used most efficiently, the outpouring of aid is a largely positive sign and all that is needed is a redirection of future efforts. Farmer and Garrett express the essence of their mindsets by describing the situation as "The burgeoning of the first sprouts of hope in a long time" and the "threat of bad seeds ruining the harvest" respectively. Farmer suggests that rather than combating "the disproportionate use of scarce health-care resources", we are better to re-focus our enthusiasm "into efforts to close the widening 'outcome gap' between rich and poor."
ReplyDeleteFarmer and Garrett agree that the efforts of many of the organizations working to develop "stovepipe" AIDS treatment programs have created a "brain drain" of healthcare personnel, however Farmer disagrees with the notion that it is necessary for us to directly combat the brain drain conundrum. Farmer suggests the viable alternative of training "accompagnateurs" to provide local treatment and dispersal of HIV/AIDS drugs. Farmer disagrees with Garrett's claim that it is necessary to have Doctors and Nurses in order to establish a viable HIV/AIDS treatment program. Farmer's solution of training "accompagnateurs" would not only solve the problem of needing trained workers to distribute AIDS medication, but that these workers would replace the role of valuable doctors and nurses in dispersal and delivery of HIV/AIDS medications and free them for general practice in a community, a notion that Farmer says is more valuable for HIV/AIDS patients because they can then receive treatment for the various other ailments which coincide with AIDS such as Malaria and TB. Farmer touts HIV/AIDS outcomes better than those in "inner-city" America. Farmer's model of "accompagnateurs" solves the problem Garrett describes in that "stovepipe" models prevent doctors from working to improve the overall health of the community by training local workers and playing off of the doctors and nurses of local hospitals and clinics. In this way they work hand-in-hand with the same medical staff that provide essential services to entire populations instead of stealing them away to work solely for the "stovepipe" program. This is a way in which dedicated funding can still be used to improve fundamental health standards in poor countries while still addressing their target goals.
Farmer agrees with Garrett's claim that corrupt governments and bureaucratic oversight provide a significant challenge to organizations with concerns over the ultimate destination of their money. Farmer counters, however, that the entities providing the oversight are contributing to the problem by creating barriers between the sources of the funding and the projects who need the funding.
Farmer questions the validity of the data which Garrett cites in reaching her conclusion that the focus on HIV/AIDS efforts in Haiti (which she uses as an example applicable to other instances around the world) have actually detracted from the overall health markers of the population, raising complicating factors such as a lack of accurate surveying and a coup which lead to widespread political upheaval and widespread breakdown of the established healthcare infrastructure.
Farmer suggests that while Garrett's concern over the "stovepipe" method, that a more efficient change would be simply changing these stovepipe programs so their resources are addressing their target goals while impacting the general health in the surrounding community. Farmer moves that, although outcomes which starve communities of critical healthcare resources are a huge concern, it is possible to carefully design programs to interact ideally with community healthcare systems that work towards improving overall health in the community. Farmer suggests that Garrett's criticism would be better directed solely at the poorly designed programs which are in fact detrimental to a community, and cautions against criticism which might have the subverse effect of stifling the ballooning enthusiasm for global healthcare projects.
Paul Farmer and Laurie Garret agree on many things and their responses to each other seem more like explanations than rebuttals. They both go on to say how they agree with one another and then go to into further explanations on how they would help. However there are some facts with which they disagree on.
ReplyDeletePaul Farmer has a more hopeful view on the health care.
• He is more interested in closing the gap between rich and poor.
• He thinks that “Accompagnateurs” are of more use than doctors, or nurses when distributing medications.
• “Accompaniment” can help with home-based therapy, social and psychological support, and help with everyday task that would involve feeding families.
• International Financial institutions such as World Bank are not innocent and that they are just as bad as the corrupt governments with giving resources to the non-poor.
• Central Haiti is the exception to the “stovepiping” theory.
Laurie Garret seems to agree with most of everything that Farmer says. She goes into further explanations of their ideas so that they come together as a whole. After reading her response it was as if most of both of their opinions had been combined into one answer. Garret thought that Business and Franchise models should be involved in large schemes of health. She also went on to say that since there is no central drug purchasing center the market for those products remains irrational for the development of cheaper products in poor to middle income countries.
Some of the main things that they agree on would be that Community Health workers are not treated well and should be paid fairly for the work that they do and that a holistic view on health care is required in order to change anything for the better. They also bring up the points that if the countries that were suffering were cleaner, had safer water and better food, the patients would have a better chance of getting better.
Overall, Farer mostly agrees with Garret's thoughts, but sometimes he has to add statistics that proves the examples she used to back up her points weren't necessarily the best ones to use.
ReplyDeleteAgree:
-Farmer agrees with "most of her claims," although he'd rather focus on helping the newfound focus on global health turn into efforts to "close the outcome gap" between the two ends of the economic spectrum.
-"Farmer is correct in saying that a holistic view is not only possible but required."
-Garrett
Disagree:
-Farmer feels that doctors are never good "distibutors" of medications and treatment drugs compared to trained employees, while Garrett thinks that doctors are the key to distributing drugs.
-He also thinks that Haiti isn't a good example to support our experiences at PIH. What I didn't like about Farmer's rebuttle was that he didn't state what a better example would be.
Madeline Allen
Farmer and Garrett seem to concur for the most part on those fundamental issues proposed in Garrett’s article. Agreeing that there is a “disproportionate use of scarce health-care resources” (Farmer, 155), along with an acknowledgement that stovepiping and governmental corruption serve as major hindrances to the success of a global health initiative, Farmer’s main discrepancy is with Garrett’s pessimistic implications; he agrees that the “global health outcome gap” is worsening in certain areas, while arguing that this is the result of poor organization on the part of some NGO’s, not all of them.
ReplyDeleteIn her article, Garrett calls to light the detriment to health care aid a bolstered emphasis on HIV/AIDS treatment provides. Farmer agrees that in the most impoverished countries there is no “veritcle” or narrowly defined solution, and that money needs to be spent in a universal way as citizens often suffer from more than one illness, while he also discredits Garrett’s broad example. In rural Africa, Farmer says that, even as AIDS is not the only disease faced, “it is the leading infections cause of adult death” (Farmer, 155); the extra resources allotted to combat AIDS has saved thousands, and were resources well spent. Farmer also accounts for countries where stovepiping was overcome or “subverted”; money and aid were used to augment basic health care and infrastructure, and therefore do not always lead to the hopeless outcome that Garrett portrays.
Farmer also addresses the shortage of trained medical personnel to administer treatments in destitute communities. Both Farmer and Garrett agree that a solution to the dominant issue can be found in employing local hands as accompangneurs, or locals to assist in “health promotion and patient supervision” (Garret, 160).
Garrett provides Haiti as a prime example of “the distortions that frequently ensue when large sums of money are introduced into cash-starved health systems” (Farmer, 157), and the problem with stovepiping. Farmer maintains that the ideas are good; introducing too much money into an impoverished system leads to many detrimental outcomes as does money filtered in for one sole purpose while other issues are neglected. He disputes, however, the use of Haiti as an example of such. HIV treatment has been a major focus with Haiti with promising outcomes unrelated to the uprising of any other infectious diseases circulating. Furthermore, he argues that stovepiping is not such a big factor in Haiti, as money was used to “strengthen the public health system in general” (Farmer, 158).
Finally, Farmer offers a correction of Garretts statement that NGO’s do little to nothing to help the global health crisis, saying that “perverse effects… occur only when programs are poorly designed” (Farmer, 159), and that some funds have indeed made a substantial difference in the health systems of some very poor countries. He encourages a new emphasis on organizing and analyzing those programs that aren’t effective, as progress is possible and continues to be made in some ways.