In 1848, Rudolf Virchow, one of public health's heroes, contended that "medicine is a social science, and politics is nothing other than medicine writ large." It would please me greatly to think that Virchow's point has been taken. Although I'm a physician, these past two years have been an object lesson about the difficulties of scaling up and of moving from caring for individual patients to building health systems in settings of privation and disarray.
A few years ago, building health systems was precisely what I thought I knew most about. But the January 2010 earthquake that ended so many Haitian lives and destroyed so much of its infrastructure was a grim reminder that we still lack the ability to translate goodwill and resources into robust responses. Reflect, for a minute, on the limits and the potential of the activity that used to be called "charity" or "foreign aid" but that I prefer to call "accompaniment."
"Accompaniment" is an elastic term. It has a basic, everyday meaning. To accompany someone is to go somewhere with him or her, to break bread together, to be present on a journey with a beginning and an end. There's an element of mystery, of openness, of trust, in accompaniment. The companion, the accompagnateur, says: "I'll go with you and support you on your journey wherever it leads; I'll share your fate for a while. And by 'a while,' I don't mean a little while." Accompaniment is about sticking with a task until it's deemed completed, not by the accompagnateur but by the person being accompanied.
Read more at at Foreign Affairs' Special Report: Global Public Health.
I teach at Harvard but volunteer with Partners In Health (PIH), an organization dedicated to providing health care for the poor that I helped found over 25 years ago. PIH has sought to make accompaniment the cornerstone of our efforts, from rural Haiti to neighborhoods in Boston and prisons in Siberia. In each of these settings, there are people who need long-term help: patients with chronic diseases and families facing persistent poverty. But health officials serving those areas routinely lack resources to provide it. In other words, even the accompagnateurs need accompaniment...