Courtesy Reuters

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

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  • PAUL FARMER is Kolokotrones University Professor at Harvard University, chairman of Harvard Medical School's Department of Global Health and Social Medicine, and a Founding Director of Partners In Health, an international charity that provides health care to and undertakes research and advocacy on behalf of the sick and poor. This article is adapted from his May 2011 commencement speech at Harvard University's John F. Kennedy School of Government.
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