The Difference Between Charity and Philanthropy

Haiti is a country rife with tuberculosis and AIDS, malnutrition, dysentery, worms, and malaria. It is plagued with alarming rates of infant and maternal mortality. A staggering 25% of Haitians die before they reach forty. In Mountains Beyond Mountains, an intriguing and page-turning account of the life of medical anthropologist and physician Dr. Paul Farmer, Pulitzer Prize-winning author Tracy Kidder transports the reader into the heart of this troubled region.

Reading Kidder’s description of Dr. Farmer’s life and work in Cange, Haiti and comparing it with Farmer’s childhood, one senses that he was particularly suited to embrace the constant sacrifices entailed in living amidst great poverty. Living simply was not a foreign concept to Farmer. He grew up the second of six children and had what can only be described as a colorful childhood. Having lived with his family of eight in a large bus (nicknamed “The Blue Bird Inn”) that his father had bought at an auction and which they drove from Birmingham to Florida and stationed at a trailer park, Paul was used to the inconveniences of doing without. Following five years of living in the bus, his father bought a houseboat. He built a cabin for it and, after a few eventful voyages into the Gulf of Mexico, anchored it in an otherwise uninhabited bayou. The Lady Gin then became the family home during Farmer’s high school years. Kidder’s description of this unusual childhood makes for an enjoyable and sometimes hysterical read. Fast-forwarding some years, Farmer’s home in Haiti is described as a simple peasant house with concrete floors, a metal roof, and no hot running water. The hot dog bean soup of his childhood seems to have prepared him for a lifetime of simple cuisines and opened a space for gratitude within him. Farmer’s youth included receiving the Sacraments of Initiation in the Catholic Church and attending Mass, though he described his childhood religion as “perfunctory… and nowhere near as exciting as the stuff I was reading.” Happily, among his favorites at age eleven were Tolkien’s The Lord of the Rings and Tolstoy’s War and Peace, the reading of which he describes as a religious experience.

Awarded a full scholarship to Duke, he then went on to Harvard Medical School where he also studied anthropology, becoming enthralled by all things Haitian. However, it was not until he struck up an unlikely friendship with a millionaire donor, Tom White, that his dreamed-of project in Haiti could be realized. Together with a few others, White and Farmer formed Partners in Health, a nonprofit that continues to provide much-needed nutritional and medical care to the people of Haiti, as well as other countries. Farmer’s work ethic is, at first glance, impressive; looking more closely, it appears nearly insane. With little sleep and a constant search for new ways to bring in resources and raise funds, he seems to never stop moving. In addition to its work in Haiti, Partners in Health began operations to research and fight multi-drug resistant TB in Peru, Russia, and South Africa, the findings of which were presented to the World Bank; consequently, Farmer was thrown into international health politics and a myriad of projects, too numerous to mention.

Farmer’s life’s work seems almost beyond critique. He is a man whose life is truly given for others, for the “least of these” that Christ describes (Mt 25:40). Yet despite his heroic embrace of charity as he understands it, and notwithstanding his heartfelt love for the poverty-stricken people of Haiti, Farmer’s methods as portrayed by Kidder are at times not simply unorthodox—which in a system battling constant corruption can be meritorious—but perhaps overly harsh. Writing from the Christian standpoint, one wonders if this undercuts the charity that he wishes so much to convey. His initial intentions, portrayed as youthful idealism in his college years, have an attractive purity to them. Yet alongside this there is an implied scorn for structures and institutions of power, among which the Church is subtly counted. “I’m still looking for something in the sacred texts that says ‘Thou shalt not use condoms,’” Kidder quotes Farmer saying. While the book does not address the complexity of Farmer’s interior life, it is certainly implied by Kidder that Farmer rejects formal Catholicism, insofar as he fails to see the relevance of Church precepts to international healthcare or even the importance of a personal relationship with Jesus.

More positively, Kidder often describes Farmer as one who listens. Farmer immersed himself in Haitian culture and took notes wherever he went, inquiring about water and food supplies, sanitation concerns, local health centers, livestock, vaccinations, and mudslides. He had a keen sense of awareness that the people of Cange would know best what the people of Cange needed. But while he certainly gave an ear to the local people at any moment when beckoned, one wonders if he would have been willing to listen to other missionaries that had gone before him, whose mission was to bring, firstly, the light of Christ into the darkness of the world. For instance, one wonders whether his embrace of the Marxist ideology of liberation theology, which initially attracted him to his Catholic faith, is adequate to addressing the most essential questions, the questions that would have motivated Farmer’s predecessors: namely, who the Person of Jesus Christ is, and, ultimately, how to relieve the greatest poverty that exists in every corner of the world—that is, the absence of the light of Christ.

“One Nation Under Stress,” a 2019 HBO documentary produced with Dr. Sanjay Gupta, offers an American comparison. This film highlights the staggering rise in the United States of what have become known as “deaths of despair” (i.e., opiate overdose, drug and alcohol abuse, and suicide). The documentary serves as a poignant reminder that the lack of meaning and hope is a poverty that demands a response in the modern world. While not the same as the squalor, disease, and inequality that exists in Haiti, it is nevertheless a great suffering. As Mother Teresa observed in a 1975 interview, the poverty of the developed West was greater than the poverty of India because “your people suffer such terrible loneliness and emptiness. They feel unloved and unwanted.” A response to any form of poverty, material or spiritual, requires a response commensurate with the fullness of the human person—a response that seems lacking in the liberation theology that captivated Farmer.

If he had had the opportunity to meet witnesses to the faith who were not simply Marxist ideologues, would he have been drawn to a more substantive proposal of the Church and to the Person of Jesus Christ, rather than feeling the need to set up a parallel structure, the “church of Paul Farmer” as Kidder describes? For Farmer, the attraction to liberation theology is bound up with its emphasis on “service and remediation.” He wants a “pragmatic God” who lives and works in solidarity with the poor whom he loves. This beautiful instinct plays itself out in Farmer’s late nights working, his long treks through the Haitian countryside to check on patients, his offering of himself to the soldiers who come to the hospital looking for villagers who had spoken out against the government, and his righteous anger at the corruption that leads over and over again to innocent deaths in the poorest of countries throughout the world.

And yet, Paul Farmer himself is not the hope of salvation for anyone. While we can all learn much from his passion for the poor and the challenge his witness offers to recognize the poor in our midst or hidden in the corners of the world where Partners in Health courageously serves, it yet remains true that “man does not live on bread alone” (Mt 4:4). I am reminded of Pope Benedict XVI’s beautiful encyclical Spe Salvi: “to be without God is to be without hope.” To offer true hope to the people of Cange (to believe that their deepest desire is for more than clean water, nutrition, and sanitation) is to point to Another, to the only One who can save us—rich and poor alike.

Mandy Reimer, MD, MTS is a general neurologist who lives in Auburn, AL. She is a graduate of the John Paul II Institute in Washington, DC.

Keep reading! Our next article is Brian Rottkamp's review of The Monks of Tibhirine: Faith, Love and Terror in Algeria.