A Path Out of Poverty

"If you have come here to help me, you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together."
—Lilla Watson, Aboriginal activist and artist

World-renowned physician and public health pioneer Dr. Paul Farmer has long been devoted to caring and advocating for the world's poorest people, and challenging wealthy Western countries to address the underlying causes of poverty and disease in the developing world. He and the organization he cofounded, Partners In Health, have built medical centers and health systems first in Haiti and then around the world—in Rwanda, Mexico, Nepal, Sierra Leone, Russia, the U.S. and more—that also address patients' social, nutritional, financial, and long-term care needs.

But as he and his colleagues have learned in assessing their own efforts, and indeed all efforts, to turn goodwill into a robust and enduring response to the profound problems of structural poverty, they have learned that success requires more than good intentions, expertise, and material resources. It requires replacing time-limited, contractual, and almost invariably inegalitarian arrangements between aid workers and aid recipients with an approach based on genuine partnership and solidarity. Farmer calls this new model for assisting the poor accompaniment. Accompaniment, he explains, is about sticking with a task until it's deemed completed, not by the accompagnateur but by the person being accompanied.

Through stories about his experiences and the evolution of his thinking,and incisive analysis of both existing data and the lessons of history, Farmer explains in this book what accompaniment means and how it works. In Part II of the book, a group of colleagues draw on their own experiences and studies to showcase accompaniment in action, illuminating both its enormous potential for transforming the lives of the poor, and the challenges and dilemmas they face.

Many people in the world of foreign aid and charitable giving have long championed the principles of accompaniment, but there remains a huge gap between rhetoric and implementation. Part of the reason for that gap has been an absence of data about the effectiveness of accompaniment-based initiatives. This book provides compelling, concrete data that accompaniment works—and that it works better than other approaches.

Inspiring, thought-provoking, and likely controversial, this is important reading for anyone who, like Farmer, seeks to create a better world.

Dr. Paul Farmer, physician and anthropologist, is chief strategist and co-founder of Partners In Health, an international non-profit organization that since 1987 has provided direct health care services and undertaken research and advocacy activities on behalf of those who are sick and living in poverty. He is Kolokotrones University Professor and chair of the Department of Global Health and Social Medicine at Harvard Medical School, and chief of the Division of Global Health Equity at Brigham and Women's Hospital in Boston. He has also served as U.N. Special Adviser to the Secretary-General on Community-based Medicine and Lessons from Haiti.

Dr. Farmer is the recipient of numerous honors, including the Margaret Mead Award from the American Anthropological Association, the American Medical Association's Outstanding International Physician (Nathan Davis) Award, the John D. and Catherine T. MacArthur Foundation Fellowship, and, with his PIH colleagues, the Hilton Humanitarian Prize. He is a member of the Institute of Medicine of the National Academy of Sciences and of the American Academy of Arts and Sciences.

He has written extensively on health, human rights, and the consequences of social inequality. His most recent books are In the Company of the Poor: Conversations with Dr. Paul Farmer and Fr. Gustavo Gutiérrez; Reimagining Global Health: An Introduction, and To Repair the World: Paul Farmer Speaks to the Next Generation.

Jennie W. Block is a Dominican laywoman, practical theologian, and chief advisor to Dr. Paul Farmer. She was also Farmer's chief of staff in his role of United Nations Deputy Special Envoy for Haiti under President Bill Clinton.

Steve Reifenberg is Executive Director of the Kellogg Institute for International Studies at Notre Dame University and author of Santiago's Children: What I Learned About Life at an Orphanage in Chile.