diagnosis of poverty | mountains beyond mountains | haiti, 2011.

After graduating from Arizona State University with a biomedical engineering degree, I went to Boston to work at the Children's Hospital doing neuroimaging research. For the first time in my life, I was able to get lost. It was an opportunity to isolate myself from the world that I came from and hear my inner calling. We all have a calling in life, we are all given gifts. It's a journey to discover those gifts and use it to better and serve humanity.

It was in Boston that I discovered Dr. Paul Farmer, one of the co-founders of Partners in Health. Dr. Farmer was an infectious disease doctor and anthropologist. One of the most passionate and influential voices for global health equity and social justices. He was an ambasssador for the poor.  He made it his mission to transform health care on a global scale to reach the most impoverished communities. I devoured every scientific article he published and every book he had written

Over 2.6 billion people live on $2/day. One quarter of all children in developing countries are at risk of experiencing long- term effects of undernourishment. Over 1 billion people do no have access to clean water, 2.6 billion lack accesses to sanitation. More than 10 million children die of hunger and preventable diseases—that is over 30,000 per day and one every 3 seconds. One in four adults in the developing world—872 million people—is illiterate. Universal primary education would cost $10 billion a year—that is half what Americans spend on ice cream.  

A 23 year old woman dying in childbirth, a man whose guts were shredded by bacteria as a result of impure water, and a 10 year old boy who writhers from spasms—what do they all have in common? They all suffer from “stupid deaths,” deaths that are easily preventable with proper health care, food and clean water, and with twenty-cent inoculations. Thousands needlessly die every day as a result from AIDS, TB, malaria, diarrhea, respiratory infection, and other fatal diseases that target bodies weakened by chronic hunger.

Structural violence was termed by Johan Galtung during the 1960’s, describing the social structures of economic, political, legal, religious, and cultural, that prevent individuals, groups, and societies from attaining their full potential as human being. Structural violence is a term used to denote a form of violence that describes the systematic pattern in which a social structure or institution kills people gradually by preventing them from obtaining their basic human needs and rights.  Structural violence eventually leads to hate crimes, family and racial violence, genocide, and war.  

The tragedy is not necessarily that people are dying, but more so, that people are dying from something that is systematically preventable from something that is as simple as being fed and nourished, or being vaccinated at a low cost. The tragedy is that some live in freedom and have that right to survive, while others suffer from lack of food—the most basic right to survive. It is merely by our birth right of where we are born that we are given such a privilege or a curse. 

In 1995, the World Health Organization acknowledged that poverty is the world’s greatest killer:

“Poverty wields its destructive influence at every stage of human life, from the moment of conception to the grave. It conspires with the most deadly and painful diseases to bring a wretched existence to all those who suffer from it."

Poverty is the compounding element that further atrocious situations of poverty, including illness and premature death. The world’s poor are the paramount victims of structural violence. It is this distinct population that has the shortest life expectancy, even prior to birth. 

Pablo Richard, a Chilean theologian, compares the poor not only suffering, but also suffering unnoticed, to the fall of the Berlin Wall: “We are aware that another gigantic wall is being constructed in the Third World, to hide the reality of the poor majorities. A wall between the rich and poor is being built, so that poverty does not annoy the powerful and the poor are obliged to die in the silence of history." The chief victims of structural violence—the poor, suffer in complete silence.  

Sixty years ago, medicine and allied health sciences became involved in the work of human rights that was established by Article 25 of the Universal Declaration of Human Rights, which emphasized social and economic rights:

“Everyone has the right to a standard of living adequate for the health and well- being of himself and of his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.” 

Never before have we seen the fruits of basic science evolve into innovations that improve the quality of life so readily. From understanding human genome to pioneering surgical tools, scientists have advanced education in biotechnology, biomaterials, biomechanics, tissue, cardiopulmonary engineering, neuroscience, and nanosystems. However, those who need it the most will not be able to reap the fruits of the modern technology. These advanced technologies are only at the disposal of those who can afford it. Herein lies the crux: is health care a commodity to be sold or is it a basic right for every human being—and if it is a basic human right, what defines a human being? 

The tragedy of it all is that the destitute dying not only concerns physicians, public health workers, and humanitarians who work amongst the poor, but all those who profess to be human beings. They are human beings just like us; they experience hatred, love, pain, suffering, joy, and jealousy—just like us. The only difference between us and them is that we are blest immensely to be born in a country that defends freedom and human rights; they were not. They were born in a country that does not make it a priority to defend basic human rights of providing opportunities for education and employment, clean food, water, shelter, and health. 

After completing my physician assistant degree, I took the opportunity to travel to Haiti, a year after the devastating 7.3 magnitude, earthquake. This was my journey--and mountains beyond mountains it was.