Film Review

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Bending the Arc

Director/Producer: Kief Davidson
Director/Editor: Pedro Kos
2017, 2 hrs 30 mins
Available at: http://bendingthearcfilm.com1517880926505ccb7faa5c9b3f0335e1a

“Bending the Arc” tells the story of Paul Farmer, his colleagues at Partners in Health, and how a tiny NGO in rural Haiti came to push the boundaries of what was possible in global health.

The film is based on the book “Mountains Beyond Mountains” by Tracy Kidder.  It offers a chronological history of Partners in Health and highlights how Farmer and his colleagues approached healthcare for the poor from a unique philosophical position.

In the film, Farmer offers many critiques of the way traditional development work and global health are framed saying, “appropriate technology just means shit for poor people and good things for rich people.”  He continually pushes viewers to challenge assumptions about healthcare for the poor.  The film also presents the claim that neo-liberalism and World Bank imposed austerity programs that have been forced upon low-resource countries have devastated the social and health infrastructure of these countries. At one point, Farmer expresses frustration with the often-quoted platitude, “it is better to teach a man to fish” because, as he says, “their ships are sunk”!  He seems to be saying, we cannot solve the healthcare problems of rural Haiti by training healthcare workers or increasing health literacy when the healthcare system as a whole is devastated by austerity programs.

PIH have confronted pessimism, cynicism and racism directed at the communities they serve.  The film shows archival footage of Farmer, Jim Yong Kim and others testifying before global health experts who make offensive statements implying that poor people in Africa are ignorant and not deserving of quality healthcare. In the film, Farmer argues that “optimism is a moral choice” and that we cannot be satisfied with mediocrity.  PIH programs are often, “so ambitious that it makes others uncomfortable”.

In the film we learn that during the 1980’s, Farmer met Ophelia Dahl, now his colleague, while working with an NGO in Haiti. He was so struck by the poverty he found there that he wanted to stay and do what he could to help.  His colleagues and friends advised him that he would be more useful in Haiti if he learned a practical skill, so despite some initial resistance, he moved to Boston to complete medical school.

After medical school, Farmer returned to Haiti to start Partners in Health with Ophelia Dahl, Jim Yong Kim and other colleagues in Boston, as well as Haitian partners, Father Fritz and Yoland Lafontant.  In the film, Farmer acknowledges that their initial attempts to treat tuberculosis (TB) were ineffective.  Many doctors blamed patients, saying that they weren’t taking their medications, but Farmer and his team instead blamed the circumstances.  The patients were poor; they had no food, inadequate shelter and no access to transportation.  In response to this challenge, PIH established the accompaniment system.  Local volunteers would visit patients receiving TB treatment in their homes to encourage them and ensure that they took their medications. The idea was to take the blame off the patient and put it on the system. Their TB program was an overwhelming success with nearly 100% of patients cured of their TB.

A close friend and mentor of Farmer, Father Jack, was serving as a priest in Peru at that time. After witnessing the success of PIH in Haiti, Farmer and his team decided to expand their project to the community where Father Jack was working.  At that time Peru had a well-respected TB treatment program, but when Farmer looked closer, he discovered a serious problem.  Many patients were dying despite treatment due to an epidemic of multi-drug resistant TB (MDR-TB). There was a lot of political opposition to acknowledging the epidemic and Farmer and his team were forbidden to treat MDR-TB in Peru by local authorities. Even the World Health Organization had a policy against treating MDR-TB in low-resource settings.

When Father Jack contracted MDR-TB and died, Farmer was devastated and felt he had to prove that it was possible to treat MDR-TB in low-resource settings.  All of the experts in global health argued that it wasn’t possible and even if it was possible, it was too costly. Farmer and his colleagues argued that cost was not a legitimate argument as cost was only ever brought up when talking about healthcare for poor people.

PIH in Peru started a project using the same accompaniment program that was so effective in Haiti. Their program was again extremely successful. Despite PIH’s success in treating MDR-TB in Haiti and Peru, global health experts were skeptical at first.  After years of advocacy, pressure on drug companies, and data demonstrating the effectiveness of the accompaniment model, the WHO now advocates for treatment of MDR-TB even in low-resource settings.  PIH now advocates for effective prevention and curative treatment for other diseases such as HIV, cancer and other diseases that global health experts argue are not sustainable to treat in low-resource settings.

Along the way we are shown how PIH has established programs in several countries around the world; from Central to South America, to locations in Africa, including Rwanda.  Farmer and others at Partners in Health now have massive influence in global health and international development policy, with PIH co-founder Jim Yong Kim occupying the position of president of the World Bank since 2012.  The film does not delve into the potential impact of this entanglement with influential policy-makers and international interests on the mission and practices of PIH. At the end of the film, I was left wondering whether the World Bank and other big players in international development have changed or if Partners in Health has been forced to compromise any of its foundational values.  When access to power affords you the ability to have greater influence and provide healthcare to more people, what do you do if it also comes with strings attached?

Overall, the film provides a great introduction to PIH and their bold perspective on global health.  By highlighting current best practices in global health that were once thought to be impossible, “Bending the Arc” challenges us to rethink what is possible in the future.

Rachel Yantzi

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