Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World

by Tracy Kidder
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Dr. Paul Farmer designed a study to find out if there was a relationship between his Haitian patients’ beliefs in sorcery as the cause of TB and their recovery from TB through medical treatment. Do you think this discovery might have a broader application—for instance, to situations in the United States?

Paul Farmer’s discovery about the relationship between Haitian patients’ cultural and religious beliefs and their recovery is applicable in the United States because of the country’s tremendous diversity. The health care professions are increasingly applying the concept of “cultural competency” to treating tuberculosis.

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Through his work with Haitian people who believed in sorcery, Paul Farmer learned about the influence of cultural and religious factors on people’s acceptance of biomedical treatments. Tuberculosis remains a medical and public health problem in the United States. Healthcare professionals increasingly aim to take into account patients’ beliefs about...

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Through his work with Haitian people who believed in sorcery, Paul Farmer learned about the influence of cultural and religious factors on people’s acceptance of biomedical treatments. Tuberculosis remains a medical and public health problem in the United States. Healthcare professionals increasingly aim to take into account patients’ beliefs about health and illness, as well as their attitudes toward the medical establishment, rather than apply a “one size fits all” approach to diagnosis and treatment. Along with physicians and nurses, medical social-service professionals may work with clients to develop effective strategies. One important factor is helping clients overcome initial reluctance to seek medical care, which may be related to their own or family members’ past negative experiences with the medical profession.

Useful suggestions are provided in a guide prepared by the Global Tuberculosis Institute of the New Jersey Medical School. One important idea presented is the importance of “cultural competency,” which includes the underlying concept that each potential patient must be considered as an individual as well as a member of a particular group that is identified by race, ethnicity, class, age, or gender. In developing and using such competency, healthcare providers need to address possible stereotyping or bias. Treating a disease such as tuberculosis depends on identifying both general and specific cultural factors that may be relevant.

This approach is especially important regarding tuberculosis in the United States, where about half of affected persons were born outside the country. Two interrelated important cultural factors are the patients’ prior reliance on a “folk healer” and their reluctance to tell the biomedical professional about this, based on their past experience of having their beliefs and practices rejected. Not only can this affect the patient’s attitude toward treatment, but it can suppress their disclosing information about taking “alternative medicines” that may negatively interact with prescribed medicines.

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