The
further I get in my education, the more I realize that learning is a
never-ending process. A salient lesson I have encountered in my last semester of
college has taken place in a final reflective sweep of my education at the
University of Montana. I have recognized that any subject of any discipline can
be viewed as the interaction of interdependent and cyclical forces. It is with
this perspective that I approach Paul Farmer’s book, Haiti After the Earthquake (2011), in an attempt to siphon out
lessons for practice in international social work from Farmer’s medical jargon
and clinical mindset. Farmer’s account of pre and post-earthquake Haiti
illustrates an exemplary case study for many issues of social work; in this
essay I will focus on lessons of ‘acute-on-chronic,’ local expertise,
transformation of worldviews, and assuaging the unremitting contradictions of
humanitarian being.
Paul
Farmer eloquently weaves top-tier and on-the-ground perspectives through a
handful of coined phrases, my favorite being ‘acute-on-chronic.’ As a medical
professional, he reminds us that immediate illnesses and social ills alike must
be viewed in terms of the chronic history of symptoms and infrastructural
fragility facilitating the onset of struggle. With this, Farmer reminds us to
always contextualize the present issue with knowledge of history, systemic
injustice, generational trauma, and other contributions to the social mélange.
In essence, Farmer reminds practitioners to confront problems with a holistic
lens—to account for the delicate ecological nature of social ills and not
attribute blame to any one cause or propone any one solution.
The
idea of ‘acute-on-chronic’ segues into Farmer’s dialogue about the importance
of language in our conceptualizations of practice. Through language, ‘experts’
construct certain realities. Farmer uses the example of the use of ‘natural disaster’ to describe the
earthquake in Haiti. He claims that the disaster in Haiti was in no way
‘natural,’ but was a social disaster resulting from, “policy decision[s] made
far from the…affected areas,” (213). Farmer challenges the reader to recognize
who is present at the table when big decisions or definitions are made; we
should always question the agenda at hand, examining who is benefiting from the
policy prescriptions. Furthermore we should identify whose perspectives are
missing from the equation and “[seek] to echo and amplify the voices of those
we encountered as well as those silenced,” (2).
As
Farmer stresses in the aforementioned quote, and to continue with the role of
language in social work practice, I am learning that it is essential to let
those affected define their experiences, problem, and solutions. It is
necessary to vouch for the inclusion of locals into the decision-making and
implementation process. As Farmer quotes Hillary Clinton, “we cannot any longer
in the twenty-first century be making decisions for people and their futures
without listening and without giving them the opportunity to be as involved and
make as many decisions as possible,” (90).
The case study of Haiti honestly examines the role
of humanitarian aid in the development process. His account attests to the fact
that ingenuity and hard earned experiential knowledge should not be wasted on
top-down innovation and implementation, as this route often proves futile.
There is a vast potential of local expertise that often goes untapped. Our role
as social workers should be to crack the well—organize an efficient means of
fostering the flow.
Even
on an interpersonal level, I must practice letting go of a solution-driven
mindset and recognize when bearing witness is the deficient resource. As
well-to-do Americans, in the words of Farmer, “it’s tempting to focus on
immediate clinical questions,” (118) and facilitate the urge to ‘fix,’ as
opposed to recognizing the value of inaction. As a westerner I put a premium on
visible progress, but there are times when my agenda does not suit the present
situation and in fact can stifle change. I have to remember to let go of my way
of doing things and practice holding the uncomfortable space, allowing for a
humble exchange of knowledge and experience.
Farmer
speaks to the interplay of praxis and policy in one of his chapters; I can also
apply this to the conceptualization of opposing tensions within the self—that
social work is the interplay of action and reflection. As social workers, our
engagement with individuals or communities has reciprocal, and indeed
transformational, effects on our personal selves. It is essential to examine the
push/pull factors within our own selves in order to explore the motives behind
our participation in this work.
Taking
from Fetcher’s Professional is Personal, one
can recognize that our work is not passive. Social workers are racialized,
socialized, historicized creatures who cannot help the tides of sociopolitical
time nor check our worldviews at the door. Personally, I must be aware of the
deep-seated guilt that accompanies my status as a privileged white American. I
must also reconcile with the fact that people may only view me as a potential
dollar sign, temporarily invested in a project for self-centered gains. As
Isla asked recently in a class lecture, “how do we balance the responsibility of coming from a
country that has access to virtually all of the world’s resources,” and in
contrast practice being present with a humble spirit?
In
learning from Farmer, my classmates, and various voices from the readings over
the semester, I believe this is answered in the process. To paraphrase Rilke,
we must live the questions themselves. We must also learn to balance the
fundamental tensions between being, at all times, the learner and the teacher,
the researcher and the subject, the doctor and the patient, the sojourner and
the native. Likewise at the micro-level are macro-level tensions between
relating international experiences back to local issues in our home
communities. How can we transform the vision of globalization to facilitate
connections in terms of promoting social justice?
Social
work is a balancing act; we straddle incongruous paths, digging for a nugget of
change out of obstinate soil. Farmer’s book has reminded me to always remain a
humble learner, even if social norms label me ‘the expert.’ Every human’s
individual experience is incomprehensible, yet it is through the power of human
stories that I believe we can reconcile coming home to advocate the process of
reverse mission and accompaniment. In the end, as Farmer alludes to, we must
put our energy in drawing out people’s stories—look for shared patterns,
themes, to develop deeper discussion that probes into peoples’ experience so
that we can extract, expand, and humanize the struggles against injustice
abroad and at home.
