Paul Farmer, a Harvard Medical School teacher, infectious disease expert, and anthropologist, has written his fourth book, “Pathologies of Power.” With grace and feeling, he communicates an obvious commitment to the notion that health care is a human right. And he practices what he preaches.

The first part of the book is devoted to a detailed recounting of medical work in Haiti, Chiapas, Peru, and in Russian prisons. Farmer then goes on to report on the devastating effects of bureaucracy, brutality, and absent health care on people’s lives. His most consistent teaching is that human suffering and the contemporary world order go together, and that is the book’s main contribution.

But ultimately his story fades, especially when he comes to strategies for corrective action. To readers conversant with historical materialism and the possibilities of class-based resistance, Farmer comes across as an idealist, a wishful thinker. His own witness to human wastage stands as a plea for change, just as does statistical documentation from the World Health Organization. Each year, malnutrition contributes to the deaths of 10 million children and 30 million of the world’s 40 million people with HIV infection live in sub-Saharan Africa.

In 2002, 585,000 women died in childbirth, 99 percent of them in poor countries. Two million people die annually from tuberculosis, 98 percent of them in poor countries. Infectious diseases cause 7.7 percent of the deaths in rich countries, 57 percent of the deaths in poor countries. Life expectancy approaches 80 years in rich countries, and is as low as 40 to 50 years in the poorest nations. In the 30 or so rich nations, plus Cuba, the infant mortality rate is less than seven deaths per 1,000 births. In the rest of the world, the rates are five to 15 times higher. But numbers do not stick in the soul the way that Farmer’s individual stories of grief do.

The U.S. Coast Guard intercepted a boat carrying Yolande Jean and other Haitian refugees. They ended up at Guantanamo Bay, Cuba, and Yolande Jean, who was HIV positive, was put in solitary confinement. Sergei, in Siberia, was arrested in 1991 on a charge of passing fake checks. But he ended up with a death sentence, because he contracted tuberculosis during pretrial detention. He would die because money was unavailable for the right drugs. (Ten years after the fall of the Soviet Union the incidence of tuberculosis had increased threefold. One out of 10 prisoners was infected.)

Farmer is no stranger to the idea that injustice has to do with class divisions. He writes that 358 individuals make as much money as do 2.3 billion other persons. He quotes the Jesuit J.L. Segundo: “The world that is satisfying to us is the same world that is utterly devastating to them.”

Farmer places “individual biography” into the “larger matrix of culture, history, and political economy.” That observation might have been a cue to delve into the intimate workings of capitalist globalization. The author’s prescriptions for action fall short. Farmer nominates health workers as front line soldiers in the battle for human rights. They would practice “pragmatic solidarity,” bring universities, medical providers, and non-governmental organizations together. They would find money and go where they are needed. Under a scheme like that, angels of light and justice would be setting up shop along every road, in every block, the world over.

Farmer admires liberation theology because of its “preferential option for the poor,” but offers few specifics. He visits Cuba and admires that nation’s approach toward the prevention and treatment of AIDS/HIV. But he holds back on any hint that Cuba might be different, that it takes seriously the socialist imperative that health care is a human right.

The overarching problem so eloquently posed in Farmer’s book, the inordinate suffering of the poor, is left unsolved. The author comes across as an expert from away and a practitioner of noblesse oblige.

Except for stories of indigenous people in Chiapas who set up autonomous organizations, his subjects seem powerless, isolated, and, most importantly, dependent. That predicament, of course, is the point at which realistic strategic analysis ought to begin. That would have been the occasion for an inquiry into the ways and means by which the disposable, oppressed people of the world might come together in class solidarity to bring about their own liberation.

Farmer does quote Bertolt Brecht: “The compassion of the oppressed for the oppressed is indispensable. It is the world’s only hope.” On their way, those in struggle would surely welcome a hand from friends like Dr. Farmer who have zeal, concern, and expertise.

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