What do the dead become but reflections of ourselves? Close to a million people have died in the United States during the Covid-19 pandemic—lives that are lost to me because I did not know them, their histories, their joys and disappointments, their fears and desires. So, for me, they get added to all the dead who came before them. Too many to name. From AIDS, from hepatitis C, from MDR-TB—all the epidemics that have taken friends, family, colleagues since my 20s. But then death, suddenly, comes for people you know, and in that moment, the numbness abates, the sorrow and anger rise up.
Last month, Paul Farmer died. Paul and I met during the 2000 AIDS conference in Durban, South Africa, at a reception where Paul lingered in a corner talking to the AIDS activists rather than hobnobbing with the AIDS research elite who mixed among themselves that night. I wouldn’t presume to call Paul a close friend or even a friend at all—we never socialized one-on-one, or met each other’s families—but we were something more than colleagues, and in the language of my South African activist friends, what comes to mind is: We were comrades. Once I entered academia, Paul would invite me and other comrades up to talk to his undergraduate global health class at Harvard and we invited him down to Yale on occasion too, including to give the Gruber Distinguished Lecture in Global Justice at Yale Law School in 2015. I asked him for advice every once in a while, and he would generously provide it, and he helped me in other ways for which I’ll always be grateful and keep between the two of us, now just in my own grieving heart.
In the dozens of elegies that have been written, Paul is venerated as a secular saint of sorts, his medical work in Haiti and Rwanda making him an Albert Schweitzer for the 21st century, but this obscures the radicalism of his scholarship and activism, and ultimately of his life and legacy. In public health, we have what we call the social determinants of health, that drive sickness and death—forces and policies that create the health disparities we know all too well in the US and around the globe. But this milquetoast language is technical, divorced from the real impact of what we do to other people—stripping it of any moral or emotional valence.
Paul borrowed the term “structural violence” from the Norwegian sociologist Johan Galtung to define these determinants in an altogether different manner, as “social arrangements that put individuals and populations in harm’s way. The arrangements are structural because they are embedded in the political and economic organization of our social world; they are violent because they cause injury to people (typically, not those responsible for perpetuating such inequalities).
Of course, the concept of structural violence harks back to Engels’s description of “social murder,” in which the “argument was that the conditions created by privileged classes inevitably led to premature and ‘unnatural’ death among the poorest classes,” as Kamran Abbasi, the new editor in chief of the medical journal BMJ, wrote last year.
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Gone now, I hope, is the idea of Paul as the good doctor, who is—was—there to make us feel like he was one of the better angels of our nature, a humanitarian who tended to the poor and sick, without making any claims on us. And in these hyper-partisan times, it’s easy to think about structural violence as something other people do to other other people. We, Nation subscribers and our kind, read week to week of GOP and corporate malefeasance and malefaction, with probably more than a little satisfaction that we are not them. But Paul—like Martin Luther King Jr. before him—knew that it wasn’t always the cruelty of bad people but sometimes the complicity of the good that should be repented of. Paul went further in his critique of white liberals (W.L.s):
I love W.L.s, love ’em to death. They’re on our side. But W.L.s think all the world’s problems can be fixed without any cost to themselves. We don’t believe that. There’s a lot to be said for sacrifice, remorse, even pity. It’s what separates us from roaches.
I can’t help but think of structural violence, social murder, and the role of white liberals in the Covid-19 pandemic. In fact, Paul wrote about it in April of last year:
Those whose lives are rarely touched by structural violence are uniquely prone to recommend resignation as a response to it.… Since the beginning of this pandemic, we’ve been mired in a sort of magical thinking about how it will end. Just because smallpox and bubonic plague no longer terrify us, this new pandemic too is sure to blow over and disappear without us exerting ourselves in new ways beyond the development of new vaccines.… But in settings in which all of us are at risk, as is sometimes true of contagion shared through the air we breathe, we must also contemplate containment nihilism—the attitude that preventing contagion simply isn’t worth it. There are a myriad of ways in which structural violence is entrenched, and these forms of resignation had devastating effects on the United States…
As the CDC and the Biden White House rolled out its new pandemic strategy last week, in which preventing contagion, or even mitigating community spread, is now no longer a priority—in which “exerting ourselves” beyond vaccination has become too much to ask of a weary American public—Paul’s words become prophetic. Our resignation in the face of Covid-19 was something he saw coming a mile away. And this latest structural violence was brought to us not by Donald Trump but by white liberals for whom the urgency of normalcy, resignation by another name, was paramount—at which moment the right and the left in America finally found common ground. The White House and CDC could do nothing but follow their lead.
Paul followed an ethics of accompaniment all his life, meaning “that the best thing to do for people going through a difficult moment—a severe bout of Covid, say, or the challenge of isolation after exposure to the virus—is not to blame them or bill them or distract them, but to keep company with them from beginning to end.”
I never understood this in any visceral way until now. As someone living with HIV, and part of that community, it was solidarity among ourselves that I could understand. But as the United States turns its back on the immunocompromised, the disabled, those vulnerable to Covid-19 in other ways, it seems like “keeping company” with them is the only honorable thing to do—rather than engage in organized abandonment, which has become our national Covid-19 strategy. This isn’t accompaniment as Paul did with his patients, but accompaniment as policy that Paul spoke about. We cannot walk away. In fact, we walk together with those whom others would rather forget, until they tell us their journey is done.
So, hamba kahle—farewell, comrade, in one of the languages of the place where we met 22 years ago, during a week in which we marched with thousands against resignation, against the idea that some people’s lives were expendable in the context of the AIDS pandemic. We will keep up the fight.
