Medicine: Heroes of global health

Journal name:
Nature
Volume:
546,
Page:
598
Date published:
DOI:
doi:10.1038/546598a
Published online

Amy Maxmen assesses a documentary on medical pioneer Paul Farmer and colleagues round the world.

Bending the Arc

Directors: Kief Davidson and Pedro Kos Impact Partners: 2017.

Moupali Dias/Partners in Health

Paul Farmer with a boy in Haiti, where his aid group runs clinics and hospitals.

At this year's Miss USA beauty contest, winner Kára McCullough reignited an old debate. A scientist at the US Nuclear Regulatory Commission, McCullough declared that health care ought to be a privilege earned through work, not a right — that the rich should not be forced to cover health costs for the poor. This is often a reality globally; as a result, skeleton-thin children die daily of diseases that are simple to fix.

There are many scenes depicting such tragedies in Bending the Arc, a documentary about aid group Partners in Health (PIH), co-founded by physician Paul Farmer. The organization, which is based in Boston, Massachusetts, aims to strengthen health systems in places where there are few or none. The film's name is based on a quote from nineteenth-century social reformer and abolitionist Theodore Parker, who said that society's actions arc towards justice over time.

Bending the Arc's producers include Hollywood heavy-hitters Ben Affleck and Matt Damon, but global-health and policy wonks will be more impressed by the involvement of hotshots such as World Bank president Jim Yong Kim and economist Jeffrey Sachs, to name a few.

With archival footage and photographs, the film follows the organization's development from its founding to today — although it bounces around in time slightly, so that projects such as tackling tuberculosis and HIV cluster together. Near the beginning, Kim and Farmer pal around as colleagues at Harvard University in Cambridge, Massachusetts. Farmer enrolled at Harvard Medical School after a trip to Haiti, where he and health campaigner Ophelia Dahl (daughter of writer Roald) worked in a medical centre.

We see the young, idealistic Kim and Farmer expounding on their responsibility as doctors to work towards social justice in post-colonial countries. Kim lays much of the blame for the lack of health-care services in these nations on World Bank austerity measures. Farmer convinces Kim to join him in building a clinic in a rural and under-served region of Haiti. Together with Dahl and others, they found PIH and create a community-based programme to treat tuberculosis. They expand to Peru, where they demonstrate that people with drug-resistant TB can stick to a daily treatment regime for up to two years and be cured — as long as doctors provide the costly pills free of charge. But when they present the data, many public-health experts and economists don't believe them. Their scepticism is rooted in the dilemma of donating expensive medicines to those who cannot afford them.

Kim then learns that the drugs are no longer protected by patents. Prices are lowered and policies change. But we don't get the details of this transformation, because the film leaps into its second act: HIV. Our protagonists are once more outraged as they watch people die from AIDS because they cannot afford antiretroviral therapy. Again, high-level experts argue that it can be no other way. The sheer number of racist and condescending statements caught on tape is dizzying.

Suddenly, in 2001, United Nations secretary-general Kofi Annan announces the Global Fund to Fight AIDS, Tuberculosis and Malaria. Two years later, George W. Bush launches the world's largest HIV fund, the US President's Emergency Plan for AIDS Relief (PEPFAR). Over the next few years, the number of people receiving antiretroviral therapy doubles.

After this, the film begins to feel like a checklist. One section flicks rapidly through the 1994 Rwandan genocide and an initiative to boost the country's corps of health-care workers. Then there's a bit about cervical-cancer screenings; an Ebola outbreak in Uganda; a Twitter account that connects health workers to the Rwandan Ministry of Health. When I hear a bold statement about how Twitter is helping to transform the nation's health system, I wonder about the film's credibility for a moment — the utility of the social platform pales in comparison to a real need for nurses, medicine and infrastructure.

But PIH has undoubtedly been successful by several measures. Rather than operate as an independent unit like so many non-profit organizations, the group integrates its aid with the public-health-care sectors in ten countries. For this, Farmer has become a hero to students of global health. And since 2012, Kim has led the World Bank. His early criticisms of it were, he notes, all down to wanting the institution to change. “If you are cynical you will live out your low ambitions,” he says. “Cultivate pessimism of the intellect but optimism of the will.”

In an out-take at the end of Bending the Arc, Farmer is on a plane, looking exhausted but satisfied. “In high school I wrote a paper saying why the right to health care is bad,” he giggles. “What an idiot.”

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