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Lessons from Living outside the Box

Many of you are already familiar with Tracy Kidder’s work through “Among Schoolchildren,” and many may know of Paul Farmer through either Kidder’s work or Farmer’s own writings. Kidder is a world-class storyteller, and Farmer a medical practitioner and anthropologist whose quest for social justice is nearly impossible to replicate, but whose example is inspiration to at least try.

Farmer is an out-of-the-box kind of guy not only because he spent part of his childhood living in a school bus, but also, and more importantly, because of how he has approached problem-solving some of the most challenging health and social issues of our day.

There are quite a few lessons to be drawn from Farmer’s story for educators, designers, and managers of learning experiences in terms of the impact we can make on people’s lives through the work we do.

“Education wasn’t what he wanted to perform on the world . . . He was after transformation.”

Farmer’s work often goes against the status quo of those in his own and related fields. Whether it is the time spent visiting patients in the far flung villages of Haiti or prisoners in Russia, or the amount of money spent per patient, or the range of services rendered, his work is seen by some as not only exceeding expectations but contradictory to accepted practices.

In the case of his beloved Haiti, as well as in Peru and Russia as well, it is not only the relief of pain and suffering from TB and AIDS, but the eradication of the conditions that caused the development and spreading of these illnesses that he has fought for.

In our own work as teachers, designers, and managers of learning, we all have the capacity for enormous change.

“Medical science does not exist to provide students with a way to make a living but to

ensure the health of the community.”

Farmer read the works of Rudolf Virchow while a student at Duke, and the medical anthropologist’s perspectives on service to the community had a huge impact on him.

Virchow himself had led a campaign for compulsory meat inspection and designed a sewage system for his native Germany while also being the first to propose that the study of disease should be focused on changes in the cell.

In Virchow, Farmer saw a model for social medicine.

In Farmer’s work, we can see a model for social impact within our respective fields.

“We should treat sick people if we have the technology.”

When Farmer was working in Peru to treat a relatively small number of MDR (Multiple Drug Resistant TB) patients, the prevailing argument was that MDR was not as pervasive as drug-susceptible disease and that it was simply too expensive and difficult to treat in these areas. Most people felt that as a clinician, Farmer was too focused on the treatment of individual patients to see the big picture required for successful public health initiatives and that efforts should continue to center on drug-susceptible disease under the current set of practices.

Not only did Farmer believe that every patient deserved to be treated, he knew the data proved that the then current course would lead to the spread of MDR and increasingly resistant strains of the disease.

He saw both the big picture and the individual impact that was required to get the disease under control.

With new technology being continually developed for educational purposes, it makes sense to not only share but focus some of this development with and on the disenfranchised or underserved.

“For me, it’s a privilege.”

This was Farmer’s response to the mother of a three-year-old patient who was thanking him for helping to save her son from MDR. In his diagnosis of the case and ensuing recommendations for treatment, Farmer drew on his vast understanding of infectious disease, but he also needed to help his fellow doctors in Peru go beyond established, approved procedures to treat this particular type of TB.

When his efforts began to prove successful, as in the case of this young child, Farmer not only provided a cure for the individual patient but enacted considerable social change as well in reducing the costs of treatment and incidences of the disease globally.

As teachers, designers and managers of learning, we share the responsibility and privilege inherent in being able to make an impact on individual lives as well as the potential for social change that comes with education.

Stay tuned in the coming weeks for more from Designs2Learn on how people in the field of education are using their skills and resources for social impact.


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As of January 2024, Rewriting Paradigms is back and I'm writing about today's  issues, those that most test us and our humanity.

Designs2Learn blogs were originally published on a separate site devoted solely to educational issues. 

With the release of the Rewriting Paradigms site, we' ported them over to their new home.

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