DR. PAUL FARMER WITH A PATIENTPartners in Health and its founders: the right to health care as a moral imperative
Ophelia Dahl, cofounder of Partners in Health with Paul Farmer and Jim Yong Kim, whose work is the subject of this film, starts us off with some blunt information: the world health picture could be much better, and the reason why it's not is not medical but political and economic. A Sixties world plan to guarantee health as a universal right, promulgated after the fall of colonialism, she says, was crushed by the rich nations, the World Bank and World Health Organization. She arrived in Haiti in 1983 at the age of 18 1/2. She met Paul Farmer there and they clicked at once. Farmer was 23, and hadn't started medical school, but was "the man who would cure the world," as described in the book, Mountains Beyond Mountains
by Tracy Kidder. It all grows from there.
This moving documentary is full of facts and dates, but its heart is its humanity, the faces and voices of these leaders in world health and their patients and their partners. Hard work, determination are mixed with warmth, caring and hope. And this film is a blend of archival, current film, and interview that tells its story not just seamlessly but electrifyingly. It's hard to watch it unmoved and one can only hope young people will be inspired to follow in the footsteps of the heroes seen here. Should the extremely poor be allowed to die because their medical care is too expensive? This film says no. It sees the right to health care as a moral imperative - as did those who drew up that world health plan in the Sixties.
Kief Davidson and Pedro Kos' documentary is about living the dream of achieving health care for all despite the negativism of the pessimists and those who simply, as they tell it, don't really like giving money to the poor or to non-whites. Now, Partners in Health is at work strengthening the health care systems of ten countries. It started small, in rural Haiti thirty years ago. Farmer loved Haiti and its culture and spoke French and Creole. He's an international medical celebrity now, but it's clear his affection for Haiti and the Haitians - and willingness to stick by them in their recent tragedies - remains as strong as ever.
The first phase is Tuberculosis; then there is AIDS/HIV; then there is, briefly but horrifyingly, Ebola. The founders were joined by Joia Mukerjee, who just wanted to be sure they had a sense of humor, and got the job from Farmer when she said she'd work for free. The first fight was alongside Father Fritz in the Central Plateau of Haiti. They made the treatment work in the poor rural areas through "Accompagnateurs," whose job is to be cheerful, go to patients every day, encourage them, and make sure they take their medications. The PIH founders got important financial aid from early on by Tom White, a rich man in Newton, Massachusetts, who wanted to give away his millions before he died - and succeeded in doing so, supporting Partners in Health from its foundation and for two decades thereafter.
PIH moved to Peru, which supposedly had a model health system. But it turned out that the TB treatment was failing. Many who'd had treatment turned out to be still sick with MDR-TB, Multiple Drug Resistant Tuburculosis. Again persistence, faith, determination, getting the funds and the medications and using accompagnateurs
to make sure they doggedly went on taking them till they got better won out.
A success story among others is Melquiades - when we first see him, it's 3 years of 11 drugs a day and "nada": he is a pitiful wraith, hopeless and suffering, and his relatives are ordering the coffin. But PIH is bent on showing their methods work, and they kept at it. So we get to see him reappear in later films, a cheerful, robust young man; and there are Haitians just like him.
The AIDS story takes Partners in Health into Africa, where we hear from the irresistibly charming, but equally tough, Dr. Agnes Binagwaho, from Rwanda, Minister of Health. In a kind of coup de theatre, she is being interviewed by the filmmakers talking about the successful battle against HIV/AIDS in Rwanda, when she receives the first report of a suspected case of Ebola on her cell phone. She shifts into rapid-fire French, giving orders how to marshal all available forces to put up protective walls against this case spreading, if it is one; later she reports to a roomful of doctors the good news that it was "negative". After the massacres when PIH came to Rwanda it had no medical system. Now with Dr. Binagwaho it has one, and the resistance to Ebola shows that.
This is one of the specific year-by-year stories that runs through the film. The long-term, big-picture story of global progress and changing attitudes is also being told. We learn, as from the first, that the international drug and bank establishment habitually doesn't want to invest in poor people so they label all the medical success stories "not proven," "not sustainable,"and "impractical." Red flag words: "sustainable" and "prevention." These words signal calls for policies that will let poor people die. And we hear lots of examples of this talk and this thinking.
PIH's early work was in the Eighties; their first big battle for global execution of their principles was in the Nineties. Other big leaps forward came in the 2000's. Two American presidents took surprising and important steps in the latter period. In 2003, George W. Bush turned the tide for Africa and the Third World with a five-year $15 billian allocation for HIV/AIDS globally. And in 2012, in an unprecedented move, Barack Obama nominated Jim Kim, PIH founder, doctor, anthropologist, not a banker, as President of the World Bank. This shift came just in time. The big Ebola epidemic began the next year and lasted three years. Only because Kim was directing the World Bank could it provide the necessary funds, which was essential, because Ebola is a disease that's truly dangerous where a country has a weak health system and is poor.
In his Sundance review in Hollywood Reporter
, Duane Byrge speaks of the "the crisp cadence of Kos and Yuki Aizawa's surgical editing" of Bending the Arc
, and indeed it's essential to a film like this that all the images and sounds come at the precise moments when they're needed. That is the key also to how well it tells and coordinates its two parallel stories: locally solving health problems year by year, and globally growing Partners in Health (PIH) and health systems in the Third World.
The beauty of this film is how it fulfills the Horatian ideal of dulce et utile
, sweet and useful. It moves us while it informs us - and more than that, educates us. It alerts us to the naysayers and pessimists who wear the blinders of money, and it teaches us how it's possible to make health care work with minimal means, so long as you build a social network and there are people with passion like those we see here working on it. The backbone comes from the screenplay by Cori Shepherd Stern, augmented by the score composed by H. Scott Salinas and Matthew Atticus Berger, and the images from dp's Nick Higgins, Guy Mossman, David Murdock and Joshua Dreyfus. Bending the Arc
, 102 mins,, debuted at Sundance Jan. 2017. Festival showings at Miami, San Francisco, Minneapolis, and Montclair. Screened for this review as part of the SFIFF. SHOWING: April 14, 2017 at
5:00 p.m. at the Castro Theatre, San Francisco.