The universe is made of stories, not of atoms.

‘‘The Speed of Darkness’’
Eyewitness accounts of the plagues of the past stress the equalizing effect of
common susceptibility as well as common suffering. Rich and poor, good
and evil, cautious and profligate—all alike fall victim to the democratic
ravages of disease. The health activist Paul Farmer disagrees. The epidemio-
logical insight that ‘‘diseases themselves make a preferential option for the
poor’’ motivates his work in the clinic and on the page.∞ From communica-
ble disease to cancer, disability to drug abuse, health outcomes display the
consequences of power and privilege as they register socioeconomic and
political inequities worldwide.
In Pathologies of Power (2005), Farmer recalls learning that lesson from
community health workers in Zanmi Lasante, the medical complex he built
in Haiti. When Farmer and his staff came together to discuss why three
hiv-negative men in their forties had died of tuberculosis despite under-
going treatment, they discovered ‘‘a fairly sharp divide between community
health workers, who shared the social conditions of the patients, and the
doctors and nurses, who did not.’’≤ The doctors and nurses attributed the
patients’ deaths to poor compliance stemming from the patients’ belief that
their illness was the result of sorcery and therefore would not respond to
biomedical treatment. The community health workers disagreed, contend-
ing that the patients’ superstitions were not the problem since their beliefs
about the cause of their illness did not prevent them from taking their
medications. Arguing that the exclusive medical focus of the doctors and
nurses masked important socioeconomic factors in health outcomes, they
offered an alternative account that linked the patients’ deaths to their
poverty: their already weakened states from malnutrition, overwork, and
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