Mara G. Block
Last week, hundreds of people crowded into the sanctuary of First Church in Cambridge to witness a conversation between Dr. Paul Farmer, Professor Davíd Carrasco, and MDiv candidate Lauren Taylor about Farmer’s newest book, In the Company of the Poor (2013), co-written with Fr. Gustavo Gutiérrez. The book’s structure emulates a conversation through six essays, old and new, alternately authored by Farmer and Gutiérrez. It culminates with the transcript of an interview with Farmer and Gutiérrez at the University of Notre Dame in the fall of 2011. The writings in the book portray a shared humility, a mutual respect, and a deep and long-standing friendship between two revolutionary thinkers whose respective disciplines share a grounding in the reality of social suffering and a preferential option for the poor—“O for the P,” as Farmer has it. Their distinct commitments and irreducible differences never challenge Farmer’s confidence that insights from liberation theology can inform the practice of medicine, nor Gutiérrez’s conviction that the work carried out by Partners In Health bears a “deep resonance with the message of the gospel.” But what exactly is at stake in this book and in the conversations that it has inspired? Certainly not a sudden and new realization that their work rests on common values. What’s remarkable here, I think, is less their comparable paths than the fact that they’re walking them together.
The motif of walking and of being on a journey is present throughout the book, and is key in Farmer’s argument that approaches to problems of social suffering should shift from models of charity to models of social justice, from aid to accompaniment. For Farmer, to accompany someone is to “[walk] together in companionable silence,” “to go somewhere with him or her, to break bread together, to be present on a journey with a beginning and an end.” Gutiérrez highlights the theological resonance here: “To be a Christian is to walk, moved by the Spirit, in the footsteps of Jesus… This is what the preferential option for the poor points to: walking with Jesus the Messiah.” The motif of walking together achieves several things. It conveys the idea that this work is in motion; that while much has been done there is much still to do, that there are “mountains beyond mountains,” as it were. Second, the notion of walking together conveys a sense of destination, goal, and purpose. As Farmer has it, “Any journey linking social justice to spirituality needs a destination: a world in which there is less violence in whatever form. The journey needs to lead away from structural violence.” Finally, the notion of walking together entails a conception of spirituality not as something unadulterated by poverty and the destitute sick, but rather as something constituted by the presence of those who suffer. Gutiérrez describes a spirituality that “refuses to be a kind of oasis or, still less, an escape or a refuge in difficult times,” one that “involves a walking with Jesus… without being disconnected from reality and without distancing itself from the narrow paths trod by the poor.”
Notably, for both Farmer and Gutiérrez the notion of walking is inextricably connected to the notion of conversion. Gutiérrez opens his essay, “Conversion: A Requirement for Solidarity,” by stating, “[a] conversion is the starting point of every spiritual journey.” Farmer’s comments on this essay in his piece, “Conversion in the Time of Cholera,” highlight an insistence on linking conversion less as a “sudden epiphany” than as a “process” to “ostensibly anodyne terms such as social change.” “Attacking poverty,” he writes, “requires the conversion of people and the institutions they create and shape.” Farmer approaches the Ancient Greek sense of conversion, epistrephein pros heauton—turning towards the self in acknowledgement perhaps of one’s complicity in the perpetuation of structural violence, but also, as a turning of the self towards that “utopian destination” of “[e]ffective care for all.” The journey, the walking together, is not something that happens after conversion. Rather, the journey is a constitutive part of conversion, of that “transformative change we will need to end poverty and related pathologies that matters most.”
Gutiérrez’s essay poses a challenge to those who would suppose that priest and medical doctor speak interchangeable languages, that theological categories like “spirituality” and “conversion” simply lend themselves to a secularized (purified?) deployment. He writes, “The solidarity required by the preferential option for the poor forces us back to a fundamental Christian attitude: a grasp of the need for continual conversion.” Carrasco, in his conversation with Farmer last week, similarly raised the indispensible role of Christian faith for Gutiérrez in passages such as the following: “The rejection of injustice and the oppression it presupposes is anchored in faith in the God of life.” I think that this opens up questions not simply about the significance of Christian faith, but also about the role of religion and religious motivations in the history of global health, the insufficiencies of an ostensibly secular discourse, and the limits of the modern juxtaposition of religion and global health.
Pamela Klassen’s recent book, Spirits of Protestantism: Medicine, Healing, and Liberal Christianity (2011), is framed with the “forgotten” connection between the modern discipline of anthropology and its Christian theological history. This “amnesia,” she suggests, contributes to a persistent “misrecognition” of the theological roots underlying contemporary anthropological theories of “embodiment, ritual, healing, and even medicine.” In an exchange published in 2011, Arthur Kleinman and Paul Farmer interrogate a similar “amnesia” in the field of global health, which both suggest is seated in a culture of medicine and public health that “leads us to dismiss the contribution religion makes to global health.” Kleinman, together with his co-author Bridget Hanna, argue that though “[w]e usually think of global health as an example of a secular tradition of science coming together with humanitarian assistance,” this “conventional conceptualization draws too simplistic a distinction between the religious and the secular.”
This “distinction” perpetuates the exclusion of three crucial issues in contemporary conversations about global health. For Kleinman and Hanna, “an inner religious impulse for caregiving” that has been a vital “source of global health and human flourishing” in both past and present narrative histories of contributors to global health complicates simple distinctions between “the religious” and “the secular.” Farmer’s “ambivalence about Christianity’s connection to state power” points to a second issue. Indeed, there is much to be said about the interconnected play of biomedicine, imperialism, and missionary work that contributed to the formation of a colonial power that has decisively shaped the social, cultural, and political lives of individuals around the globe, as well as their experiences of medicine, health, and healing. The third issue is the necessity of careful analyses of local belief and practice, and of the ways in which these both shape attitudes towards illness and impact the reception of biomedicine. As Margaret Lock and Vinh-Kim Nguyen remind us in the opening pages of their co-authored text, The Anthropology of Biomedicine (2010), the “development and implementation” of biomedical technologies “are enmeshed with medical, social, and political interests that have practical and moral consequences.”
Attention to religious motivations for global health, to the role of religion in colonial histories of medicine, and to the significance of local belief and practice might open more sophisticated patterns of thought about the ostensibly secular discourses framing contemporary conversations about global health. It is my hope that the conversation between Farmer and Gutiérrez will continue to challenge the exclusion of religion from discourse on global health, and that it will inspire further conversation between people who might have deep and irreconcilable differences but who share a passion for fostering engaged praxis and critical thought, and who incessantly aspire to ground both of these in an O for the P.
Mara G. Block is a PhD candidate in the Study of Religion at Harvard University and a researcher for the Science, Religion, and Culture Program at Harvard Divinity School.
 Tracy Kidder, Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World (New York: Random House, 2003).
 Paul Farmer, “Health, Healing, and Social Justice: Insights from Liberation Theology,” in In the Company of the Poor: Conversations with Dr. Paul Farmer and Fr. Gustavo Gutiérrez, eds. Michael Griffin and Jennie Weiss Block (New York: Orbis Books, 2013), 44-52.
Gustavo Gutiérrez, “Saying and Showing to the Poor: ‘God Loves You,’” in In the Company of the Poor: Conversations with Dr. Paul Farmer and Fr. Gustavo Gutiérrez, eds. Michael Griffin and Jennie Weiss Block (New York: Orbis Books, 2013), 31.
 See, for example, Farmer’s first chapter that addresses the longstanding influence of liberation theology on his work.
Paul Farmer, “Reimagining Accompaniment: A Doctor’s Tribute to Gustavo Gutiérrez,” in In the Company of the Poor: Conversations with Dr. Paul Farmer and Fr. Gustavo Gutiérrez, eds. Michael Griffin and Jennie Weiss Block (New York: Orbis Books, 2013), 15-26.
 Paul Farmer, “Conversion in the Time of Cholera: A Reflection on Structural Violence and Social Change,” in In the Company of the Poor: Conversations with Dr. Paul Farmer and Fr. Gustavo Gutiérrez, eds. Michael Griffin and Jennie Weiss Block (New York: Orbis Books, 2013), 129, 127.
 Gustavo Gutiérrez, “The Option for the Poor Arises from Faith in Christ,” in In the Company of the Poor: Conversations with Dr. Paul Farmer and Fr. Gustavo Gutiérrez, eds. Michael Griffin and Jennie Weiss Block (New York: Orbis Books, 2013), 148-149.
 This phrase in the title of Kidder’s biography is from a Haitian proverb, Dèyè mòn gen mòn. Beyond mountains there are mountains.
 Farmer, “Conversion in the Time of Cholera,” 114.
 Gutiérrez, “The Option for the Poor Arises from Faith in Christ,” 151.
 Gustavo Gutiérrez, “Conversion: A Requirement for Solidarity,” in In the Company of the Poor: Conversations with Dr. Paul Farmer and Fr. Gustavo Gutiérrez, eds. Michael Griffin and Jennie Weiss Block (New York: Orbis Books, 2013), 71.
 Farmer, “Conversion in the Time of Cholera,” 112, 100, 113.
 Farmer, “Conversion in the Time of Cholera,” 113.
 Farmer, “Conversion in the Time of Cholera,” 114.
 Farmer, “Conversion in the Time of Cholera,” 135.
He writes further “Accompanying the destitute sick on a journey away from premature suffering and death—out of the country of social suffering, through the door of yes—is not a single life’s work, but rather the work of many, pulling together and over long years and many miles.”
 Gutiérrez, “Conversion: A Requirement for Solidarity,” 83, my italics.
 Gutiérrez, “The Option for the Poor Arises from Faith in Christ,” 151.
 Pamela E. Klassen, Spirits of Protestantism: Medicine, Healing, and Liberal Christianity (Berkeley, Los Angeles, and London: University of California Press, 2011), xiii.
 Arthur Kleinman and Bridget Hanna, “Religious Values and Global Health,” in
Ecologies of Human Flourishing, eds. Donald K. Swearer and Susan Lloyd McGarry (Cambridge: Harvard University Press, 2011), 83.
 Kleinman and Hanna, “Religious Values and Global Health,” 82.
Kleinman and Hanna write further:
“The liberal political and legal traditions of the West also informed the missionary and humanitarian assistance projects. In this sense, at particular moments, liberalization and religion were quite compatible. If we look at the personal histories of numerous contributors to global heath, we often find this kind of conjunct impulse in their background and commitments, clearly visible in an Albert Schweitzer—less so, but still active, in a Paul Farmer (83).”
 Kleinman and Hanna, “Religious Values and Global Health,” 87.
 Paul Farmer, “Personal Efficacy and Moral Engagement in Global Health: Response to Kleinman and Hanna’s Religious Values and Global Health,” in Ecologies of Human Flourishing, eds. Donald K. Swearer and Susan Lloyd McGarry (Cambridge: Harvard University Press, 2011), 95.
 For analyses of the relationship between religion, medicine, race, and colonialism, see: John & Jean Comaroff, “Medicine, Colonialism, and the Black Body,” in Ethnography and the Historical Imagination (Westview Press, 1992), 215-233; and Megan Vaughan, Curing their Ills: Colonial Power and African Illness, (Polity Press, 1991).
 For analyses of relationships between local belief and practice on the one hand, and illness, medicine, and the efficacy of healing on the other, see: E. E. Evans Pritchard, Witchcraft, Oracles, and Magic Among the Azande, 1937; Claude Lévi-Strauss, “The Sorcerer and His Magic,” in Structural Anthropology (Basic Books, 1963), 167-185; Victor Turner, Forest of Symbols: Aspects of Ndembu Ritual (Cornell University Press, 1967), especially “Witchcraft and Sorcery: Taxonomy versus Dynamics,” “Muchona the Hornet, Interpreter of Religion”, “Lunda Medicine and the Treatment of Disease”, and “A Ndembu Doctor in Practice,” 112-127, 131-150, 299-358, 359-393; Jeanne Favret-Saada, Deadly Words: Witchcraft in the Bocage (Cambridge University Press, 1977); Byron Good, “Medical Anthropology and the Problem of Belief,” in Medicine, Rationality, and Experience (Cambridge University Press: 1994), 1-24; Heike Behrend, “The Rise of Occult Powers, AIDS and the Roman Catholic Church in Western Uganda,” in Aids and Religious Practice in Africa, eds. Felicitas Becker & P. Wenzel Geissler (Brill, 2009), 29-47.
 Margaret Lock and Vinh-Kim Nguyen, An Anthropology of Biomedicine (Wiley-Blackwell 2010), 1.