To Preferentially Care for Those Made Poor
By Sheila Davis
I was twenty-four years old, from rural Maine, and was naïve to the world and the structural violence that created the have and the have-nots of the world. It was in the 1980s when I started in nursing school and the illness that was soon to be named HIV/AIDS was synonymous with an ugly death sentence. The virus had a devastating impact on the body by attacking and imbedding itself in the host’s immune system, the thing that was supposed to stop its destruction. As horrific as the virus was to people, society was worse. Although there were those who fought to care for all, there were countless politicians, clinicians, religious leaders, and many others emboldened to blame those who had been infected with the virus as deserving of suffering and treated people as the ultimate enemy — the other.
It was clear early on that health care was not a right. It was afforded to those who were deemed worthy by those in power and the HIV virus had disproportionately impacted those who were already systematically marginalized. Men who had sex with men, those who injected drugs and people who were forced to trade sex for money were the first and hardest hit. The stigma of HIV forced people to lose their jobs, families, and place in society. There were no books about HIV yet, no plethora of peer reviewed journal articles, and no approved treatment for the deadly virus.
Early in my career, I heard of a young doctor named Paul Farmer who had a seemingly radical approach to preferentially caring for those made poor in this world because of structural violence. He and his organization, Partners In Health (PIH), talked about health as a human right and the importance of comprehensive care that included addressing the social and economic rights of people. PIH successfully treated patients in rural Haiti with the new HIV medications and provided food, water, transportation and education for the patients and their families.
My patients also taught me this important lesson. Christine was expected to take 14 pills a day, suffer with almost constant diarrhea and keep her job working as a parking lot attendant with no regular access to a bathroom. Glen, severely immune compromised, was unhoused and his only option to sleep inside came in the form of fighting for one of the dozens of cots in a room with no air flow or adequate hygiene. Susan was kicked out of her apartment with three young children because her diagnosis was disclosed and she was in danger of losing custody. The HIV virus was not their biggest challenge. Their biggest challenge was basic survival.
During the 1980’s, the foundation for the movement for global health equity was laid by Dr. Paul Farmer and radicalization of the young nurse from rural Maine began. I bore witness to the power of activism, the importance of the commitment to follow emerging science and the essential safety net that a community can provide to reduce suffering. The tenets of accompaniment and pragmatic solidarity influenced how I saw the world and the fight for health as a human right became the focus of my 35 plus years as a nurse. I had the honor and privilege to work closely with Dr. Paul Farmer until his sudden and tragic passing in February of 2022.
Dr. Sheila Davis is the Chief Executive Officer of Partners In Health (PIH), a global health non-profit organization rooted in social justice that brings the benefits of modern medical science to impoverished communities in 11 countries. She received her BSN degree from Northeastern University as well as her Masters in Nursing as an Adult Nurse Practitioner and her Doctorate in Nursing Practice with a concentration in global health from the Massachusetts General Hospital (MGH) Institute of Health Professions. She was a clinician in the Infectious Diseases clinic at MGH and an HIV/AIDS activist for over 15 years and for the past decade has held multiple cross-site roles at Partners In Health, including Chief of the Ebola Response, Chief of Clinical Operations, and Chief Nursing Officer. Dr. Davis is a frequent national speaker on global health and clinical topics including HIV/AIDS, the Ebola epidemic, leadership in public health, and the role of nursing in human rights.