Jan. 17 — Triage

Texts: Habakkuk 2:1-3a

A preferential option for the poor also implies a mode of analysis. In examining TB in Haiti, our analysis must be historically deep: not merely deep enough to remind us of the Peligre dam project that deprived the majority of my patients of their land, but deep enough to make us remember that modem-day Haitians are the descendants of a people kidnapped from Africa in order to provide us with sugar, coffee and cotton.
Our analysis must also be geographically broad. Many believe that the world as we know it is becoming increasingly interconnected. A corollary of this belief is that what happens to poor people is never divorced from the actions of the powerful. Certainly, people who define themselves as poor may control to some extent their own destinies. But control of lives is related to the control of land, systems of production and the formal political and legal structures in which lives are enmeshed. There has come, with time, an increasing concentration of wealth and control in the hands of a few. The very opposite trend is desired by people working for social justice. – Paul Farmer, “Medicine and Social Justice”

I mentioned in my Friday email news, that I had turned to the story and thinking of Dr. Paul Farmer out of my own desperation felt at this earthquake.  The story of Dr. Farmer is a remarkable story of hope in the face of very long odds.  Reading about him and about his efforts in the Partners in Health clinic in Haiti, I reflected on the two meanings of the word triage.

In situations where doctors and nurses and medical supplies are limited, triage is a method of attending first to the severely wounded who have the best chance of surviving — triage in this case is about sorting out those whom you will let die from those whom you will attempt to save.

Triage in a hospital emergency room when people and supplies are not so limited does not imply the withholding of care from anyone, rather it is about identifying grave danger and attending to it first.

In Haiti this last week triage had a third meaning — long defeat.  According to reports out of Haiti in the first 3 days following the earthquake, the situation was  so utterly devastating, there are so many people in need of care, that all supplies have run out.  All one could do is put pressure on the wounds of the ones  around you. That, thanks to an international outpouring of aid and the  fact that their airport is not so damaged as to make it non-functional, has begun to change.


Toward the end of the book about Dr Farmer, his biographer, Tracy Kidder, tells the story of a decision Farmer made to evacuate a sick, cancer ridden boy out of Haiti to Boston for treatment.  Farmer knew the cancer the boy had was deadly if not treated, but if treated properly, almost  always resulted in a fresh lease on life. The boy died.  Kidder engages Dr. Farmer in a conversation about the justice in spending $20,000 on the flight from Port-au-Prince to Boston.

Farmer’s response in the book is long and philosophical.  He wonders about other ways of posing the question:  “For example, why didn’t the airplane company that makes money, the mercenaries, why didn’t they pay for his flight?”

Farmer’s own question in response to the questions about his actions are framed and informed by his study of the Latin American theologians Leonard Boff and Gustav Gutierrez who coined the phrase, “preferential option for the poor,” by which they meant that if the gospel was not lifting the poor from their oppressive conditions then it was not the gospel.  Boff:

There are various forms of poverty brought about by socio-economic circumstances, which in addition embody specific oppressions and therefore require specific forms of liberation.  . . . . In one base community a woman described herself as oppressed and impoverished on six counts: as a woman, as a prostitute, as a single parent, as black, as poor and because of her tribal origin.,  Faced with such conditions, what can being a Christian mean except living the faith in a liberating way, trying every possible avenue of escape from such a set of social inequities? We have to tell poor persons like her that God loves them in a special way, whatever moral or personal situation they find themselves in because God in Jesus established solidarity with the poor, especially in his passion and death:: “For this reason alone, the poor merit preferential attention . . .”

The corollary to this religious vision where the poor merit preferential attention is that the life and culture of the rich must needs be critiqued.  As a man straddling both cultures,  Dr. Farmer is clear in some of our ways of living do harm to the poor.  Speaking of his area of expertise, he writes:

Charity medicine too frequently consists of second-hand, castoff services — leftover medicine — doled out in piecemeal fashion.  How can we tell the difference between the proper place of charity in medicine and the doling out of leftovers?  Many of us have been involved in these sorts of good works and have often heard a motto such as this: “the homeless poor are every bit as deserving of good medical care as the rest of us.”  The notion of a preferential option for the poor challenges us by reframing the motto:  the homeless poor are more deserving of good medical care than the rest of us.  Whenever medicine seeks to reserve its finest services for the destitute sick, you can be sure that it is option-for-the-poor medicine. Pathologies of Power, p. 155

Farmer concludes his philosophical response to the criticism with the phrase I alluded to in describing the state of triage in Haiti today.  He says, “I have fought for my whole life, a long defeat.”  By which it becomes clear that he means the he has aligned himself with the poor and that the criticisms the rich offer of his work  as  defeat do not concern him — the long defeat is a sign to him, that he’s doing the right thing.


Jesus taught his disciples a similar lesson.  We will share what we have come to call has the Last Supper in moments because Jesus taught that it is better to seek to remove systemic exploitation and die,  than to participate in the systems of injustice and live.  It is better to be harmed than to do harm.  Or, translated to the situation in Haiti — it is better to triage in the face a long defeat than to turn away in horror or despair or apathy or fear.

Let me conclude with the words of Martin Luther King, Jr.  We appreciate him today for his stirring orations about events that are safely past and about which we can agree.  But our topic requires us to hear words of his that are less comfortable, more controversial. He speaks about the elimination of poverty in his posthumously published book, Where Do We Go from Here: Chaos or Community?:

I am now convinced that the simplest approach will prove to be the most effective — the solution to poverty is to abolish it directly by a now widely discussed measure: the guaranteed income.

Earlier in this century this proposal would have been greeted with ridicule and denunciation as destructive of initiative and responsibility. At that time economic status was considered the measure of the individual’s abilities and talents. In the simplistic thinking of that day the absence of worldly goods indicated a want of industrious habits and moral fiber. Where Do We Go from Here: Chaos or Community?

We may be frozen at the enormous horror of the devastation of Haiti.  When Habakkuk wrote that he’d been instructed to write the vision on a tablet so that a runner might read it he too had been frozen into despair by the enormity of the tragedy that had befallen his people.  God will not tolerate paralysis in the face of common cause for justice.  There is a vision — let us not couch it in religious language of a better world in heaven — and are to make it plain now:  to gather up the courage and make common cause with the poor. Because God’s love is for all, no matter one’s personal or moral situation, the triage we need now, our top priority


One thought on “Jan. 17 — Triage

  1. Trish says:

    Hey Peter,
    Great idea to pair Habakkuk and Farmer. Do you suppose those two have spent time together before? I love the prophetic emphasis on the here (hear) and now.

    I was looking for your email to catch up. Drop a note.

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