Want to help? Accompany the poor

by Thomas C. Fox

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Are you familiar with the word “accompaniment” in connection with idea of foreign aid and other assistance to the poor? If not, then a recent article in the Foreign Affairs is worth reading. It was written by Paul Farmer, chairman of Harvard Medical School's Department of Global Health and Social Medicine, and a founding director of Partners In Health, an international charity that provides health care to and undertakes research and advocacy on behalf of the sick and poor. The July 29th article is actually adapted from Farmer’s May 2011 commencement speech at Harvard University's John F. Kennedy School of Government.

Farmer argues in his article that all the good intentions of all the good aid agencies, governments and NGOs, will come up short unless they involve “accompaniment,” meaning the ability to project, plan and stay with a development effort while essentially walking with those whom it is aimed to aid.

From my experiences many years back, in Vietnam, when I worked as a volunteer with war refugees, Farmer is right on the mark. The problem with so many aid projects overseas is the inability to stay with them, to “accompany” the needy, to stay flexible when it is required. More often than not, aid projects are determined from outside the country, or at least from outside the experiences and lessons of those for whom the aid is intended to help. In some ways, foreign aid gets too big, bringing too much “expertise,” and ends up on the short side of successful implementation.

“Accompaniment” is an elastic term, Farmer explains. It has a basic meaning: “To accompany someone is to go somewhere with him or her, to break bread together, to be present on a journey with a beginning and an end. There's an element of mystery, of openness, of trust, in accompaniment. … The companion says: ‘I'll go with you and support you on your journey wherever it leads; I'll share your fate for a while. And by “a while,” I don't mean a little while.’”

Unpacking the word, “accompaniment,” Farmer points out it comes from the Latin: ad + cum + panis, which, he notes, is one way of saying “breaking bread together.” Some Catholics, of course, are familiar with the word as it shows up in liberation theology. Farmer notes that the organization he founded, Partners In Health, was inspired, in part, by the writings of Latin American theologians.

“The great failures of policy and governance usually result from failures of implementation, and accompaniment is good insurance against such failures, writes Farmer. “In other words, as institutions are rationalized, and as platforms of accountability are strengthened, the potential for accompaniment can be threatened, since it is open-ended, elastic, and nimble.”

Applying the idea of accompaniment to Haiti in the wake of the earthquake, the lessons are striking, says Farmer. “We all waited to be saved by expertise, but we never were. True accompaniment does not privilege technical expertise above solidarity, compassion, and a willingness to tackle what may seem insuperable challenges. It requires cooperation, openness, and humility.”

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