Walter Brueggemann: Let Us Now Praise Famous Health Care Providers

The Apocrypha of the Old Testament includes the book of Ecclesiasticus, The Wisdom of Jesus son of Ben Sirach. The book, a collection of various kinds of wisdom sayings, is commonly dated to 180 BCE. In what follows I will juxtapose two famous sections of the book as background for my appreciation of care-givers.

First, in Ben Sirach 38 there is a celebrative ode concerning doctors (38:1-15):

Honor physicians for their services,

for the Lord created them;

for their gift of healing comes from the Most High,

and they are rewarded by the king.

The skill of physicians makes them distinguished,

and in the presence of the great they are admired.

The Lord created medicines out of the earth,

and the sensible will not despise them (vv. 1-4).

Lest there be any tension between faith and medical science, the writer sees that medicine is a good gift from the creator God. As direct advice for the sick, the writer urges prayer, penitence, and offerings to God:

My child, when you are ill, do not delay,

But pray to the Lord, and he will heal you.

Give up your faults and direct your hands rightly,

and cleanse your heart from all sin.

Offer a sweet-smelling sacrifice, and a memorial portion or choice flour,

and pour oil on your offering, as much as you can afford (vv. 9-11).

But after these urgings of piety, room is made for the doctor:

Then give the physician his place, for the Lord created him;

do not let him leave you, for you need him.

There may come a time when recovery lies in the hands of the physicians,

for they pray to the Lord

that he grant them success in diagnosis and in healing,

for the sake of preserving life (vv. 12-14).

The final aphorism links sin against the creator God to defiance of the doctor:

He who sins against his maker,

will be defiant toward the physician (v. 15).

This linkage of God and doctors is not unlike Proverbs 17:5 that voices a direct link between mocking the poor and insulting the creator. As the poor are intimately linked to God, so doctors are closely connected to the creator.

The other citation from Ben Sirach to which I make appeal here is the long section of 44:1-50:21 introduced by the familiar phrase, “Let Us Now Praise Famous Men.” What follows is a long list of “famous men” in the memory of Israel who are indeed men of faith who contributed effectively to the life of Israel. (Yes, the list includes only men, even though the tradition markedly includes many women of faith who mattered decisively, including Sarah, Miriam, Deborah, Hannah, and Hulda). In this rendition the writer names men of prominence, but then acknowledges that there are many others not included or remembered:

But of others there is no memory;

they have perished as though they had never existed;

they have become as though they had never been born,

they and their children after them.

But these also were godly men,

whose righteous deeds have not been forgotten;

their wealth will remain with their descendants,

and their inheritance with their children’s children.

Their descendants stand by the covenants;

their children also, for their sake.

Their offspring will continue forever,

and their glory will never be blotted out (44:9-13).

There is some irony in this acknowledgment, since the writer intends to identify “famous men.” This juxtaposition suggests that some who are not famous are indeed to be honored alongside the famous.

The move from “famous men” (in our case “famous doctors”) to those most often not mentioned or remembered, permits us to recognize and take with serious appreciation those health care deliverers who are most often not mentioned or remembered. Our move in this same direction is helped along by the classic book of James Agee and Walker Evans, Let us Now Praise Famous Men (1941). Agee and Walker take up the well-known introductory phrase of Ben Sirach 44:1 in order to present a study of three share-cropper tenant farmers and their families in Alabama. Their names are Fred Garvrin Ricketts, Thomas Gallatin Woods, and George Gudger. The prose of Agee and the photography of Walker present what they can see and observe, almost without interpretive comment. Nor do they comment on the title they have used, even though its usage is thick with irony. The point of the title, I take it, is that these share-cropper farmers and families are not “famous,” but they are worthy of close and appreciative attention. So it is with our consideration of health care deliverers. Many of them are not “famous,” but they are worthy of appreciative attention.

The long recital of “famous men” in Ben Sirach 44-50 includes, at the outset Enoch and Noah, and then the patriarchs of Genesis; then follow the names of historical narrative memory including kings (David, Solomon, Rehoboam, Jeroboam, Hezekiah, and Josiah, but alongside the kings are the prophets, Elijah, Elisha, and Isaiah). The list concludes with reference to “Simon,” a Maccabee, from nearer the writer’s own time (50:1-21). All of these “famous men” are grounded in faith; they did bold things for their people.

If indeed we see a link between chapter 38 on doctors and chapters 44-50 on “famous men,” we may especially consider famous doctors (along with many other health-care providers who, even though it is as if “they had never been born,” will have their names recalled in generation after generation). They are the doctors, nurses, and medical technicians not widely known, but to whom specific persons and families are abidingly grateful for the careful caring work they have done.

Now as I juxtapose doctors and famous men, I want to reflect on the life and work of Paul Farmer who has just died. See “He Wanted to Make the Whole World His Patient” by Tracy Kidder (The New York Times 2/24/2022 A20). Farmer was the Presley Professor of Medical Anthropology at Harvard Medical School. With that as his home base, Farmer moved around the world into the deepest trouble spots, mobilized his medical skills, his great compassion, and his alert social imagination to transform societies and countries into healing venues. Especially in Rwanda and notably and abidingly in Haiti, Farmer put his buckets down to impact the lives of many needy and desperate people. His work is described in the biography by Tracy Kidder, Mountains beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World (22003) and in Farmer’s own book, Pathologies of Power: Health, Human Rights, and the New War on the Poor (2005).

Farmer brought to his work a keen awareness of the force of rapacious power, the ways in which power apportioned health resources, and ways in which symbol systems make for inclusive or exclusive care. He was powerfully informed by liberation theology, discerning the ways in which social injustice impinged upon health care:

But we will critique them [social democracies], and bitterly, because access to the fruits of science and medicine should not be determined by passports, but rather by need. The “health care for all” movement in the United States will never be morally robust until it truly means “all.” (Pathologies of Power 152-53).

He understood that truth about social reality is not monopolized by those with power and money:

Truth—and liberation theology, in contrast to much postmodern attitudinizing, believes in historical accuracy—is to be found in the perspective of those who suffer unjust privation. Cornel West argues that “the condition of truth is to allow the suffering to speak. It doesn’t mean that those who suffer have a monopoly on truth, but it means that the condition of truth to emerge must be in tune with those who are undergoing social misery—socially induced forms of suffering” (153).

In his appeal to liberation theology, he saw that “charity medicine” is often “second-hand, cast-off service.” To the contrary he insisted:

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 it is option-for-the poor medicine (155).

Following the work of George Pixley and Clodovis Boff, Farmer critiqued developmental approaches to health care delivery that are based on “liberal” views of poverty:

Liberal views place the problem with the poor themselves; these people are backward and reject the technological fruits of modernity. With assistance from others, they too will, after a while, reach a high level of development. Thus does the victim-blaming noted in the earlier discussion of tuberculosis recur in discussions of underdevelopment (155).

Farmer’s deep understanding of the matter of health-care delivery as it is related to liberal values (and violence!) was matched by his personal attentive compassion and generosity. Kidder, “He Wanted to Make the Whole World His Patient,” described one moment in Farmer’s engagement with his patients:

Paul was visiting a hospital to meet with Peruvian doctors about a different patient when he ran into the boy’s mother and father and saw the boy running toward him down a hospital hallway, actually running. The boy wasn’t just healed, he was restored. After cries of delight and hugs, Paul met with the Peruvian doctors and then headed to the parking lot. I sensed that someone was following us. I turned, and so did Paul, and we saw the little boy’s mother with her head bowed. She came up to Paul and said in Spanish, “I want to say many thanks.” Paul immediately took her hands and said also in Spanish, “For me, it is a privilege.”

The wonder of Farmer’s work is that he combined the patient attentiveness of a real live doctor with his acute awareness of how social structures and social policies impinge on the health or unhealth of the “undeserving” people with whom he used his skills. He is indeed a “famous man” who should be praised, remembered, and celebrated.

From his extraordinary life two things occur to me while you, dear reader, may think of many others. First, while Farmer is and was “larger than life,” he may be a stand-in for the countless doctors, nurses, and health-care providers who do the daily hard work of medicine, who possess technical competence and human passion, and who give themselves away in tireless work in hard circumstances and against great odds. Many of them will leave no memory and will be “as though they have never existed.” Except that in the midst of our forgetfulness, their names will “never be blotted out,” because some grateful family will recall them and their brave tireless work. Thus for example my Dad from his younger days always remembered “old Doctor Bunge” in Bland, Missouri. He never spoke of him other than as “old Doctor Bunge” who had saved his life in an emergency appendectomy and who eventually mentored him to seminary and into ministry. My Dad’s life was better because of “old Doctor Bunge.” And his name lingers for us!

Second, it is possible and important to read our present health care crisis in our society through the lens of Farmer’s work. While we quibble variously about coverage, co-pays, deductions, and drug prices—all made as complicated as possible—the simple obvious daily reality of our society, matched by our affluent resources, is a travesty and an embarrassment.  Our economic circumstance does not require parsimony toward those who need health care. Rather our circumstance might regularly evoke open-handed generosity that is capable of health care for all those who require it. Of course the bugaboo is “socialism,” a term that is reiterated as often as possible. But that of course is a phony quarrel. What is not phony is the way in which generous resources are withheld from the common good, and the way in which the powerful ration care for the vulnerable.

It belongs exactly to the work of the church to educate about the common good, and the allotment of common resources for the sake of the common good.  It is exactly the capitalist ideology of extreme individualism that makes our parsimony toward the poor, needy, and vulnerable seem like a virtue. If we require a text to make the crisis clear, we might consider the juxtaposition of Acts 4:32-37 and 5:12-11. In the former the clear mandate is that the community held “all things in common.” In the latter Ananias and Sapphire are rebuked (and dead!) precisely because they withheld property and profit from the community.

Yes, let us praise famous men and women!

Yes, let us praise famous doctors, nurses, and all other health care providers.

Yes, let us praise those who are most often mentioned and whose names are not remembered at all:

Then give the physician his place, for the Lord created him;

do not let him leave you, for you need him (Ben Sirach 38:12).

And then let us resolve to do the hard work of learning from Dr. Farmer that good medical practice requires a restored decision for communal solidarity. It might be a good idea to take up Farmer’s own book, Pathologies of Power, as a study guide for the congregation. After all, what Famer knew and practiced is simply is the core obligation of our faith. It is no wonder that when Jesus sent out the seventy, he gave them a simple terse charge:

Cure the sick who are there and say to them, “The Kingdom of God has come near to you” (Luke 10:9).

The coming Kingdom is the practice of neighborliness, the redistribution of resources, the valuing of the most vulnerable, and the rehabilitation of the most hopeless. Ben Sirach declares:

There may come a time when recovery lies in the hands of physicians,

for they too pray to the Lord that he grant them success in diagnosis and in healing,

for the sake of preserving life (38:13-14).

The withholding of good health care is indeed a way to defy the doctor. It is also a way to sin against our Maker:

He who sins against his maker,

will be defiant toward the physician (38:15). 

Jesus reiterates after he commissions the healers:

Yet know this: the kingdom of God has come near (Luke 10:11)!

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Used with permission. Originally posted on Church Anew, a ministry of St. Andrew Lutheran Church in Eden Prairie, MN.

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