Jonathan P. Baird

We live in an age of unparalleled cynicism. Kleptocratic dictators launch invasions of sovereign nations. Authoritarianism trends internationally, gravely threatening democracy. Powerful legislators sell out for the money. Billionaires pay no taxes and think it is fine. Ethics and truth are downgraded and dismissed. Dark money and misinformation are epidemic.

Our capitalist system has proven to be dysfunctional. The needs of working people are routinely disregarded by both political parties while the 1% makes out like a bandit. The system cannot accomplish absolutely needed reforms to tackle climate change, income inequality, or institutional racism. Our pandemic response was badly botched, leading to hundreds of thousands dying needlessly. It would be easy to despair.

But then the world also produces people like Dr.Paul Farmer. He proved that one determined and passionate man could defy all odds and change the world. From nothing, he almost single-handedly founded a global health movement that has provided high quality care to millions in some of the most impoverished countries on the planet.

Farmer died unexpectedly on February 21. He was only 62. Farmer had a broad vision of equity and justice for everyone. He once said:

“The idea that some lives matter less is the root of all that is wrong with the world.”

Farmer lived that credo. He re-defined what it meant to be a good doctor. After graduating Harvard Medical School, he moved to Haiti, a country he loved. His mission was to provide high quality health care to patients from the most destitute backgrounds.

In 1987, he co-founded the organization Partners in Health. Its accomplishments are staggering. It now employs 18,000 people in twelve countries. It has helped create 230 medical facilities around the world. When Farmer died, he was in Rwanda where he helped with the creation of a hospital, a cancer center, and a medical school. He travelled tirelessly to places where there were grotesque health inequalities and he addressed that.

Partners in Health expanded to countries across Africa, Latin America, Russia and to the Navajo Nation in the U.S.. Farmer was not trying to bring basic services to the people. He wanted to bring the most sophisticated treatments.He brought HIV drugs to Haiti in the early 2000’s when that was not considered financially possible. His clinics treated drug-resistant tuberculosis, malaria, other infectious diseases and Ebola.

Farmer always fought for free, high quality health care. He never accepted that inequality of health care access was natural or inevitable. Part of what made Farmer so unusual was his philosophy which is up front in the Partners in Health mission statement.

“Our mission is to provide a preferential option for the poor in health care. By establishing long-term relationships with sister organizations based in settings of poverty, Partners in Health strives to achieve two overarching goals: to bring the benefits of modern medical science to those most in need of them and to serve as an antidote to despair.”

Farmer engaged communities in designing solutions to their problems. 99% of Partners in Health’s 18,000 employees are from the countries where they work. A key part of Farmer’s philosophy was what he called “accompaniment”. The idea was to keep the patient company and share their fate and not for a little while. That runs so contrary to how medicine is now practiced in America.

As a medical anthropologist (he also had a Ph.D. in medical anthropology), Farmer studied the interconnection of health and poverty which he saw as very connected. He once said:

“You have to look at what’s happening to the patient in front of you and think about ways to address social disparities. If there is food insecurity then you provide food when you provide care. Or if patients drop out of treatment, you provide transportation to the clinic, or you send community health workers to the patient.”

In his wonderful biography of Farmer, Mountains Beyond Mountains, Tracy Kidder describes Farmer’s attraction to liberation theology. That came alive for him living in Haiti. He had an enthusiasm and joy in service to the poor. When asked what kept him in global health, he replied, “Doing hard things with friends”.

The accomplishments of Partners in Health speak for themselves. Life expectancy in Rwanda doubled in the last ten years. In Haiti, community health workers stopped people dying from tuberculosis. Something similar happened in Peru. As his colleague Dr Joia Mukherjee explained, Farmer helped to create an enormous community of people committed to a new model of social medicine. His example is also a roadmap for health care in the future.

Farmer believed health care was a human right. He also worked at Brigham and Women’s Hospital in Boston part of every year and he was intimately familiar with the quality of health care in America. He said it was very expensive to give bad medical care to poor people in rich countries.

He believed many deaths were “stupid deaths” and that who lived and who died depended on what type of health care system was available. To quote him:

“I was tempted to record the cause of death as ‘weak health system for poor people’, ‘uninsured’, ‘fell through gaping hole in safety net’ or ‘too poor to survive catastrophic illness’.”

When I read Mountains Beyond Mountains, I was struck by Farmer’s audacity. He had a can-do, positive attitude with an expansive vision that permeated his whole career. He called Partners in Health a “house of yes’.

Dr. Farmer inspired a generation of medical and public health workers.

Ralph Waldo Emerson once said:

“The purpose of life is to be useful, to be honorable, to be compassionate, to have it make some difference that you have lived and lived well.”

Although he left us way too soon, Paul Farmer more than made a difference. He pioneered what is possible as one engaged human being.