PAUL FARMER – HEALTHCARE CHAMPION OF THE POOR

By Joseph Collins

Paul Farmer with patientPaul Farmer has been described as a source of light in a world haunted by darkness.  A physician and medical anthropologist, Farmer has been on a mission for over thirty years to transform health care on a global scale by focusing on the poorest and most underserved people on earth. As part of his efforts, Farmer co-founded a nonprofit organization known as Partners in Health. Through the organization, Farmer tends to the medical needs of underprivileged communities all across the globe – from the island nation of Haiti to the most remote regions of Siberia to isolated villages of Peru. As he works with local communities, Farmer not only wants to heal his patients of physical maladies, but also fill them with a sense of hope and enthusiasm for life

Dr. Paul FarmerHaving grown up in poverty himself, Paul Farmer can identify with the poor and their daily struggles. Over the years, he has received much attention for his altruistic devotion to treating the poor and his enormous sense of social justice.  In fact, he has recently been the subject of a documentary called “Bending the Arc,” showcasing his work in Haiti, which has been his main focus of attention.  He and his organization now serve about 1,000 patients a day for free in the Haitian countryside, where many of the poorest reside. Although he is confronted with devastating, ongoing poverty every day, Farmer remains remarkably positive and optimistic. In fact, he is excited about a recently completed hospital in Haiti, the largest solar-powered medical facility in the world (Hopital Universitaire de Mirebalais). He is also enthusiastic about recent advances in vaccines for infectious diseases, which are his specialty.  Whatever the daily challenges life brings, Paul Farmer presses on tirelessly, always ready to share a glowing and encouraging smile with others.

Paul Farmer with child patientFor me, an area of moral clarity is: you’re in front of someone who’s suffering and you have the tools at your disposal to alleviate that suffering or even eradicate it, and you act.  I mean, everybody should have access to medical care.  And, you know, it shouldn’t be such a big deal.” – Paul Farmer

POOR POCKETS, RICH MIND

Paul Farmer was born on October 26, 1959, in North Adams, Massachusetts. His father was a salesman, a high school teacher, and a free spirit with a hunger for travel. As a result, Paul Farmer grew up in an unconventional family that moved frequently and faced financial struggles for over a decade, living at times on a boat, in a trailer park, and in a bus in Florida without running water. One summer, when money was short, the family picked citrus fruit alongside immigrant Haitian workers. It was Farmer’s first contact with people from Haiti, but it would not be his last.   

In spite of his childhood hardships, Paul Farmer had a knack for making friends easily and possessed a photographic memory for facts, a gift that helped him ace his way through school. In fact, he was adept at learning languages, including French, a skill that served him well later in life. Farmer graduated from Hernando High School (Brooksville, FL) as valedictorian and went to Duke University, North Carolina, on a full scholarship. It was while at Duke that Farmer discovered the works of German physician Rudolf Virchow, a champion of medicine for the underprivileged, sometimes called “the father of public health.”  Farmer was greatly influenced by Virchow’s humanitarian notion that “physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.” 

migrant tobacco farm workersPaul Farmer’s concern for the poor rose to a new level when he started touring tobacco plantations in North Carolina, while still a student at Duke. On these plantations, Farmer was able to observe first-hand the difficult conditions under which migrant workers toiled – most of whom were from Haiti. Over time, Farmer became intrigued by these workers and their country, and he began learning all he could about Haiti, including the Creole language. After graduating Summa Cum Laude in 1983, with a Bachelor of Arts of medical anthropology, Farmer went on to attend Harvard University. He was determined to learn as much as he could, so that he could help those less fortunate than himself. In 1990, at the age of 31, Farmer graduated Harvard with an M.D. and Ph.D. in medical anthropology, feeling more determined than ever to help the people of Haiti gain access to quality medical care.

In 1987, while still a student at Harvard, Paul Farmer co-founded the nonprofit organization Partners in Health. The goals of the organization are simple: “bring the benefits of modern medical science to those most in need of them and to serve as an antidote to despair.” Although based in Boston, Partners in Health has since grown into a worldwide organization that helps provide medical assistance to the poor in places like Liberia, Mexico, and Rwanda. Farmer co-founded the organization with several other humanitarians including Jim Yong Kim, physician/anthropologist, and Ophelia Dahl, a British-American social justice and health care advocate.

Paul Farmer with PIH co-founders Jim Yong Kim and Ophelia Dahl

“The essence of global health equity is the idea that something so precious as health might be viewed as a right.” – Paul Farmer

FIGHTING THE TIDE

When Farmer first began making a concerted effort to bring comprehensive health care to Haiti, it wasn’t an easy task.  Many people from the United States thought it would be in impossible battle that could not be won.  He first started working in Haiti in the summer of 1983, when he traveled to the small island nation to get a firsthand look and to establish some good will. 

Jean-Claude Duvalier

At the time, the country was going through a difficult period, with poverty rising under the rule of dictator Jean-Claude “baby doc” Duvalier, a tyrant known for his harsh, repressive rule. After witnessing the abject poverty and the daily struggles of average Haitians, Paul Farmer returned to the states to attend Harvard, but continued to visit Haiti periodicallydetermined to return. In the summer of 1984, on follow-up trip to the island, Farmer established the Zanmi Lasante Clinic as a first step to help the impoverished people living there. The more he came to know the local communities, the more he grew to love and care about them.  Their inner strength and resilience impressed and inspired him, and he wanted to meet them half way and give them the health care they deserved.

“The only way to do the human rights thing, is to do the right thing medically.” – Paul Farmer

Although determined to make a difference for the long-suffering poor of Haiti, Farmer was often stymied by political apathy from both local and international politicians, as well as a skeptical scientific community that thought little could be done to help an isolated island with so many deep-rooted problems. But Farmer was convinced they were wrong.

Despite the obstacles, Farmer persisted. To get the medicines he needed, he was willing to be bend the rules and do whatever was necessary. Often, he needed to obtain medicines that were hard to come by to combat difficult diseases, like tuberculosis or AIDS.  Thanks to Paul Farmer’s determined efforts, however the Zanmi Lasante Clinic has made impressive headway in alleviating the spread of HIV/AIDS.  In fact, the rate of transfer from mother to new-born children has been brought down to just 4%, an astonishing accomplishment when dealing with such an easily transferable disease. 

GREAT RISK, GREAT REWARD

Of course, this work is not without risks. Often, Farmer’s efforts expose him to the very diseases that he’s trying to cure or prevent.  Over the years, he has been seriously ill many times“I get the odd bout of Malaria,” he said in an interview.  “Once I contracted TB [tuberculosis].  I also came down with amoebic dysentery in Haiti. I ended up in a shabby hospital in Port-au-Prince with no toilets or beds so I had to lie on the floor.  I also contracted hepatitis A.” 

Nevertheless, Paul Farmer is undaunted. His determination to continue helping the world’s poor, sometimes at great risk to his own health, is a testament to his endless compassion for others and his heroic steadfast nature. In short, Farmer believes that the thousands of people in Haiti and countries around the world with health issues should not be abandoned for the convenience of one person. Willing to sacrifice himself for the greater good, he  also constantly fights to acquire much-needed medicine, equipment, and funding from First World nations that he sees as indifferent and content with the unfair distribution of resources. 

“It is clear that the pharmaceutical industry is not, by any stretch of the imagination, doing enough to ensure that the poor have access to adequate medical care,” says Farmer.   The idea that some lives matter less is the root of all that is wrong with the world.”

With a powerful sense of justice, however, Paul Farmer is determined to change this situation. And his years of effort have been paying off. Today, the Zanmi Lasante Clinic is a highly successful and well-regarded medical center that trains and employs local personnel as community health workers. It is a huge hospital with modern facilities, serving more than 150,000 people every year, saving thousands of lives in the process.

Hôpital Universitaire de Mirebalais – built by Partners in Health

Beyond health care, the clinic also provides a range of other services to local communities. The staff at Zanmi Lasante dispenses food and water to local residents, offers housing assistance, and even provides other social services, such as education.

By the end of the 20th century, the clinic had built schools, houses, communal sanitation and water facilities throughout the central plateau. Additionally, it had vaccinated all the children in the area, dramatically reducing malnutrition and infant mortality. Finally, it had even launched programs for women’s literacy and AIDS prevention, hoping to use education as a tool for improving local health. And all of these efforts have had a huge impact. One of the clinic’s greatest successes has been in curtailing the spread of AIDS throughout Haiti.  Its model has been so successful, in fact, that WHO, the World Health Organization, has adopted Farmer’s methods and now uses it in over 30 countries around the world.

Although Farmer spends a few months of any given year in Boston, most of the time he can be found in Haiti providing medical care or visiting other impoverished countries around the world.  From successfully controlling HIV, to trekking across Haiti in search of one patient suffering from tuberculosis, to suppressing an outbreak of Typhoid in the village of Cange by reforming the water supply, Farmer has accomplished so much and helped so many over the years. As a result, many consider him to be a true hero, a modern-day Robin Hood, doing everything he can to help the poor and underserved. 

In fact, in 1993, the McArthur Foundation, recognizing Farmer’s important, life-saving work, awarded him a $220,000 grant to support his efforts. Farmer promptly used the money to start a research program, the Institute for Health and Social Justice, broadening his campaign to bring comprehensive health care to the poorest people around the world, and further cementing his reputation. 

TIRELESS DEVOTION

Over the years, Farmer has also found the time to write several books about his life and work, hoping to raise awareness about the needs of the poor. His published works include the following: Aids and Accusations (1992), Infections and Inequalities and Pathologies of Power (2001), The Uses of Haiti (2005), and most recently To Repair the World (2013).

After more than 30 years of service, Paul Farmer’s astounding success as a compassionate physician has also earned him many awards: The 9th Annual Heinz Award in the Human Condition (2003); International Human Rights Award by Global Exchange (2005); Peace Abbey Courage of Conscience Award (2008);  and the S. Roger Horchow Award for Greatest Public Service by a Private Citizen (2010), as well as countless others. Farmer continues to receive grants from many philanthropic individuals and organizations to help him expand his activities, including a $13 million grant from the Global Fund to help with his projects in Cange, and funding from the William J. Clinton Foundation (former president Bill) for a project in Rwanda, Africa

Globally, Farmer is responsible for successful health care projects in Haiti, Lesotho, Malawi, Peru, Russia, Rwanda, and the United States, and he supports additional projects in Mexico and Guatemala. Together, this is an impressive list of accomplishments, especially for a man who grew up in poverty himself.   

Today, Farmer can mostly be found traveling from country to country, overseeing projects that he has set up, and monitoring new health care programs established at key medical centers. At night, while most of us are asleep in bed, Farmer is more often than not hunched over a laptop, reaching out to others to secure yet more funding for Partners in Health. In spite of an unconventional, sometimes disadvantaged, childhood, Farmer proves that your background does not have to hold you back from achieving great things in life.  And today, he is a hero to millions of people worldwide.

“We’ve taken on the major health problems of the poorest – tuberculosis, maternal mortality, AIDS, malaria – in four countries,” says Farmer  “We’ve scored some victories in the sense that we’ve cured or treated thousands and changed the discourse about what is possible.   If you’re asking my opinion, I would argue that a social justice approach should be central to medicine and utilized to be central to public health.  This could be very simple: the well should take care of the sick.”