Paul Farmer, Pioneer of Global Health, Dies at 62
As a medical student, Dr. Farmer decided to build a clinic in Haiti. It grew into a vast network serving some of the world’s poorest communities.
Dr. Paul Farmer speaking with an H.I.V. patient,
Altagrace Cenatus, at a Partners in Health hospital in Haiti in 2003. He worked
to provide quality health care to some of the poorest people in the world.
Paul Farmer, a physician, anthropologist and
humanitarian who gained global acclaim for his work delivering high-quality
health care to some of the world’s poorest people, died on Monday on the
grounds of a hospital and university he had helped establish in Butaro, Rwanda.
He was 62.
Dr. Farmer attracted public renown with “Mountains
Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the
World,” a 2003 book by
Tracy Kidder that described the extraordinary efforts he would make to care for
patients, sometimes walking hours to their homes to ensure they were taking
their medication.
He was a practitioner of “social medicine,” arguing there was no point
in treating patients for diseases only to send them back into the desperate
circumstances that contributed to them in the first place. Illness, he said,
has social roots and must be addressed through social structures.
His work with Partners in Health significantly
influenced public health strategies for responding to tuberculosis, H.I.V. and
Ebola. During the AIDS crisis in Haiti, he went door to door to deliver
antiviral medication, confounding many in the medical field who believed it
would be impossible for poor rural people to survive the disease.
he often lived among the people
he was treating, moving his family to Rwanda and Haiti for extended periods.
“There are so many people that are alive because of
that man,”
Dr. Anthony S. Fauci, President Biden’s top medical adviser, broke down
in tears during an interview, in which he said he and Dr. Farmer had been like
“soul brothers.”
“When you talk about iconic giants in the field of
public health, he stands pretty much among a very, very short list of people,”
said Dr. Fauci, who first met Dr. Farmer decades ago, when Dr. Farmer was a
medical student. He added, “He called me his mentor, but in reality, he was
more of a mentor to me.”
Remembering Paul
Farmer (1959-2022)
The pioneer of global heath died on Feb.
21, 2022. He was 62.
Dr. Farmer, who never settled into the easy life of
an elder statesman, was vigorously involved in the response to the Covid-19
pandemic, prodding the Biden administration to drop intellectual property
barriers that prevented pharmaceutical companies from sharing their technology.
Paul Edward Farmer Jr. was born on Oct. 26, 1959,
in North Adams, Mass. Paul’s mother, Ginny (Rice) Farmer, worked as a
supermarket cashier, and his father, Paul Sr., was a salesman and high school
math teacher.
When Paul was around 12, his father bought an old bus and fitted it with
bunks, converting it into a mobile home. Paul, his parents and his five
siblings spent the next few years traveling, mostly in Florida, living for a
time on a boat moored on a bayou. He credited this period with giving him a knack for sleeping anywhere and an
inability to be shy or embarrassed.
One summer, he and his family worked alongside
Haitian migrant workers picking oranges, listening curiously as they chatted to
one another in Creole from atop ladders. That was Paul’s first encounter with
Haiti, the country that would captivate him in his 20s and then propel him
toward a career in public health.
After graduating from Duke University, he moved to
Haiti, volunteering in Cange, a settlement in the central Artibonite plateau of
the country. He arrived toward the end of the dictatorship of Jean-Claude
Duvalier, when Haiti’s hospital system was so threadbare that patients had to
pay for basic supplies, like medical gloves or a blood transfusion, if they wanted
treatment.
In a letter to a friend, he wrote that his stint at
the hospital wasn’t turning out as he had expected. “It’s not that I’m unhappy
working here,” said the letter, excerpted in Mr. Kidder’s book. “The biggest
problem is that the hospital is not for the poor. I’m taken aback. I really am.
Everything has to be paid for in advance.”
Dr. Farmer decided to open a different kind of clinic. He returned to
the United States to attend Harvard Medical School and earn a degree in
anthropology, but he continued to spend much of his time in Cange, returning to
Harvard for exams and laboratory work.
Over the years, Dr. Farmer raised millions of
dollars for an ever-expanding network of community health facilities. He had a
contagious enthusiasm and considerable nerve. When Thomas J. White, who owned a
large construction company in Boston, asked to meet him, he insisted that the
meeting take place in Haiti.
Mr. White eventually contributed $1 million in seed money to Partners in
Health, which Dr. Farmer founded in 1987 along with Ophelia Dahl, whom he had
met volunteering in Haiti; a Duke classmate, Todd McCormack; and a Harvard
classmate, Dr. Jim Yong Kim.
In 1996 he married Didi Bertrand, the daughter of a
pastor and a school principal in Cange; she was described in Mr. Kidder’s book
as “the most beautiful woman in Cange.” She became a researcher for Partners in
Health and survives Dr. Farmer, along with their three children, Catherine,
Elizabeth and Sebastian; his mother; his brothers, James and Jeffrey; and his
sisters, Katy, Jennifer and Peggy.
The clinic in Haiti, at first a single room, grew
over the years to a network of 16 medical centers in the country, with a local
staff of almost 7,000.
Among them was a teaching hospital in Mirebalais,
about 40 miles north of Port-au-Prince, that opened in 2013 and offered
chemotherapy drugs, a gleaming new $700,000 CT scanner and three operating
rooms with full-time trauma surgeons. There, poor patients with difficult
diseases paid a basic fee of around $1.50 a day for treatment, including
medication.
Partners in Health also expanded into Rwanda, where
Dr. Farmer helped the government restructure the country’s health system,
improving health outcomes in areas like infant mortality and the H.I.V.
infection rate.
Dr. Farmer died in Butaro, a mountain town on the
border of Uganda where he and Partners in Health collaborated with the Rwandan
government to build a complex devoted to health and health education
Dr. Farmer also helped develop new public health
approaches in Peru, Russia and Lesotho, among other places.
He was particularly proud of the fact that the clinics he helped build
were staffed by local doctors and nurses whom he had trained.
“I’m not cynical at all,” he once said. “Cynicism
is a dead end.”
Over the years, he kept in touch with many of his
patients, as well as their children and grandchildren. He was godfather to more
than 100 children, most of them in Haiti, said Laurie Nuell, a close friend and
board director at Partners in Health.
Over the weekend, Dr. Farmer sent her a photo of a
colourful bouquet of flowers he had put together for one of his terminally ill
patients in Rwanda. “Not my best work,” the accompanying text said.
“He had a very tender heart,” she said. “Seeing
pain and suffering was very hard for him. It just hurt him. I’m a social worker
by training. One thing I learned is about detachment. He wasn’t detached from
anyone. That’s the beauty of it.”
