by Holly Tanguay
Instead of speaking about America today I am going to tell you about a great American, Paul Farmer, a physician, writer and teacher who died this last February at the age of 56. In his short life he established first class health care systems serving the poorest of the poor in rural Haiti and elsewhere, rewrote the book on treatment of antibiotic resistant tuberculosis, aids and other infectious diseases, and changed world health policy. Paul was an American but not an American patriot. He was a world citizen and an impassioned advocate for the poor everywhere.
I never met Paul Farmer but I felt I knew him after I read, almost twenty years ago, Mountains Beyond Mountains, by Tracy Kidder, an account of Farmer’s life and work in Haiti. When Paul died this year, unexpectedly in his sleep from a cardiac event, I was stunned and grief stricken. So were all who had come under his influence. Ever since I have been pondering how his life had such a profound emotional and spiritual effect and what to make of his example.
Paul was first and foremost a physician and healer who felt most alive when he was helping people. He might have been raised Catholic but he was a committed Universalist thinker. He said
“The idea that some lives matter less is the root of all that is wrong with the world.”
His work was spiritually driven: He said
“If I am hungry, that is a material problem; if someone else is hungry, that is a spiritual problem.”
And his work was indeed driven: he said
“I can’t sleep. There’s always somebody not getting treatment. I can’t stand that.”
His passion for serving the poor grew in part out of his exposure to Liberation Theology, a movement in Christian theology, developed mainly by Latin American Roman Catholics, that emphasizes liberation from social, political, and economic oppression. From that movement Paul adopted the “preferential option for the poor” or POP, one of the founding principles of Partners in Health.
Liberal Catholic theology was one source of Paul’s calling. What else? Undoubtedly his unconventional upbringing taught him to think outside the box. (To tell you about Paul’s life I will draw extensively on a biography of him on the Academy of Achievement website.)
Paul was born in West Adams, in Western Massachusetts, the second of six children. When he was seven years old, his father, a salesman and high school math teacher, moved the family to Birmingham, Alabama, and five years later, to Brooksville, Florida, a small town north of Tampa, inland from the Gulf of Mexico. Here, the elder Farmer found jobs teaching, and working with developmentally disabled adults.
Farmer described his father as “a free spirit.” When they moved to Florida, he housed his family in an old school bus he converted into a mobile home, replacing the seats with bunk beds. He wired the bus with electricity, but it lacked running water. In the bus, the family of eight migrated from one trailer park to another. When the father decided to try his hand at commercial fishing, he moved his family to a houseboat in the Gulf. Tiring of fishing, the elder Farmer moored the boat in an undeveloped bayou called Jenkins Creek. The family bathed in the creek and brought their drinking water back from Brooksville in jugs.
Despite his unconventional home life, Paul excelled in school. Both of his parents enjoyed reading serious literature to their children and encouraged them to take an interest in the wider world. When money was short one summer, the family picked citrus fruit alongside Haitian migrant workers. This was Paul Farmer’s first encounter with Haitian people and their Creole language, and was probably another source of his calling.
Throughout his career Paul would not be limited by conventional rules or expectations. He founded a medical clinic before he became a doctor. While in Harvard medical school he “borrowed” medicines and equipment from resource rich Harvard and carried them in his baggage to Haiti. He rejected conventional wisdom that poor, uneducated patients could not comply with complex medical regimens. Assuming that the problem lay not in the patients but in the health care system, he trained cadres of community health workers to visit patients, sparing them arduous trips to the clinic, and provided wrist watches, nutrition and other support when needed. Patients complied and cure rates soared.
Farmer rejected as unconscionable, the almost universal assumption that expensive first world treatments could not be offered to the poor.
“Since I do not believe that there should be different recommendations for people living in the Bronx and people living in Manhattan, I am uncomfortable making different recommendations for my patients in Boston and in Haiti. The assumption that the only health care possible in rural Haiti is poor-quality health care—is a failure of imagination.”
While Paul worked in Haiti a wave of multidrug-resistant tuberculosis arose in the developing world. Improper treatments heightened the threat of a global epidemic. Observing dangerous relapses in patients, Farmer and his colleagues at Partners in Health pressed the World Health Organization and pharmaceutical companies to change international protocols and drop drug prices for expensive second line antibiotics, arguing the existing standards were effective death sentences for the TB-infected poor.
It’s no accident that thee now international charity founded by Paul and his colleagues is called “Partners in Health.” Paul viewed partnerships with individuals and organizations as essential to tackling health care inequities and other complex problems.
“With rare exceptions, all of your most important achievements on this planet will come from working with others—or, in a word, partnership.”
Farmer treated patients, medical students, allied professionals, drivers, indeed everyone as equals. He was always teaching but also listening for what others had to teach him and demonstrating that everyone mattered to him.
Ingrid Katz a student and then medical colleague remembered Paul this way:
“In many ways, I chose the field of infectious diseases because of Paul. He was my attending physician when I was in training. I recall the word on the street was, if you are rounding on patients with Paul, be prepared to pack your dinner, since you will be there late. The reason was — everyone mattered. We could barely get out of the elevator before Paul was swarmed with people who wanted to chat, and he made time for EVERYONE.
He was fluent in French-Creole, so he could comfortably speak with members of the large Haitian community who work at the Brigham. He would joyfully engage with them about their family, their life, even what books they were reading. Each person mattered — whether it was the hospital CEO or the person who took the food tray away. I loved that about Paul. We all did. Everyone mattered to him and everyone had a story to share. And he remembered them all, remarkably, by name. Paul is truly one of the most remarkable people to have walked this earth and we all miss him dearly.”
In spite of his track record of solving problems other saw as unsolvable Farmer was acutely aware of the long, long odds against, and maybe impossibility of vanquishing health care inequity.
“We want to be on the winning team, but at the risk of turning our backs on the losers, no, it is not worth it. So we fight the long defeat.”
And here’s another thing about Paul Farmer – he was irreverent, funny, even silly. Partners In Health board member Professor Steve Reifenberg recalled:
“He had nicknames for everyone. It was one of a dozen ways he seduced people into joining the work, but it also expressed his real friendship and love. For the last dozen years, he called me “Estebe,” a Spanglish version of my name, mostly because he enjoyed ribbing me about my gringo accent when I spoke Spanish. “Estebe,” he would say in front of a group of people, “say fosforos!,” hoping I would indulge him, bad accent and all, which would send him into peals of laughter. One time I saw Paul on a Zoom call with forty other Partners In Health board members. “Estebe!” he wrote in the chat. He always did that, and it always made my day. If you could see his keyboard on the Zoom screen, you’d see his long fingers flying as he sent dozens of chats to other board members, nicknames leading the way. He was like that everywhere he went, and he was always going somewhere.
After Paul died, when I told my daughter Natasha that I was struggling to write something about him, she texted me, “Emphasize his joy and sense of humor…. He saw such awful things all the time but was joyous and funny!”
So what are we to make of examples like Paul Farmer? We cannot hope to emulate such achievements. We cannot help but come up short if we use lives like Paul’s to measure our own. Yet encountering Paul’s story has not made me feel small. Instead I feel enlarged by knowing of him. Why is that?
I am reassured to know that goodness like his exists in the world. Yes, I partake in a small way in that goodness by supporting his work.
More importantly his life helps me feel possibilities:
The possibility of fighting the long defeat
The possibility of avoiding failures of imagination by thinking big
The possibilities of joy and humor
The possibilities that lie in partnerships
The possibility of showing through my actions that each person matters
The possibility of living my beliefs.
