To save one person is to save the world: in memory of Paul Farmer

Posted on by jgreenberg5

We cannot build an environmental movement or movement for sustainable development that does not have the social and economic rights of the poor at its center. Paul Farmer, March 28, 2008:

Dr. Paul Farmer died yesterday in Rwanda, in his sleep, at the age of 62, in his modest home on the grounds of University of Global Health Equity, a medical school he co-founded with Dr. Agnes Binagwaho.   Among many African, Latin American and Central Asian countries where he worked, Farmer spent much of his adult life in Rwanda and Haiti, where he lived with his family to be close to his patients:  treating people in impoverished, isolated communities suffering from virulent diseases; establishing new clinics and hospitals, and building the medical staff necessary to support high level healthcare over the long term; saving countless lives.  Farmer co-founded Partners in Health (PIH), one of the most important health delivery organizations for the poorest people in the world, caring for hundreds of thousands of people who would otherwise not have access to medical services.
A medical anthropologist as well as a physician,  Farmer was recognized as a giant in the field of public health by some of the most distinguished academic and medical institutions in the U.S. and internationally.  At Harvard Medical School, Farmer was Kolokotrones University Professor and chair of the Department of Global Health and Social Medicine.  At Brigham and Women’s Hospital in Boston, he was chief of the Division of Global Health Equity.  He received some of the world’s highest honors or awards.  Announcing his selection as a 1993 MacArthur Fellow, the MacArthur Foundation award noted Farmer’s dedication to “the prevention and treatment of infectious and parasitic diseases, in community-based responses to endemic and epidemic disease” and to the anthropological investigation of HIV, tuberculosis and other diseases, focussing on “the experience of suffering and its sources at the intersection of poverty, political oppression, powerlessness, and pain.”  Moral philosopher Kwame Anthony Appiah, Jury Chair for the 2020 Berggruen Prize for Philosophy and Culture,  explained that Farmer “has reshaped our understanding not just of what it means to be sick or healthy but also of what it means to treat health as a human right and the ethical and political obligations that follow.”  
But he didn’t care about recognition or fame.   He cared about his work treating people suffering from disease and sickness in places that had been neglected and abandoned by the developed world.  When he received money ($250,000 from MacArthur, for example, or $1 million from Berggruen), he gave all of it to Partners In Health.  For Farmer, it was all about serving the poorest of the poor.   In a remembrance published in The Atlantic online (“There Will Never Be Another Paul Farmer”), Bill Gates remembers that Farmer “was never happier than when he was caring for patients in one of the clinics he helped create. I have never known anyone who was more passionate about reducing the world’s worst inequities in health—or who did more to live by his values.”   
Days and nights ran together. He has a small house in Cange, the closest thing in his life to a home, perched on a cliff across the road from the medical complex. It’s a modified ti kay, the better sort of peasant house, with a metal roof and concrete floors, and is exceptional in that it has a bathroom, albeit without hot water. Farmer told me that he slept about five hours a night, but, many times when I looked inside his house, his bed seemed unused. Once he told me, “I can’t sleep. There’s always somebody not getting treatment. I can’t stand that.” I suppose he slept some nights. His days usually began around dawn. He’d spend an hour or so among the people who had camped out in the lower courtyard, to make sure the staff hadn’t missed someone critically ill, and another hour gobbling a little breakfast while answering E-mail, from Peru and other Partners in Health outposts, and Harvard students, and colleagues at the Brigham, and the various warring factions involved in the effort to stop the Russian t.b. epidemic. Then he saw patients in his office.Most of the patients were indeed the poor and the maimed and the halt and the blind.
It was all about the patients, and about Partners in Health, the organization he co-founded in 1987 by opening a small clinic in Cange.  Here is PIH’s mission statement:
“We are a global health and social justice organization that responds to the moral imperative to provide high-quality health care globally to those who need it most.
We strive to ease suffering by placing patients at the center of all care, meeting not only their physical, but also their mental, emotional, and daily needs so that they can recover from illness and maintain good health. We bring the benefits of modern medicine to those who have suffered from the overt and subtle injustices of the world, in the past and in the present.  We refuse to accept that any life is worth less than another.”
In Haiti alone, Farmer’s initial one-room clinic expanded to a network of 16 medical centers and hospitals, in two of the country’s poorest and most remote regions, run by almost 7,000 Haitian doctors and staff.  In Kazakhstan, PIH focusses on fighting TB.  In Lesotho, PIH strengthens health systems, combats high rates of HIV and TB, improves maternal and child health, and reshapes care delivery.  Coming to Liberia to fight Ebola at the government’s request,  PIH stayed to strengthen the public health system and improve access to care.   Since 2007, PIH has worked in rural Malawi to provide comprehensive, integrated care for more than 140,000 people.  PIH trains the next generation of clinicians and improves access to health care in rural Chiapas, the poorest and most marginalized region of Mexico.  In the Navajo Nation, PIH works with local partners to address health disparities faced by American Indian populations.  PIH is fighting diseases and improving health care access in some of Peru’s most vulnerable communities. In the wake of Ebola, and amidst some of the world’s worst health outcomes, PIH invests in health systems across Sierra Leone, transforming health care and radically reducing maternal mortality.  Responding to the COVID-19 pandemic, PIH has recently launched program in the United States to strengthen public and community health systems. 
I encourage everyone to visit the Partners In Health website, to appreciate the extraordinary public health accomplishments PIH has achieved throughout the world, and the countless lives saved as a result — and I encourage everyone to honor Dr. Farmer’s memory by including PIH among the charitable humanitarian organizations you support financially.   
I heard Farmer speak on two occasions over the years.  In each case I was part of a small audience.  Each time I was shaken up.  Farmer was morally challenging, provocative, even confrontational.   As Kidder observed, “Farmer wasn’t put on earth to make anyone feel comfortable, except for those lucky enough to be his patients.”  Farmer enjoyed challenging white liberals (he called them “W.L.s”)  including and especially his own supporters,  
‘I love W.L.s, love ’em to death. They’re on our side,’ Farmer once said. ‘But W.L.s think all the world’s problems can be fixed without any cost to themselves. We don’t believe that. There’s a lot to be said for sacrifice, remorse, even pity. It’s what separates us from roaches.’  As often as not, he prefers religious groups and what he calls ‘church ladies.’
Like many of the most courageous humanitarians and fighters for human rights, Farmer was a person of faith.   He affiliated himself with “liberation theology,” the radically egalitarian stream of Catholic social thought — focussing on the needs and rights of the least of these my brothers; listening to and heeding the cry of the poor, and following the example of the tradition’s practitioners of revolutionary love, including Fr. Pedro Arrupe, Archbishop Oscar Romero, Gustavo Gutiérrez, and Pope Francis.  
Dr Paul Farmer

For Farmer it was about actions, not words.  Nevertheless he spoke frequently, and wrote books, and used words eloquently — to inspire and mobilize action.  Some of words are collected in his book To Repair the World:  Paul Farmer Speaks to the Next Generation (University of California Press, 2013).

I share with you below some of those words:

“We fail to think about equity because we are anesthetized.  This kind of anesthesia—the bad kind—-occurs chiefly because we live in the violently unequal world. In the speeches reprinted here, I’ve drawn a distinction between event violence, such as war and genocide, and the insidious structural violence that accompanies poverty and inequalities of all sorts. Psychological, moral, or economic anesthesia dulls us most effectively to structural violence. We interpret disparities in health and income and good fortune as ‘the way things are.’  Structural violence is never anybody’s fault.  Inequalities of risk and outcome—and our toleration of them—are evidence of the effectiveness of such anesthesia.”

From Farmer’s commencement speech at the Harvard School of Public Health, June 10,2004:

I read last week that the current U.S. administration has spent $191 billion on wars in the Middle East. During the same years, we’ve seen health care in this country take a hit in the name of neoliberal ideology: witness 6 million low-income seniors losing Medicare eligibility, and 3.8 million more Americans losing their health insurance. The current administration has cut back on its pledge to fight global AIDS and has imposed strictures on how this aid is to be used. These strictures, including and effective preference for programs that privilege abstinence-based HIV prevention, are often informed by ideology and dogma rather than evidence.

Imagine if we had even half of that war chest, the mere bagatelle of $95.5 billion, for weapons of mass salvation. In contrast to certain WMDs, these weapons do exist. They are vaccines and programs of prevention and care; they are decent sanitation and enough to eat. And don’t you wonder if attacking the social problems of the bottom billion might be a more effective means of expunging terrorism than some of the current strategies being employed?

One thing on our to-do list, if we want to make the world a more decent and safer place, is to bridge the gap between public health and medicine and between the haves and the have-nots. How will you all do this?

The fight over “scarce resources” involves no small amount of chicanery. There are enough resources on this planet to do the job right. These resources are far less than those required to wage war whose justifications are never quite as good as their champions make them out to be.

From Farmer’s commencement speech at Georgetown University, May 21, 2011:

“As we dig our way out of a global financial crisis that will affect your paths in the coming months and years, don’t we need to reflect on Martin Luther King’s argument that “True compassion is more than flinging a coin to a beggar…[True compassion]comes to see that an edifice which produces beggars needs restricting ”? How can we address these structural and social complex problems if we don’t understand them?

Gustavo Gutierrenz, often called the father of liberation theology, has been a mentor to me for all of my adult life. As he often observes, structural violence forces us to try to make sense of suffering in our time. But we must first acknowledge that the suffering of “good people” isn’t really the right place to start. Rather, it is poor, wounded, vulnerable people who can reveal the world to us. As Dietrich Bonhoeffer asked from a Nazi prison two decades before Gutierrez helped lay the foundations of liberation theology, “Who stands fast?”

This question that Bonhoeffer and Archbishop Oscar Romero and Father Gutierrez asked has been post for millennia. Its significance is sapped unless we add, “Stands fast where? Why and with whom?” Bonhoeffer learned, as did his spiritual forebears two thousand years previously, the answers to these questions. Taking the view from below is the only way to seek to understand our world.

Every struggle is fraught with such perils. The fight against poverty and inequality—against structural violence—is, I am persuaded, the only holy war out there. And it’s a fight best fought as Bonhoeffer and Romero and Martin Luther King Jr. fought it, and Gutierrez fights it to this day. Their patient non-violence, their solidarity with the poor and oppressed, speak of an even better and more pragmatic form of solidarity. We too seek to lessen violence not by taking up arms but by building schools and hospitals.

The real protagonists of the war poverty must of course be those struggling to free themselves form it. This point was made by each of the men mentioned above; it is the thesis of Gutierrez’s We Drink from Our Own Wells. But the poor and oppressed—whether during the great European conflict that claimed Bonhoeffer or the civil-rights struggle that claimed MLK or the Latin American liberation struggles that claimed Romero—desperately need allies.

The poor also need people of privilege who understand their own good fortune and do not turn away from the suffering of others.

When speaking about such lofty, freighted topic as social justice and solidarity, it’s important to acknowledge how difficult these are to understand or measure. There’s no “key performance indicator” or “process measure” to help us here. Goodness and decency and social justice and the patient accompaniment of the sick and imprisoned and despised are not so easy to put in a formula. But just because we cannot yet quantify the impact of accompaniment, or the virtues that underpin it, does not mean we can afford to postpone it for another day. In my experience, accompaniment offers the surest means of protecting against the pitfalls inherent in our quests for personal efficacy and of moving forward, however slowly, toward equity, justice, compassion, and solidarity.”

And this is from Farmer’s speech at at Boston University’s Martin Luther King Jr. Day Celebration,  January 19, 2009

If MLK had a dream toward the end of his life, it was the dream of more radical equity. It is for this reason that he has never faded away, as have many other noble people martyred for their just beliefs. MLK’s mature dreams, those laid out with clarity in the last months of his life, are precisely those we need to inspire us in a time of great need.

In celebrating Dr. King, we need to respect his own trajectory and growth, not just the final form of his name, the postage stamps, monuments, chapters in history books. We need to acknowledge that he was working toward a goal: the fight for social justice for all, the fight against poverty. “The curse of poverty has no justification in our age,” he wrote in 1967. “The time has come for us to civilize ourselves by the total, direct and immediate abolition of poverty.”

As in his final sermon, he spoke of the hungry, the naked, the homeless, the thirsty, the vulnerable.  Elsewhere, he spoke explicitly of health disparities, and in a way that no doctor should fail to appreciate. “Of all the forms of inequality.” he said, “injustice in health care is the most shocking and inhumane.” Will this form of inequality be addressed in our lifetimes?

MLK also believed the resources spent on war should be spent on the war on poverty. He argued that “a nation that continues year after year to spend more money on military defense than on programs of social uplift is approaching spiritual death.”

But the greatest thing about King’s redemptive vision is that all of us may, at any time, choose to place the well-being of others above our own. All of us may strive for compassion, justice, and altruism. None of us need have the vision, talent, and heroism of an MLK to succeed in this humble and necessary task. “Everybody can be great,” said Dr. King, “because anybody can serve.”

Now—as our country and our world faces financial crisis, environmental disaster, war, and growing inequality—is a time to serve. It’s a time to concern ourselves with the oppressed or those less fortune. It’s time to do what many BU students have done: to draw on deep reserves of compassion and solidarity and, above all, to engage in the movement to make the world safer, more just, more humane. If this is what we do with our Drum Major Instinct, we need not be troubled by it.

Everybody can be great, because anybody can serve.

jgreenberg5

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