The global-health pioneer redefined his field to make it more human, in part by being so wonderfully human himself.By Ashish K. Jha
February 22, 2022
Several years ago, Paul Farmer and I both spoke at a conference at Harvard on the history and future of global health. As our program finished, Paul was immediately inundated with a throng of students eager to speak with the guru of the field, the man who inspired us all and asked more of each of us. I shuffled off to speak with the few avoiding the crowd.
After Paul finished with the students, he came over to give me a hug, and we made small talk. Then he asked for a favor: Could he borrow a pair of socks? “Socks?” I asked. “Why yes,” he said, as if socks were a totally normal thing to be in need of in a lecture hall. He was in Boston briefly, stopping on his way from Geneva to Rwanda, and he had exhausted his supply. I walked over to my briefcase, pulled out a pair of socks, and handed them to Paul; he quickly put them away.
For years, I often carried an extra pair if I was going to see Paul, especially when he was just passing through town. He was so deeply focused on the people around him and making the world a better place that he often forgot what he needed to put on his own feet. Paul was the creator of the modern global-health movement. He was a founder of Partners in Health, which changed the way we all understood what it means to care for the world’s poor. In service of this role, he was a world traveler, always on the road, preaching his message of caring for all. Many of us who loved Paul had at least one occasion to “lend” him socks, knowing there was little risk of ever seeing those socks again.
Paul died , a shocking and devastating blow to his friends and the generations of people inspired by his work. Throughout his life, he fought against a counterproductive mindset that has haunted efforts of global health. The field that started as “tropical health” had been deeply rooted in the colonial context of caring for the subjects of Western rule. As European powers left their colonies in the global South, the nomenclature of the field changed to “international health,” but the field kept that deeply colonial framework—we the anointed global North providing charity for the uncivilized global South. Even now, the field often views its work from a perspective of constraint. With the limited resources we have, what is the most good we can do?
Paul hated that question. He preferred to flip it on its head: Given all the good we can do for our fellow humans, what are the resources we need to make it happen? He was unconstrained by small thinking. He rejected the artificial limitations we put on caring for the world’s poor—limits we would never put on ourselves or our families. He refused to accept the soft bigotry of low expectations.
When HIV was devastating Haiti, the standard response in public health was to write off people, saying HIV therapies were too expensive and difficult to deliver to the world’s poor. So Paul set out to prove everyone wrong. He set up clinics and hospitals with a simple goal: deliver the same quality care that he provided when he was caring for patients in Harvard’s teaching hospitals. It wasn’t an easy task, but it worked. Tens of thousands of people received the latest HIV care. So many lives were saved.
Paul brought this approach to tuberculosis in Peru, to Ebola in West Africa, and to COVID-19 in the United States. In so doing, he built a new model of global health—one that begins not with constraints but with needs. It means asking what will allow people to lead healthy, productive lives and then, in Paul’s case, spending every second of his days generating the resources, assembling the systems, and training the people needed to deliver it. The work is hard, making things that don’t exist and convincing people that what feels aspirational is actually doable. But it’s the only way forward in a world so connected. As two years of the coronavirus pandemic have made glaringly clear, people acting only in their own self-interest hurts us all in the long run. Paul understood that the world’s health is our health. We must all care for one another—anything less is morally unacceptable.
He was the Chair of the Department of Global Health and Social Medicine at Harvard Medical School, and co-founder of Partners In Health, an international non-profit, featured in the film Bending The Arc (on Netflix).
As a student of medical anthropology, Paul Farmer began to understand the systemic inequities in primary health care provision in low- and middle-income countries and made tireless efforts to “irrigate” the health and clinical deserts of West Africa, Haiti, and economically poorer sections in the United States.
As a teacher, orator and practitioner, Farmer advocated for the explaining the “control-over-care approach” and its historical, colonial origins in the field of public health. He reframed the field of health in terms of equity and challenged the colonial-era policies that are still prevalent in a command-and-control approach as witnessed even in the isolation, quarantine and handwashing approaches put in place during the Covid-19 pandemic.
His extensive work and writing about Haiti was filled with assurance, having lived and worked there throughout his adult life and a familiarity that he had nourished within its rural reaches as an anthropologist and as a doctor who cares for the destitute sick.
Many challenges
In his foreword to Farmer’s seminal work, Pathologies of Power: Health, Human Rights, and the New War on the Poor, Amartya Sen, the senior economist lauds Farmer’s knowledge of maladies such as AIDS and drug-resistant tuberculosis, which in combination with his expertise on culture and society, acquired not just by learning from a distance but also from actually living and working in different parts of the deprived world.
Paul Farmer and his colleagues have laid the ground of valuing critical insight on legal and historical ramifications of ignoring the care aspect of health care systems, especially in underdeveloped and resource-afflicted countries because of years of violence, disease outbreaks and imposition of Western ideals of medicine and health.
However, the global challenges faced today are manifold – racism, transnational and transregional health disparities based on class, caste, gender, sexual preferences, and several other factors.
It is Farmer’s dogged determination that enabled the global health community to see beyond the immediate ramifications of living and responding to a global pandemic but also question, reflect, and look deeper into the systemic injustices and deprivations that cause death and suffering without any support.
Paul Farmer may have shown that despite the outcome, the fight must continue. As more like-minded individuals come together, the diverse views we can gather could help spark the change we want to see.
Paul inspired generations of medical and public-health students and practitioners to reach beyond their self-imposed limitations and do more. That day at Harvard, I spoke about the future of global health. While the words were mine, the ideas and sentiments had been deeply shaped by Paul. I talked about how the future of global health must begin with the notion that all lives have value. That high-quality care that preserves human dignity is not a privilege of the few but the right of all.
At a different time, in a different context, those words might have felt lofty or untethered to the difficult reality on the ground. But sitting next to Paul, those were the only words that made sense. He showed all of us what was possible. A few pairs of socks were the least I could give him in return
.Ashish K. Jha, a physician, is the dean of Brown University’s School of Public Health.
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