Global health crusader Paul Farmer, MD, PhD, had a wildly unconventional childhood, which helped inform his adult life as a medical humanitarian. Dr. Farmer was born in West Adams, a town that lies along the verdant valley surrounding the Hoosic River in northern Massachusetts. He was the second of six children born to a restless father, a door-to-door salesman, and a high school math teacher who relocated the family to Birmingham, Alabama, when Dr Farmer was seven. After 5 years, the elder Farmer once again uprooted the family to Brooksville, Florida, a working-poor town just north of Tampa, where he found jobs teaching school and working with developmentally disabled adults.
Soon after settling in Florida, Dr. Farmer’s father converted an old yellow school bus into a makeshift mobile home, in which the family of eight migrated from one shabby trailer park to the next. He would later swap the house bus for a houseboat he moored in the Gulf, as he tried his hand at commercial fishing, a short-lived adventure of hard work and too few fish.
Dr. Farmer described his father as a free spirit, and despite his rambling, resource-challenged childhood, he excelled in school. Both parents were devoted to higher education and read serious literature to their children, a nightly routine Dr. Farmer often recalled during interviews, as being a formative part of his intellectual growth. During a patch of particularly hard times, the Farmer family did a stint in sweltering fruit groves picking oranges alongside Haitian migrant workers. It was young Dr. Farmer’s first encounter with Haitian people, and their Creole culture, planting a seed for future humanitarian work in their poverty-stricken homeland.
A Trip to Haiti Sets a Career in High Gear
Dr. Farmer attended Hernando High School in Brooksville, Florida, which has been in operation since 1889, making it one of the nation’s continuously operating public schools. Dr. Farmer thrived in high school, becoming president of his senior class and winning a full scholarship to Duke University, Durham, North Carolina. At Duke, he took an assortment of science courses before concentrating on medical anthropology. Taking advantage of a foreign fellowship program, Dr. Farmer spent half a year studying in Paris, where he attended some of the final lectures of the prominent anthropologist and ethnologist Claude Lévi-Strauss, whose work was key in the development of structural anthropology.
“I feel it’s part of my job to make the problems of the poor compelling. The poor are doing their job—they’re shouting as loud as they can. It’s we who can’t hear them.”— Paul Farmer, MD, PhD
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Back at Duke, Dr. Farmer’s voracious curiosity led him to the writings of Rudolf Virchow, the famous 19th century German physician and scientist who founded cell theory and fought a legion of critics to establish the practice of public health medicine, which further inspired Dr. Farmer’s passion for humanitarian medicine. After graduating summa cum laude from Duke in 1982, Dr. Farmer did a brief postgraduate fellowship at the University of Pittsburgh. He then applied to Harvard Medical School, one of two institutions in the nation to offer a joint-degree program in medicine and medical anthropology. While awaiting a decision from Harvard, he traveled to Haiti, where he planned to spend a year working in public health clinics, mastering the Creole language, and learning more about the country, which had the long-standing distinction of being the poorest in the Western Hemisphere.
While Dr. Farmer was still in Haiti, he received word that he had been accepted at Harvard Medical School, where he would simultaneously pursue a medical degree and a doctorate in medical anthropology. He returned to the States to enroll at Harvard, but shortly into his studies, he took his course work back to Haiti; for the next 3 years, he would return to Harvard just to complete exams and mandatory laboratory work. Despite the hardships imposed by his distant relationship with the classrooms of Harvard, he insisted to his peers that the experience of treating the poor and sick in Haiti had more long-term value than any classroom lecture. Moreover, his work in Haiti didn’t adversely affect his academic progress, as his grades were among the highest in his class.
In 1983, during a trip back to Cambridge, Dr. Farmer attained funding from a modest medical charity called Project Bread to build a bakery in Cange, which he felt was a way to assure the impoverished there would at least have access to wholesome bread. Along with several colleagues, Dr. Farmer would then develop a community-based health program known as Zanmi Lasante. About the conditions in Cange, Dr. Farmer commented: “An individual might exist in misery this great almost anywhere, but it was hard to imagine an entire community poorer and sicker than this.” Dr. Farmer set up Zanmi Lasante to be a fully functioning, autonomous health-care system, even in his absence, which it did with remarkable success.
A Clinic Is Born
In 1985, Paul Farmer and his associates opened Clinique Bon Sauveur, a two-room clinic in Cange. That same year, philanthropist Tom White read a compelling article Dr. Farmer had written for a Harvard Medical School journal and asked to meet him. Tom White, who ran a large construction company in Boston, was a Harvard graduate himself and a World War II veteran. After a few spirited back-and-forth conversations, Mr. White visited Dr. Farmer in Haiti and soon became convinced that the project Dr. Farmer was advocating for was worth his support, and he donated a generous amount of seed money to jump-start the program.
At the same time, AIDS, which was already pandemic in Haiti’s urban slums, began ravaging the country. Making matters worse, violent demonstrations to remove the persistently corrupt regime of President Jean-Claude Duvalier. In the midst of this sociopolitical turmoil, Dr. Farmer set out to form a permanent charitable foundation to fund his ongoing work in Haiti. In 1987, with Ophelia Dahl and his former Duke classmate, Todd McCormack, Dr. Farmer founded Partners In Health in Boston. Ms. Dahl would serve as President and Executive Director. Tom White contributed a million dollars in seed money. Another Harvard Medical School student, Dr. Jim Yong Kim, soon joined them. Like Dr. Farmer, Dr. Kim was an aspiring medical anthropologist with a specific interest in devising effective treatment strategies for impoverished communities and in negotiating with pharmaceutical corporations for the best possible deals.
In 1990, after earning a medical degree and a doctorate in anthropology, Dr. Farmer did a year’s residency at Brigham and Women’s Hospital in Boston. The indefatigable doctor was also able to remain in Haiti for much of each year, returning to Boston for a few months at a time, often sleeping in the Partners In Health headquarters. In Boston, Dr. Farmer served as an attending specialist at Brigham, where he launched an initiative to combat rising rates of HIV and tuberculosis in the inner city of Boston.
Growing Success in Haiti
In a few short years, the Zanmi Lasante project had grown from a one-room clinic to a fully operational hospital with a nursing school, satellite communications, and blood bank. Zanmi Lasante serves a community of more than 150,000 people; it eventually built schools, houses, and water sanitation systems throughout its catchment area to prevent disease as well as to treat it once it arose. Dr. Farmer’s achievement was recognized by the MacArthur Foundation in 1993 with a $220,000 award that Dr. Farmer donated to Partners In Health to start a research program, the Institute for Health and Social Justice.
In 1996, Dr. Farmer married Didi Bertrand, the daughter of a pastor and a school principal in Cange, who he described as “the most beautiful woman in Cange.” A medical anthropologist and community health specialist by profession, she became a valued researcher for Partners In Health.
Sharing the Message
Dr. Farmer was a practitioner of “social medicine,” arguing there was no point in treating patients for diseases only to send them back into the same circumstances that helped to cause them in the first place. “Illness has social roots and must be addressed through social structures,” he said during an interview. Although he worked in the world of development, he had a somewhat critical view of international aid, preferring instead to work alongside local providers and leaders, living among the people he was treating, moving his family to Rwanda and Haiti for extended periods. Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World, a 2003 book by Tracy Kidder, described the extraordinary efforts he would make to care for patients, sometimes walking hours to their homes to ensure they were taking their medication.
In short, Dr. Farmer believed through action that it was his responsibility to be outspoken, as he lectured widely on global health. “I feel it’s part of my job to make the problems of the poor compelling. It’s only through a failure of imagination that people turn away. The poor are doing their job—they’re shouting as loud as they can. It’s we who can’t hear them. What the American public thinks is very important to the future of global health. Many people are moved by the idea that there is unnecessary suffering in the world, and we could do a lot to stop it. We have the technologies necessary to stop most of the suffering.”
A Visionary Taken Too Soon
On February 21, 2022, Dr. Farmer died at the age of 62 while in Rwanda, where he’d been teaching at the University of Global Health Equity, the medical school he helped found, partnering with the country’s ministry of health.
Dr. Farmer’s friend and colleague, oncology luminary Larry Shulman, MD, Senior Oncology Advisor to Partners In Health, was in touch with Dr. Farmer almost daily in the weeks before his death and told The ASCO Post: “Paul was a visionary in so many ways. He viewed health care as a human right—all should have access to life-saving treatment, regardless of where they lived or the color of their skin. And poverty would never be a barrier to receiving this care. He refused to accept that anything was impossible and accomplished what so many said was, in fact, impossible. He was acutely aware of the role that structural violence and racism played in inequities in care and outcomes long before this was so well articulated (though still a burning issue). In his book published in 2004, Pathologies of Power: Health, Human Rights, and the New War on the Poor, he described what we are still learning in this and so many other countries. Paul was the most engaging and impactful teacher I have ever known, and countless of us have learned lessons we otherwise would not have, if not for our time with Paul. But most of all Paul was a doctor—it was what he loved most. He rounded on our cancer wards at Butaro Hospital in Rwanda for the 2 weeks before his death and died there at the adjacent University for Global Health Equity, of which he was founder and Chancellor.”