I don’t really believe in heroizing individuals, but Paul was, for me and for many, a hero. As a medical anthropologist and physician, he was deeply committed to the belief that all human lives had dignity and that every person deserves access to high-quality health care. He lived this belief for his entire career.
As a clinician, he often walked miles to make house calls to ill patients; as an advocate, he worked tirelessly to expand health-care access; and as an author, he wrote many invaluable books.
In 1999′s “Infections and Inequalities: The Modern Plagues,” he explored how poverty drives infectious disease and ill health, especially multi-drug-resistant tuberculosis, or MDRTB, and HIV. “Opposition to the aggressive treatment of MDRTB in developing countries may be justified as ‘sensible’ or ‘pragmatic,’” he wrote, “but as a policy it is tantamount to the different valuation of human life, for those who advocate such a policy … would never accept such a death sentence themselves.”
And by refusing to accept these “sensible pragmatisms,” Paul helped save countless lives. In 2001, the head of the U.S. Agency for International Development told Congress that he opposed efforts to extend antiretroviral medication access to poor people around the world. He said such an initiative to treat HIV would inevitably fail, because for the treatment to be effective, the medications must be taken on a schedule, and that in impoverished communities, “people do not know what watches and clocks are.”
The head of the United States’ largest health aid organization really said that. To Congress. But by then, this despicable lie had already been exposed. In 1998, Paul and Partners in Health (PIH) had launched the HIV Equity Initiative in Haiti, one of the world’s first programs to provide comprehensive care, including antiretroviral therapy, to people in impoverished communities.
Using a network of community health workers, PIH proved that with adequate support and accompaniment, HIV treatment could achieve outcomes in poor countries similar to those in rich ones. Today, more than 12,000 people receive HIV treatment in Haiti through PIH-supported facilities. In Sierra Leone, PIH reports that the monthly average rate of HIV patients returning for ongoing care is over 99.9 percent.
This is what Paul did his entire career. Of course, he was never alone — partners is built into the name of Partners in Health and is deeply embedded in the way Paul worked. Partnering with hospitals and health ministries and philanthropists and, most of all, with fellow clinicians working in the communities. Paul talked a lot, but his genius was listening — listening to the needs of his patients, and the communities where they lived.
The world said, “A country like Haiti can never have a world-class teaching hospital,” and Paul said, “Yes, it can,” and led the way to founding the University Hospital in Mirebalais.
The world said, “We must accept a world where 1 in 17 women die in childbirth in Sierra Leone,” and Paul said, “No, we don’t,” and so PIH is now partnering with that country’s health ministry to build a world-class maternal care hospital in Sierra Leone’s Kono District.
Over and over and over, the world said that improving struggling health-care systems is too logistically complicated, or too expensive, or too inconvenient. And Paul would respond: But what if this was your mother? Your kid? Your friend? Then it wouldn’t be too anything.
Today, the global mortality rate for children under age 5 is the lowest it has ever been. Health-care systems are getting stronger even in extremely poor communities. But profound health inequities persist, and Paul Farmer was never satisfied with progress in a world where such injustice persisted. We shouldn’t be, either. Instead, we must carry forward his legacy.
John Green discusses this piece in more detail on James Hohmann’s podcast, “Please, Go On.” Listen now.