Global health pioneer Paul Farmer dies at 62

Paul Farmer, a physician, anthropologist and humanitarian who gained global acclaim for his work delivering high-quality health care to some of the world’s poorest people, died Monday on the grounds of a hospital and university he had helped establish in Butaro, Rwanda. He was 62.

Partners in Health, the global public health organization that Farmer helped found, announced his death in a statement that did not specify the cause.

Farmer attracted public renown with “Mountains Beyond Mountains: The Quest of Dr Paul Farmer, a Man Who Would Cure the World,” a 2003 book by Tracy Kidder that described the extraordinary efforts he would make to care for patients, sometimes walking hours to their homes to ensure they were taking their medication.

He was a practitioner of “social medicine,” arguing there was no point in treating patients for diseases only to send them back into the desperate circumstances that contributed to them in the first place. Illness, he said, has social roots and must be addressed through social structures.

His work with Partners in Health significantly influenced public health strategies for responding to tuberculosis, HIV and Ebola. During the AIDS crisis in Haiti, he went door to door to deliver antiviral medication, confounding many in the medical field who believed it would be impossible for poor rural people to survive the disease.

Although he worked in the world of development, he often took a critical view of international aid, preferring to work with local providers and leaders. And he often lived among the people he was treating, moving his family to Rwanda and Haiti for extended periods.

News of Farmer’s death rippled through the worlds of medicine and public health Monday.

“There are so many people that are alive because of that man,” Dr Rochelle Walensky, director of the Centers for Disease Control and Prevention, said in a brief interview, adding that she wanted to compose herself before speaking further.

Dr. Anthony Fauci, President Joe Biden’s top medical adviser, broke down in tears during an interview, in which he said he and Farmer had been like “soul brothers.”

“When you talk about iconic giants in the field of public health, he stands pretty much among a very, very short list of people,” said Fauci, who first met Farmer decades ago, when Farmer was a medical student. He added, “He called me his mentor, but in reality, he was more of a mentor to me.”

In the latter part of his career, Farmer became a public health luminary; the subject of a 2017 documentary, “Bending the Arc”; and the author of 12 books.

In 2020, when he was awarded the $1 million Berggruen Prize, given annually to an influential thought leader, the chair of the prize committee said Farmer had “reshaped our understanding” of “what it means to treat health as a human right and the ethical and political obligations that follow.”

Farmer, who never settled into the easy life of an elder statesman, was vigorously involved in the response to the COVID-19 pandemic, prodding the Biden administration to drop intellectual property barriers that prevented pharmaceutical companies from sharing their technology.

“It’s not just about health security, in the senses of defending yourself,” he said. “It’s not just about charity, although that’s not so bad. It’s also about pragmatic solidarity with those in need of assistance.”

Paul Edward Farmer Jr. was born Oct. 26, 1959, in West Adams, Massachusetts. His mother, Ginny (Rice) Farmer, worked as a supermarket cashier, and his father, Paul Sr., was a salesperson and high school math teacher.

When Paul was about 12, his father bought an old bus and fitted it with bunks, converting it into a mobile home. Paul, his parents and his five siblings spent the next few years traveling, mostly in Florida, living for a time on a boat moored on a bayou. He credited this period with giving him “a very compliant GI system,” a knack for sleeping anywhere, and an inability to be shy or embarrassed.

One summer, he and his family worked alongside Haitian migrant workers picking oranges, listening curiously as they chatted to one another in Creole from atop ladders. That was Paul’s first encounter with Haiti, the country that would captivate him in his 20s and then propel him toward a career in public health.

After graduating from Duke University, he moved to Haiti, volunteering in Cange, a settlement in the central Artibonite plateau of the country. He arrived toward the end of the dictatorship of Jean-Claude Duvalier, when Haiti’s hospital system was so threadbare that patients had to pay for basic supplies, such as medical gloves or a blood transfusion, if they wanted treatment.

In a letter to a friend, he wrote that his stint at the hospital wasn’t turning out as he had expected. “It’s not that I’m unhappy working here,” said the letter, excerpted in Kidder’s book. “The biggest problem is that the hospital is not for the poor. I’m taken aback. I really am. Everything has to be paid for in advance.”

Farmer decided to open a different kind of clinic. He returned to the United States to attend Harvard Medical School and earn a degree in anthropology, but he continued to spend much of his time in Cange, returning to Harvard for exams and laboratory work.

Over the years, Farmer raised millions of dollars for an ever-expanding network of community health facilities. He had a contagious enthusiasm and considerable nerve. When Thomas White, who owned a large construction company in Boston, asked to meet him, he insisted that the meeting take place in Haiti.

White eventually contributed $1 million in seed money to Partners in Health, which in 1987 Farmer founded with Ophelia Dahl, whom he had met volunteering in Haiti; a Duke classmate, Todd McCormack; and a Harvard classmate, Dr. Jim Yong Kim.

In 1996, he married Didi Bertrand, the daughter of a pastor and a school principal in Cange; she was described in Kidder’s book as “the most beautiful woman in Cange.” She became a researcher for Partners in Health and survives Farmer, along with their three children, Catherine, Elizabeth and Sebastian; his mother; his brothers, James and Jeffrey; and his sisters, Katy, Jennifer and Peggy.

The clinic in Haiti, at first a single room, grew over the years to a network of 16 medical centers in the country, with a local staff of almost 7,000.

Among them was a teaching hospital in Mirebalais, about 40 miles north of Port-au-Prince, that opened in 2013 and offered chemotherapy drugs, a gleaming new $700,000 CT scanner and three operating rooms with full-time trauma surgeons. There, poor patients with difficult diseases paid a basic fee of about $1.50 a day for treatment, including medication.

Partners in Health also expanded into Rwanda, where Farmer helped the government restructure the country’s health system, improving health outcomes in areas such as infant mortality and the HIV infection rate.

Farmer died in Butaro, a mountain town on the border of Uganda where he and Partners in Health collaborated with the Rwandan government to build a complex devoted to health and health education. Farmer had homes in Rwinkwavu, Rwanda; Cange, Haiti; and Miami.

Farmer also helped develop new public health approaches in Peru, Russia and Lesotho, among other places.

He was particularly proud of the fact that the clinics he helped build were staffed by local doctors and nurses whom he had trained.

“I’m not cynical at all,” he once said. “Cynicism is a dead end.”

Over the years, he kept in touch with many of his patients, as well as their children and grandchildren. He was godfather to more than 100 children, most of them in Haiti, said Laurie Nuell, a close friend and board director at Partners in Health.

Over the weekend, Farmer sent her a photo of a colourful bouquet of flowers he had put together for one of his terminally ill patients in Rwanda. “Not my best work,” the accompanying text said.

“He had a very tender heart,” she said. “Seeing pain and suffering was very hard for him. It just hurt him. I’m a social worker by training. One thing I learned is about detachment. He wasn’t detached from anyone. That’s the beauty of it.”

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