Paul Farmer, a physician, anthropologist and visionary leader of the American non-profit organization Partners in Health (PIH), challenged skeptics who called poor countries “health deserts”. Forging partnerships between governments, academic institutions and philanthropists, he has enabled even the poorest communities to have world-class hospitals and amazingly successful health programs.
Farmer, who died suddenly at the age of 62, co-founded PIH in 1987 and led its work in 12 countries, including Haiti, Rwanda, Peru and Sierra Leone, with 18,000 employees. A strong supporter of social justice and building local capacity, he said medical care is not enough if people are sick because they are hungry and destitute. He said PIH should be “the house of yes”, working with government partners to put in place comprehensive care that met short- and long-term needs, money for patients to buy food, community health workers, sanitation, hospitals and schools. .
Farmer’s ambition to found PIH was sparked while living in Haiti at the age of 23. After studying anthropology at Duke University in North Carolina, he worked for a Haitian charity before going to Harvard Medical School. It was a country marked by centuries of exploitation, poverty and colonial domination. Following the construction of the Péligre dam in the center, displaced families lived in camps with little food, sanitation and running water, at the mercy of malaria, tuberculosis and typhoid. Spending time in this area, in the village of Cange, Farmer is dismayed and wants to set up a decent medical service.
In Haiti and later at Harvard, Farmer discussed his ideas with kindred spirits Ophelia Dahl, then a volunteer in Haiti, his Duke University friend Todd McCormack, and fellow Harvard physician Jim Yong Kim, who became his co-founders of PIH. The project received a huge boost when Boston philanthropist Tom White read an article Farmer had written. White offered $1 million in funding, and in 1987 PIH began.
Now Farmer was a medical student. He would cram his studies into four days and fly out to Cange in Haiti on a Thursday evening (sometimes with drugs begged from the Harvard dispensary in his suitcase) to treat patients at the tiny PIH-funded clinic, which was the only medical center miles away. Central to its success was a network of community health workers who could travel to outlying settlements and monitor patients at home.
After graduating in 1990, Farmer rose through the ranks to become chair of global health and social medicine at Harvard Medical School and chief of global health equity at Brigham and Women’s Hospital in Boston. Nimble, tall and always working at a breakneck pace, throughout his career he combined teaching and treating patients in Boston with writing books and continued to provide the roadmap for PIH.
The organization grew exponentially from the 1990s, aided by partners including governments, corporations and charities such as the Gates Foundation. Moreover, whenever Farmer won an award (like the $200,000 “genius grant” in 1993 from the MacArthur Foundation), he funneled it to PIH.
For decades, Farmer has been on the move, flying from country to country, pushing PIH projects forward. Its ambitions to bring quality health care to Haiti culminated with the state-of-the-art Mirebalais University Hospital in 2013. During the recent earthquake of 2021, the first responders were the new cohort of trained doctors and nurses in Mirebalais.
In Peru, Farmer desperately wanted to fight tuberculosis. The matter had become stark when in 1995 his friend Catholic priest Jack Roussin died of a drug-resistant form of the disease contracted while living and working in the country. PIH has implemented programs to help TB patients in Peru, with an 83% success rate.
He has expanded his remit there to manage mental health, HIV, and maternal and child health programs.
At an AIDS meeting in New York, Farmer met Dr. Agnes Binagwaho, later Rwanda’s health minister. As a result, PIH was asked to help rebuild Rwanda’s health system, which had been devastated by the 1994 genocide, and worked in the country from 2005. Some of the world-class initiatives included the vaccination of 93 % of girls against cervical cancer in record time, by opening the Butaro Cancer Center in 2012 and creating the University of Global Health Equity.
Farmer faced one of his biggest challenges when he traveled to West Africa in 2014 to organize the fight against Ebola in Liberia, Sierra Leone and Guinea. He documented this rapid episode in his 2020 book Fevers, Feuds, and Diamonds: Ebola and the Ravages of History.
He has written a dozen books and was the subject of a 2017 documentary film, Bending the Arc. Her story was first told in Tracy Kidder’s book Mountains Beyond Mountains: One Doctor’s Quest to Heal the World (2003).
Farmer was born in North Adams, Massachusetts, the second of six children. Her father, also Paul, was a teacher and her mother, Ginny (née Rice) worked in a supermarket. They were a family of free spirits, encouraged to take risks and follow their dreams, all of which were very different; his younger brother Jeff, for example, became a professional wrestler. When Paul was seven, the family moved to Alabama, but, not liking the racist politics there, they moved to Florida. Their home was a bus, which was originally a mobile tuberculosis clinic, and for a short time they lived on a houseboat.
He went to school in Brooksville, Florida before winning a scholarship to Duke University. He spent a summer in Paris, where he spoke French fluently, read the works of Rudolf Virchow and was passionate about epidemiology and public health. While at Duke, Farmer met a nun, Sister Julianna, who worked with Haitians employed on tobacco plantations, and he became interested in their history. After graduating in 1982, it seemed natural to visit Haiti while waiting to go to medical school.
Farmer’s long association with Haiti was further strengthened when he married Didi Bertrand, a Haitian medical anthropologist, in 1996.
He was constantly pushing himself, always worried that there was another patient to treat, another article to write. He died in his sleep of a cardiac event, after a day teaching students at the hospital he helped build in Butaro, Rwanda.
Farmer is survived by Didi and their three children, Catherine, Elizabeth and Sebastian; his mother, Ginny; his brothers, James and Jeffrey; and her sisters, Katy, Jennifer and Peggy.
