THE POWER OF ONE

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 on Monday on the grounds of a hospital and university he had helped establish in Butaro, Rwanda. He was 62.

The cause was an “acute cardiac event,” according to a statementby Partners in Health, the global public health organization that Dr. Farmer helped found.

Dr. 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.

Though 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 Dr. Farmer’s death rippled through the worlds of medicine and public health on Monday.

“There are so many people that are alive because of that man,” Dr. Rochelle P. 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 S. Fauci, President Biden’s top medical adviser, broke down in tears during an interview, in which he said he and Dr. Farmer had been like “soul brothers.”

In the latter part of his career, Dr. 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 chairman of the prize committee said Dr. Farmer had “reshaped our understanding” of “what it means to treat health as a human right and the ethical and political obligations that follow.”

Dr. 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.”

“When you settle on a problem, devote the resources to it and have at least some ability to incorporate new information, every time, it gets better,” he says. “I don’t have any experience, anywhere, where you just apply yourself, along with others, and then do not see progress. My optimism has pretty honest roots. “Although,” Farmer adds after a brief pause, “I would probably be an optimist even if not.” “I’m going to sound very touchy-feely-ish, but it’s [about] compassion and empathy and fellow feeling,” Farmer says. “You can’t do anything in public health without fellow feeling.”

Paul Edward Farmer Jr. was born on Oct. 26, 1959, in North Adams, Mass. Paul’s mother, Ginny (Rice) Farmer, worked as a supermarket cashier, and his father, Paul Sr., was a salesman and high school math teacher.

When Paul was around 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.

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, like 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 Mr. 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.”

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

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

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 around $1.50 a day for treatment, including medication.

Partners in Health also expanded into Rwanda, where Dr. Farmer helped the government restructure the country’s health system, improving health outcomes in areas like infant mortality and the H.I.V. infection rate.

Dr. 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. Dr. Farmer had homes in Rwinkwavu, Rwanda; Cange, Haiti; and Miami.

Dr. 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.

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, Dr. Farmer sent her a photo of a colorful 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.”

As long as poverty and inequality persist, as long as people are wounded and imprisoned and despised, we humans will need accompaniment–practical, spiritual, intellectual.
– Paul Farmer –

CAN ONE PERSON MAKE A DIFFERENCE
CAN ONE PERSON
ACTUALLY BE
A CONTAGIOUS CARING CATALYST.    .   .
CAN YOU BE
THE CASE IN POINT
OF PROVING IT
(or not)