How Paul Farmer Changed Medicine

dr. Paul Farmer, a physician, medical anthropologist and mentor to many, died Monday in Butaro, Rwanda. Partners in Health, the organization he co-founded, confirmed his death in a tweet on Monday. He was 62. Farmer is survived by his wife, Didi Bertrand Farmer, three children and thousands of patients and students, like me, who honor his memory today. As reports come from heads of state and celebrities, it is the unified voice of grief from his colleagues and students that underscores the tremendous loss being felt in the field of global health. dr. Paul Farmer has been a guiding light and inspiration to thousands seeking to improve the health of vulnerable people around the world.
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After graduating from Duke University in 1982, Farmer joined Harvard University, where he earned an MD and a PhD in medical anthropology. In these early years he made many trips to Haiti and did volunteer work at a hospital in Cange, Haiti. Here he helped introduce a revolutionary concept in health care and medicine that has gradually become a privilege of those with money, access and other forms of power: that all people deserve equally excellent care. He believed, “The idea that some lives matter less is the root of everything that is wrong with the world.” This led him to found Partners in Health in 1987 as a young medical student at Harvard Medical School, along with Ophelia Dahl, Thomas J. White, and Jim Yong Kim. The organization was able to provide high-quality care in resource-constrained environments, such as Haiti, Rwanda and Lesotho.

dr. Farmer not only believed in the idea of ​​health as a human right, he lived and learned those values. With a remarkable but characteristic move, Dr. Farmer continued his role as a practicing physician throughout his career. While to those outside of medicine this may not resonate as important, for those of us within that circle it is an extraordinary step – moving mountains at a systemic level by leading an organization or making changes to international health policy takes so much time and energy. that physicians typically interrupt their clinical practice temporarily or indefinitely. for dr. Farmer was always about changing an individual’s life. As Tracy Kidder, the author of Mountains Beyond Mountains, a book on Farmer, wrote, “He was a doctor first and foremost.” dr. Farmer was always known for his personal rounds of the hospital wards, guiding himself and others through the life experience of patients.

For those of us lucky enough to be his students, Dr. Farmer determined to lead us on his path to promote the health of all. He taught us with a passion that made it clear that the fate of individual men, women and children rested in the care we provided. And it wasn’t just writing down a patient’s medication or writing down a diagnosis on a chart. Rather, it meant hearing their stories. As a student from 2014 to 2015 in the master’s degree in medical anthropology at Harvard University, where Dr. Farmer taught with giants like Arthur Kleinman, I learned from him how biopsychosocial factors such as poverty, the environment, and public policy caused ill health. These concepts are only recently beginning to make their way into medical education. At a time when medicine was about anatomy, biology or physiology, he learned how deep poverty in Haiti could increase the lethality of a manageable condition like HIV/AIDS, or how lack of access to roads could prevent a person from getting the necessary tuberculosis is on medication. In addition to knowing what HIV/AIDS does to a person’s immune system or what antibacterial drugs to give for tuberculosis, understanding a patient’s real, full-life life story to understand their illness was a matter of course.

“If you look at apartheid in South Africa, you see that people get tuberculosis, malaria and other diseases because of poor working conditions, lack of jobs, slums. You need to look at what is happening to the patient in front of you and think about ways to address social inequalities. If there is food insecurity, you give food when you provide care. Or if patients stop treatment, you provide transportation to the clinic, or you send community health workers to the patient,” he told NPR in a 2020 interview. He trained a generation of health care providers to understand these factors as a critical part of health. and illness, at a time when few others made these connections before us.

With his radical approach and generosity of spirit, he paved the way for global health as a social justice movement. Through his own work and through the continuous work of his students, he improved the lives and well-being of countless patients around the world. As a testament to how widely loved he was, from patients to interns to colleagues, Dr. Farmer is the godfather to more than 100 children, most of them in Haiti.

Importantly, Dr. Farmer brought this movement for social justice and caring for vulnerable populations around the world to the hearts and minds of a wide audience, bringing global health back to the US. the public and helped shape a generation of doctors and healthcare providers.

Bringing together health experts, government officials and donors, he helped establish the University of Global Health Equity in Butaro, Rwanda, in 2015. And he brought everyone on this journey with kindness, grace and humility. When I asked him from Rwanda for help in setting up our early partnership with the University of Global Health Equity, after resolving the situation he replied with gratitude for our work, as if it wasn’t all there because of his vision and efforts.

It’s only once in a lifetime that a doctor comes along so imbued with caring, compassion, and selfless service, who can not only change the world for a patient, but also change how the world understands patients. As a giant has left us, the field of global health will be continued by thousands of his students and countless others inspired by his work, with the vision of providing equitable healthcare for all.

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