A Tribute to Dr. Paul Farmer: The World is Much Quieter Now

Credit: CNN

The first time I heard Paul Farmer’s name, I was warned. I was seated under the busy ceiling fans on the veranda of the gingerbread Hotel Oloffson in Haiti’s capital, Port-au-Prince. An American hospital volunteer was across the table from me. “Have you heard about the doctor from Harvard who’s building a clinic in the countryside, Paul Farmer,” and then looking at me with a teasing smile, “he’s not going to like you.”

This was more than 30 years ago, when a cadre of young people, mostly Americans, made life-changing trips to Haiti after serendipitous events. For Paul, who died in his sleep on February 21st at 62, it was after meeting Haitian migrant orange pickers in Florida. For me, I first traveled to Haiti after befriending the Haitian dishwashers in a Greenwich Village jazz club that I worked in. What we saw changed our lives as we visited a country that was in the midst of an undeclared civil war after the heroic toppling of the Duvalier family dictatorship: a military regime versus an uprising of the poor dreaming of a country that reflected their personal dignity and values.  

All of us in the informal foreign brigade of young anthropologists (like Paul, who went onto become a physician), foreign correspondents, human rights activists, filmmakers, painters, and volunteers felt we could help build a new post-Duvalier Haiti. Many risked our lives in doing so. Thirty years later many of us must admit we failed, and failed badly. Haiti today is a disaster with a plethora of heavily armed gangs, kidnappings, inhumane hunger, and collapsing infrastructure.

We all failed, except for Paul, who not only changed Haiti for the much better, building two modern hospitals which are thriving today, he changed the world for the better. From scratch, Paul and his small team of public health visionaries built a non-governmental organization, Partners in Health (PIH), that today employs 18,000 people (mostly health workers) in Haiti and a dozen locations across Africa, Central Asia, Latin America, and the United States. In Rwanda, PIH opened a university and a hospital. It’s where Paul spent his last night after attending the university’s first graduation of “white-coated” doctors.

Arguably his greatest legacy was in the fight for HIV and AIDS treatment. Paul used his first hospital in Haiti as a test case to prove that poor communities could effectively treat HIV patients with anti-retroviral (ARVs) drugs. His findings were contrary to the policies of the United Nations as well as the U.S. Agency for International Development which argued the drugs were too expensive and that poor countries couldn’t store the ARVs correctly and patients – most controversially -- lacked the needed education to follow the prescriptions.

On cost, Paul got on the phone with Indian pharmaceutical companies and overtime negotiated the annual price of a prescription from about $20,000 to less than $80. Paul’s team then did a study that documented his patients in Cange were more thorough taking their drugs then patients in wealthier countries. Paul and his international social entrepreneur colleagues carried the day and changed WHO policy. Today in countries like in my home of Zambia more than a million patients are receiving free HIV treatment, living healthy and full lives. Without it, most likely many of these patients would be dead today. Paul and his “accompaniment” colleagues saved millions of lives.

If he had lived longer, I have no doubt Paul would have won the Nobel Prize for Peace; proving Paul’s fellow anthropologist Margaret Mead’s maxim of “Never doubt that a small group of determined people can’t change the world. Indeed, it’s the only thing that has.” And this from a man who grew up poor in Florida, whose family lived for many years in a converted school bus. One of Paul’s brothers was a professional wrestler.

It was Paul’s radical Catholic philosophy that me made nervous my friend’s prophecy would come true when I finally set off to visit Farmer’s hospital in Cange in 2003. Paul had largely kept prying eyes away from Cange during the 20 years he and PIH were building it. But after the Millennium, Paul was ready to showcase his life’s work so its lessons and practices could be used to save millions of lives in poor communities worldwide.

To mitigate any radical Catholic thoughts Paul might have had for a mainstream American newspaperman like myself, I was carrying a letter of introduction from a mutual friend in New York, which I slipped into Paul’s hands after I introduced myself as “Patrick Slavin.” Minutes later while briefing the UNICEF team, I noticed Paul had not opened the letter yet when he turned to me and asked, “Are you J.P. Slavin?” I blanched as Paul said aloud my reporter’s byline. I summoned the courage to whimper, “Yes.”

“I’ve enjoyed your work over the years. It’s great to meet you in person,” he said with his characteristic empathy and infectious playfulness. I somehow mustered a “thank you.” Later that day, always a great doctor, Paul consulted me on my smoking, “Just try to have 15 a day.” With Paul’s help by email, later I did successfully quit.

A secret of Paul’s monumental success was that he was a strategic pragmatist. If you were in the arena, moving the chains forward as aid workers like to say, he was your advocate and welcomed your assistance.

Walking through the Cange medical campus with Paul carrying his trademark stethoscope around his neck, he invited me over to his simple wood frame home. On the side I was absolutely stunned that this mighty frequent flyer, arguably the world’s best email correspondent, who on top of his global work rose to be the tenured Chair of Harvard University’s Department of Global Health and Social Medicine, Paul somehow, someway had also found the time to plant and grow a perfect Japanese garden.

Who else but my friend, Dr. Paul Farmer?

Slavin is the Communications Associate with the Johns Hopkins Center for Health Equity and the Johns Hopkins Urban Health Institute. He worked as a foreign correspondent in Haiti from 1990-94; later serving as an editorial consultant with the National Coalition for Haitian Rights in New York City.