How Paul Farmer Changed Medicine

Dr. Paul Farmer, a physician, medical anthropologist, and mentor to many, died on Monday in Butaro, Rwanda. Partners in Health, the organization he co-founded, confirmed his death in a tweet on Monday. He was 62. Dr. Farmer is survived by his wife, Didi Bertrand Farmer, three children, and thousands of patients and students, like myself, who honor his memory today. While messages pour out from heads of state and celebrities, it is the unified voice of grief from his colleagues and students that underscores the resounding loss felt within the field of global health. Dr. Paul Farmer was a guiding light and inspiration to thousands looking to advance the health of vulnerable people across the world.

After graduating from Duke University in 1982, Farmer joined Harvard University, earning an MD and a PhD in medical anthropology. He made many trips to Haiti during these formative years, volunteering at a hospital in Cange, Haiti. Here, he helped introduce a revolutionary concept into the field of healthcare and medicine, which has progressively become a privilege of those with money, access, and other forms of power: that all people are deserving of equally excellent care. He believed, “The idea that some lives matter less is the root of all that is wrong with the world.” This led him to co-found Partners in Health in 1987 as a young medical student at Harvard Medical School, alongside Ophelia Dahl, Thomas J. White, and Jim Yong Kim. The organization succeeded in bringing high-quality care in resource limited settings such as Haiti, Rwanda, and Lesotho.

Dr. Farmer didn’t just believe in the idea of health as a human right, he lived and taught those values. In a remarkable but characteristic move, Dr. Farmer maintained his role as a practicing physician throughout his career. While to those outside of medicine, this may not resonate as significant, to those of us within that circle it is an extraordinary move – moving mountains at the systemic level by leading an organization or making change in international health policy requires so much time and energy that typically physicians temporarily or indefinitely pause their clinical practice. For Dr. Farmer, it was always about changing an individual life. As Tracy Kidder, the author of Mountains Beyond Mountains, a book about Farmer, wrote, “he was a doctor first of all.” Dr. Farmer was always known for personally going on rounds in the hospital wards, letting the lived experience of patients guide him and others.

To those of us that had the good fortune to be his students, Dr. Farmer was determined to bring us along his path to advance 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 didn’t stop at noting a patient’s medication or writing down a diagnosis in a chart. Rather, it meant hearing their stories. As a student from 2014 to 2015 in the masters of medical anthropology program at Harvard University where Dr. Farmer taught alongside giants like Arthur Kleinman, I learned from him how biopsychosocial factors such as poverty, the environment, and public policy caused ill health. These concepts only recently have started to find their way into medical school education. At a time when medicine was about anatomy, biology, or physiology, he taught how deep poverty in Haiti might increase the deadliness of a manageable condition like HIV/AIDS, or how a lack of access to roads might prevent an individual from getting necessary tuberculosis medications. In addition to knowing what HIV/AIDS does to a person’s immune system or what antibacterial medications to give for tuberculosis, it was about understanding the real, full life story of a patient to understand their illness.

“If you look at apartheid in South Africa, you see that people get sick with tuberculosis, malaria and other diseases because of poor work conditions, lack of jobs, shantytowns. You have to look at what’s happening to the patient in front of you, and think about ways to address social disparities. If there’s food insecurity, then you provide food when you provide care. Or if patients drop out of 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 healthcare providers to consider these factors a critical part of health and illness, at a time when few others were making these connections for us.

With his radical approach and generosity of spirit, he trailblazed a pathway for global health to be a social justice movement. Through his own work, and through the continued work of his students, he improved the life and wellbeing of countless patients across the world. As a testament to how universally beloved he was, from patients to trainees to colleagues, Dr. Farmer was the godfather to more than 100 children, most of them in Haiti.

Importantly, Dr. Farmer brought this social justice movement and the care of vulnerable populations across the world to the hearts and minds of a broad audience, bringing global health back to the U.S. Through articles and 12 books he explained his vision for more equitable health to the public and helped shape a generation of doctors and healthcare providers.

Bringing together health experts, government officials, and donors, he helped found the University of Global Health Equity in 2015 in Butaro, Rwanda. And he brought each person along this journey with kindness, grace, and humility. When, from Rwanda, I’d asked him 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 though it wasn’t all there because of his vision and efforts.

It is but once in a lifetime that a physician so steeped in caring, compassion, and selfless service comes along who can change not only the world for a patient, but who can change how the world understands patients. While a giant has left us, the field of global health will be carried forward by thousands of his students and countless more who have been inspired by his work, with the vision of providing equitable healthcare for all.