Dr. Paul Farmer is an American medical anthropologist and physician. He is co-founder and chief strategist of Partners In Health (PIH), an international non-profit organization that brings the benefits of modern medical science to those who need it the most. We talked to him about his journey as a physician and a global healthcare strategist using humanitarian work as a tool to prevent violence around the world.
I grew up in a large family of modest means. For many years, we lived in a bus or a boat. But I also learned later that I had grown up in a very intact, loving family with certain cultural ambitions for all of us. I don't regard myself as having grown up with any privation, even though from outside it might look that way. I knew that none of us was really, in any way, suffering. We did see migrant farm workers in Florida working in inhumane conditions, and that woke up something in me, even as a child․
I always wanted to be a doctor, but I didn't know why. For me, there was always a connection between medicine and humanitarian work. I like the direct contact with patients and the idea that you're helping someone in need, someone usually in far greater need than you are. So, I came into it that way and I've been happy in the profession of medicine ever since. My life has changed a lot over decades, but the joy of taking care of people is still there.
Partners In Health
I went to Haiti in 1983, so that was at the tail end of the Duvalier dictatorship. I knew, going to Haiti, I was going to learn a lot about a new place. I wanted to learn and that was part of my project. I wanted to learn about the history of Haiti, the culture, the art, everything else. But it also reinforced my commitment to be a clinician. I saw a lot of things in those years that I wish I hadn't seen, but they taught me something. And those early years in Haiti just cemented my desire to be a physician who was focused primarily on the needs of poor people, and that's why we started Partners In Health.
Staff, Stuff, Space, System, Support
You always need staff, you need stuff: you need supplies, you may need COVID vaccines, surgical tools. You need space to work in, and if you’re in the middle of an earthquake and the hospital collapses, you don’t have the space anymore, if you’re in the middle of an Ebola epidemic and you don’t have an Ebola treatment unit with a safe way of getting in and a safe way of getting out, then you need more space. But it’s always that same list: staff, stuff, space, systems. For example, infection control is a system. But getting the nurses paid on time is a system too. And then, finally, support. Everybody needs support – the patients, especially the afflicted, but sometimes it’s the health care providers and managers who need support as well. So that little list: staff, stuff, space, systems and support.
The Challenge of COVID-19
The advent of COVID-19 was the biggest shock to our worldwide system of Partners In Health. It’s in 11-12 countries, with 15,000-16,000 people working in those places. Just to give you an example, we have over 6,000 employees in Haiti. They're all Haitian. We have thousands in Rwanda – Rwandans. It was very clear to us from the beginning that we would be affected in all the places we work, and it turned out especially in the United States. We realized that a lot of the things that we've learned in Haiti, in Rwanda, in Sierra Leone fighting Ebola, the lessons that we've learned were relevant to what was going on in the United States. In Haiti, we launched the national treatment center for COVID while also working on vaccine strategies, etc. COVID really upended a lot of our work, but it made us stronger as well and it brought us together – unfortunately, not physically.
The COVID experience has been an affirmation – for me, anyway – that we were right to focus so many of our energies and our resources on building local capacity. We had done well to invest in local institutions, whether that's hospitals, Ministries of Health, universities, schools, you know, in Rwanda, Haiti, Malawi, to help all these places build the local capacity. So I think we're going to be spending more of our energy in our time on investing in that part of the formula and that requires, of course, training programs, universities, what Americans call residency training programs for doctors and nurses to become specialists. We've already done that in Rwanda for the last 10 years and we learned a lot doing that as well. And now, we're going to amp that up in our work everywhere. One of the things that we're very interested in is local production of COVID vaccines on the continent of Africa. That's what local capacity-building looks like in that arena. It's not just importing them or receiving them as gifts; it's learning how to build the vaccine production capacity itself. In Africa, 99% of all vaccines that are being used, pretty much all of them are being imported from elsewhere, and we've seen how that can slow down the rollout of a vaccine program in the COVID example. That's not how we think this should roll. Let the Rwandans be their own humanitarians for each other and other parts of Africa in the world. Let the Haitians make their contributions to the global health, let the Navajo make their contributions to the health equity in the United States and beyond. And I believe that's also the intention of the Aurora Prize – to build up a community of people engaged in lifesaving or life-promoting work, and that can happen and it can work and it can work quickly.
Aurora: A Different Way of Thinking
The Aurora Prize signals a different way of thinking about humanitarian work and acknowledging it. It is about capacity-building; it is about lifting up others. And even the idea that we should all be documenting the efforts of those who seek to save the unknown stranger, that's the golden rule, but it's also the parable of the Good Samaritan, a powerful one to this day. For that reason, after all, it's about helping a stranger. That's what it's about.
And I think, in addition to elevating that work, it’s about elevating a network of people and bringing together people who share the same concerns. Let's not turn away from human suffering, especially human suffering caused by something that might have been averted. I think the Aurora Prize is unique in that sense. I must also say that the Prize has a formal link to the Genocide against the Armenians. That's about the hardest way to start a reflection on saving lives in the middle of a moment where too few of them were saved. But I've seen this in Rwanda, too. I've seen how acknowledgement, understanding and, yes, a real pledge to make sure it doesn't happen again, how that can bring people together. I saw that people could make real progress. It forever changed the way I think about conflict.
I think the conflict part of this is built into the Aurora Prize, reflection on how the work that is humane and thus humanitarian can prevent outbreaks of violence as well. I believe that. If you look at what causes the most disgruntlement in the world, it's usually inequality. But this is often related to things like education, healthcare, the ability to have freedom from want. So, if we can address those needs which is what Partners In Health is focused on, I think we'll have a less troubled world going forward and I think the Aurora Prize and this community also recognize that.
Paul Farmer has helped millions of people by strengthening healthcare systems in 11 countries. To help fearless modern-day heroes like him continue their life-changing work, support Aurora at auroraprize.com/en/donate.