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  • Writer's pictureThe San Juan Daily Star

Paul Farmer, pioneer of global health, dies at 62

Dr. Paul Farmer listens to a man seeking treatment for his daughter at the Partners in Health hospital in Cange, Haiti, Nov. 2003.

By Ellen Barry and Alex Traub

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

Partners in Health, the global public health organization that Farmer helped found, announced his death in a statement that did not specify the cause.

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.

His work with Partners in Health significantly influenced public health strategies for responding to tuberculosis, HIV and Ebola. During the AIDS crisis in Haiti, he went door to door to deliver antiviral medication, confounding many in the medical field who believed it would be impossible for poor rural people to survive the disease.

Although 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 Farmer’s death rippled through the worlds of medicine and public health Monday.

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

“When you talk about iconic giants in the field of public health, he stands pretty much among a very, very short list of people,” said Fauci, who first met Farmer decades ago, when Farmer was a medical student. He added, “He called me his mentor, but in reality, he was more of a mentor to me.”

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

When Paul was about 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.

One summer, he and his family worked alongside Haitian migrant workers picking oranges, listening curiously as they chatted to one another in Creole from atop ladders. That was Paul’s first encounter with Haiti, the country that would captivate him in his 20s and then propel him toward a career in public health.

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, such as 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 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.”

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

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

In 1996, he married Didi Bertrand, the daughter of a pastor and a school principal in Cange; she was described in Kidder’s book as “the most beautiful woman in Cange.” She became a researcher for Partners in Health and survives Farmer, along with their three children, Catherine, Elizabeth and Sebastian; his mother; his brothers, James and Jeffrey; and his sisters, Katy, Jennifer and Peggy.

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, 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.”

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