In the 1980s, Dr. Paul Farmer set up a community health clinic in a remote area of Haiti. Within a decade, it grew to include a hospital and an outpatient clinic. Today it is one of the largest international non-profit health organizations in the world.
A graduate of Harvard Medical School, Farmer was not just a benefactor who wanted to help the poor. He sought to hire and train locals to staff medical facilities.
One day, a 13-year-old girl arrived by donkey ambulance at the hospital. Two young Haitian doctors tried to treat her, but she continued to moan in pain.
Quickly assessing the situation, Farmer realized the doctors’ error. But rather than scolding them, he said in a stern but gentle voice, “Doctors, doctors, what’s happening to you?
He told them not to give an antibiotic to a patient with meningitis until they had performed a lumbar puncture to learn more.
“There was a calculation behind a lot of the things he did,” said Tracy Kidder, author of “Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World.”
Teach, don’t belittle
Kidder, who witnessed this exchange, marveled at how Farmer pointed out the young doctors’ error without embarrassing them. Instead of castigating and adopting a harsh tone, he was plaintive.
Farmer (1959-2022), who earned an MD and Ph.D. from Harvard, co-founded Partners in Health in 1987. A central part of his life’s work, the Boston-based nonprofit brings health care to the poor in many countries.
Instinctively, Farmer understood how to gain the trust of others. He had an amazing ability to connect with all types of patients.
As a leader, he was a great role model. His passion for his work drove him to prioritize patient care above all else. His team had to run to keep up.
“Nobody worked harder than him,” Kidder said, noting his mental and physical stamina. “He led by example. He never gave up.”
Kidder remembers meeting a young employee who believed deeply in the mission of Health Partners. “I wouldn’t trade a minute working there,” she told Kidder. “But it was agony for me. The work was so hard, but so inspiring.”
Keep calm in peril like Paul Farmer
Farmer died aged 62 in February 2022 of an “acute cardiac event” on the grounds of a hospital he helped establish in Rwanda, according to Partners in Health. He won the MacArthur Fellowship “genius grant” in 1993 and the $1 million Berggruen Prize in 2020, among a long list of awards for his groundbreaking advances in saving lives around the world.
Much of Farmer’s work involved extraordinary risk and high stress. He would face soldiers who threatened him. He walked for hours over dangerous terrain to visit a patient in rural Haiti.
But he managed to keep calm and carry on.
Jim Yong Kim, co-founder of Partners in Health, remembers Farmer picking up hitchhikers every time he drove around Boston.
When one of them pulled out a knife, Farmer replied, “All I have is $10. You can have this. And you can have my clothes. It would be nice if you put that knife down .”
The thief was so disarmed by Farmer that he thanked him before fleeing with the money and some of his clothes.
“At that time, Paul was thinking about this guy who was so desperate he thought doing this was the only way to survive,” said Kim, president of the World Bank from 2012 to 2019.
When smuggling $10,000 into Haiti to donate to the peaceful resistance against the military junta in the early 1990s, Farmer knew the situation was difficult.
“It was incredibly dangerous for him, but he knew it was more dangerous for the people who would suffer” if that money didn’t arrive in the right hands, Kim says.
Farmer: learn the culture
Farmer was accepted wherever he went. Before attempting to open a medical clinic or provide other services in an unfamiliar location, he researched the country and its people.
Kim says Farmer, who was also a medical anthropologist, excelled in ethnography. He was researching a culture and seeking to understand the daily lives of the poor and the challenges they faced.
Such research began with questions such as “Who are these people and what do they want?” “What is the social system here?” and “Where does the power lie?”
Collecting responses without judgment gave Farmer and his team the insight to deliver the most needed care in the most efficient way.
“What was so unusual was his deep love and compassion for people,” said Dr Joia Mukherjee, chief medical officer at Partners in Health. “He met everyone with the same open heart. He took on the best of everyone.”
Set high goals
Farmer set ambitious goals and never lost sight of his vision of creating sustainable systems to deliver patient care in some of the world’s most beleaguered places, even against the odds.
Mukherjee recalls rushing to Haiti after the 2010 earthquake. As she and Farmer assessed the damage to the general hospital and the collapse of a nursing school, they were momentarily overwhelmed .
“We weren’t moored by sadness and grief,” she said. Then they turned to each other and agreed that they needed to restore medical education.
“We knew we had to train the next generation of doctors and nurses,” Mukherjee said. “We asked, ‘What good can we do in the future?’ This led us to build a university hospital in Mirebalais where we trained hundreds of doctors and nurses, most of whom remained in Haiti.”
Set the moral standard
Many leaders articulate their core values. Instead of writing a list of his core beliefs, Farmer and his team identified what they called AMCs (areas of moral clarity).
Farmer’s moral beliefs were unwavering, Kim says. An example: Stand on the side of the poor.
“It’s about having a moral compass and being clear about what you want to accomplish,” Kim said. Establishing a clear, non-negotiable understanding of what to do despite myriad obstacles has helped Farmer achieve big goals and win over critics.
Asked by public health officials about the cost of treating HIV-positive patients in impoverished parts of the world with the newest drugs, Farmer didn’t flinch. Responding to criticism that resources were limited and advanced drugs were expensive, he said: “Never has a patient said to me, ‘Don’t treat me. I am not profitable.
Remembering names: Paul Farmer saved details
Farmer went to great lengths to remember the names of the people he met – from poor patients to wealthy donors – as well as biographical facts about their lives.
“He remembered so many little details to make people feel important,” Mukherjee said. “The names of their children. Their hometown. People thought Paul liked them best.”
On trips to places like Haiti and Rwanda, Paul English observed how Farmer went into “laser-focused mode” when caring for a patient. Farmer leveled with patients and spoke with clarity and compassion.
“He spoke very clearly,” said English, a Boston-based serial entrepreneur and co-founder of Kayak. “He had this combination of humility and confidence.”
After his death, a tearful Dr Anthony Fauci said, “He called me his mentor, but really he was more of a mentor to me.”
Paul Farmer Keys:
- A Harvard-trained doctor who has saved countless lives around the world by building health care systems in impoverished areas.
- Lesson: Overcome stress and regroup after setbacks by looking beyond your own personal circumstances to focus on helping those in need.
- “I don’t care how often people say, ‘You are a saint.’ It’s not that it bothers me. It’s that it’s inaccurate. People call me a saint and I think I have to work harder. Because a saint would be a good thing to be.
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