The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USAUnited States
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Doctor Paul Edward Farmer passed away on 21 February, 2022 of an acute cardiac event in his sleep at University of Global Health Equity (UGHE) in Butaro, Rwanda, an institution which he helped found. Launched in September 2015, UGHE is a new kind of university focused on delivering the highest quality of health care by addressing the critical social and systemic forces causing inequities and inefficiencies in health care delivery.
OpenJournal Obituary The Life of One Patient - Memories of Dr. Paul Farmer (1959-2022) * Nathanael E. Hughes, MPH, MPP, MPhil* The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA * *Corresponding author Nathanael E. Hughes, MPH, MPP, MPhil Senior Director, Business Development at Peachtree Bioresearch Solutions,The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; E-mail: natehughes73@gmail.com Article information th th th Received: March 15 , 2022; Accepted: April 6 , 2022; Published: April 7 , 2022 Cite this article Hughes NE.The life of one patient - memories of Dr. Paul Farmer (1959-2022). Anthropol Open J. 2022; 5(1): 16-18. doi: 10.17140/ANTPOJ-5-126 “It always seems impossible until it’s done”.
inequities and inefficiencies in health care delivery. That week, Paul - Nelson Mandela had been teaching and treating sick patients, one of which passed away from complications of late-stage acquired immune deficien- cy syndrome (AIDS), a young man in his mid-thirty’s whom Paul “Christians have not done enough in this area of conversion to the neighbor, to had cancelled a trip to Sierra Leone for. He was devastated when social justice, to history. They have not perceived clearly enough yet that to know he lost the patient, after trying out different life-saving therapies, God is to do justice. They have yet to tread the path that will lead them to seek interventions, and possible hospital transfers to save the life of one effectively the peace of the Lord in the heart of social struggle”. patient. A few days later, exhausted and in bed to rest for only a - Gustavo Gutierrez few hours, the man who had the world’s biggest heart, himself died octor Paul Edward Farmer passed away on 21 February, 2022 away of a cardiac event. Part of me thinks that Paul internalized of an acute cardiac event in his sleep at University of Global the pain his one patient was suffering.
D Health Equity (UGHE) in Butaro, Rwanda, an institution which he helped found. Launched in September 2015, UGHE is a new kind Despite the life of prodigious, accomplished achieve- of university focused on delivering the highest quality of health ments - a MacArthur “genius” award in 1993, member of the care by addressing the critical social and systemic forces causing Academy of Arts and Sciences and the Institute of Medicine of cc Copyright 2022 by Hughes NE. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which Anthropol Open J. 2022; 5(1): 16-18. doi: 10.17140/ANTPOJ-5-126 the National Academy of Sciences, from which he was the recip- then much later as anthropologist-physician at Harvard. (All Duke ient of the 2018 Public Welfare Award, co-founder and self-de- flags on campus will be lowered through Wednesday in his hon- scribed “chief strategist” (he gleefully commented) of Partners or.) Then of course Paul went to Haiti. One day in Berkeley Paul In Health (PIH), Kolokotrones University professor at Harvard showed up to my crowded house asking for a couch to sleep on. Medical School, comfortably wrestling between the foundations of The next morning Paul was in the kitchen washing dishes with our power and the “poorest of the poor”, Paul lived his life in contrast. former Gov. Jerry Brown, then Mayor of Oakland. At one point we bumped into each other during the end of Cuba’s human im- Here are just a few metrics from PIH and what the non- munodeficiency virus (HIV)/AIDS sanatorium.
profit has accomplished since its inception in 1987: 2.8 million outpatient visits in supported clinics, 2.1 million women’s health Paul inspired so many people and organizations to fight checkups around the world and over 2.1 million home visits con- epidemics, social and political injustice, and the basic needs of ducted by community health workers.
the world’s sick-poor. He argued for a political economy of death counts (à la German anthropologist, Rudolf Virchow). As a phy- Paul and I were so close. I imagine part of it was his try- sician-theologian, Farmer had a unique ability to capture the em- ing to grapple with being a medical anthropologist and a practicing bodiment of institutionalized violence and suffering. In addition physician, having left his family so many times to be in the field to fighting the bureaucratic global international health regime Paul with his patients. He understood that I myself was a child who carved out time to heal the sick. His double consciousness as a phy- grew up as a third culture kid in the field of anthropology, and dur- sician-anthropologist, a policy maker and a healer, an activist and a ing my childhood and adolescent years, I was left with my sisters theologian, Paul was able to work between his philosophical critical in Northeast Brazilian pharmacies hearing about the maladies of thinking and his feet-on-the-ground ‘being there’ anthropologist. poor peasants while my mother conducted social epidemiological At times there was a certain world-weariness as he made his back research for her masterpiece “Death Without Weeping”, a book Paul through capitalist foundations and the everyday sickness of needy often told me was one of his favorite ethnographies and which bodies, just as he was impatient with medical anthropologists. He had an immense influence on his own writing in Haiti, and later wanted more, much more from us. I remember Paul saying that he Rwanda.
refused to listen to one more Haitian story of ‘sorcery-sent’ illness when it was ‘for-profit medicine’ that was to blame for the dead. Another aspect of our over 30-year friendship was that I knew Paul since he was a medical student. I saw him develop his With tears and love”, own brand of activism, and I while my mom had mentored him at Nancy a critical juncture in his life, so had he played that role for me in my own development, which ultimately led me to the field of global Nancy Scheper-Hughes, Chancellor’s Professor Emerita public health.
Department of Anthropology, University of California Berkeley He wanted to know that he was a good father and was it “Dear Nancy and all, OK that his priority was to the poor, the life of one patient. His daughter, Katherine, during a ceremony at Trinity Church in Bos- Thank you for sharing these wonderful words...My own friendship th ton on March 12th, 2022, described perhaps my favorite story (and with Paul happened around our mutual admiration for Cuban pub- there are so many) of Paul. During the last couple of years amid lic health and one of my other heroes and dear friend, Jorge Pérez, the coronavirus disease (COVID) pandemic, Paul spent more time copied here too. Paul was so gracious that when we decided to in Miami with his three children and wife Didi Bertrand and had an make the film SALUD! he was eager to share his thoughts on film abundant garden outside which he spent several hours working on. and was a major influence in turning the documentary from a fea- At one point working in the garden, he turned to Katherine with ture on Cuba’s international health teams into a much deeper look tears welled up in his eyes, and almost apologetically said, “I had to at the reasons why poor people the world over don’t have access to do this work. I had to do it. And if I had the chance to do it all over again, what makes them healthy, including decent public health systems. I would have done the same thing”. Kathrine embraced her father. She As you all know, Paul slept very little--his work, his patients, his understood, and she was OK with it. He always led with love, he writing, and activism all-consuming. But when he arrived in Cuba, led with compassion.
as Tracy Kidder described in his book: “When we got to our hotel, Farmer said, ‘I can sleep here. Everyone here has a doctor. ´ He lay I wanted to make sure that I sent some memories from down on his bed and within a few minutes he was asleep....” Paul’s teachers, mentors, and friends, to capture who he was – and how he will be remembered. All of us agree, that we must do the Rest in power, dear Paul. We need to do so much more to live up work to bring good trouble in medicine and medical anthropology to your legacy.
Warm regards to everyone and un abrazo”, “Dear Arachu and friends, Gail Reed, International Director of Medical Education Cooperation with We must all have so many memories of Paul. I first met Cuba (MEDICC) Paul when he was an eager undergraduate at Duke University and Anthropol Open J. 2022; 5(1): 16-18. doi: 10.17140/ANTPOJ-5-126 “He was so admirable a human being in so many ways. smile was infectious.
And the outpouring of emotion for him almost everywhere speaks to his true place at the moral core of humanitarianism, global When I was at a low point in my life in 2010, I went out health, social medicine. medical anthropology, infectious disease to Boston to spend time at PIH and seek solace, a quiet guidance research and practice and more. As he said in a message two days from him since I have known him since I was a kid in North Car- before he died, he was my symbolic son, and the tragic irony of olina. Lost, I found my way, since he recommended an Master of history is that he pre- deceased his mentors. He influenced me so Public Health (MPH) program and set up a fortuitous meeting very much and I loved him. it was a 40-year relationship, and I had with his PhD advisor, Dr. Arthur Kleinman at the Asian Center at the full measure of Paul, so extraordinary were his virtues, his vi- Harvard.
sion, his down to earth humanity, and the lightness of being he an- imated. Paul is irreplaceable, but we will all struggle to pick up the One time in 2017, I had asked his assistant, Katherine, burden and continue his work and your work to repair the world. to set up a meeting in downtown Boston. “Paul is running late and Because you, Nancy Scheper-Hughes, modeled for him productive had to see patients in Haiti. But he is on the next flight to see you”. I met ways of destabilizing the status quo and reframing the future to Paul in a downtown restaurant, where he plotted down with a bag privilege the wretched of the earth. Blessings in his memory on all full of stethoscopes and was in route later to Amsterdam and then of us who care”.
West Africa, where we had been discussing a possible trip together to see patients. He wanted to know how my nascent engagement -Arthur Kleinman, PhD advisor, and Professor of Medical Anthropology, was going at the time. He often quoted Gustavo Gutierrez, the lib- Department of Global Health and Social Medicine, Harvard University eration theologian. Paul and I talked fondly of our mutual friend, Tolbert Nyenswah, who was Liberia’s deputy minister of health for “Paul gave everything - everything - to others. Life was disease surveillance and epidemic control from 2015-2017, during not about what he could do for himself. It was about what he could the Ebola crisis.
do for others, and in that, life’s successes were measured. When I told him I was writing about trade unions for my undergraduate In 2021, when another colleague asked if Paul could honors thesis at University of California (UC), Berkeley, USA he speak for United States Agency for International Development chided me for thinking so linearly about institutions and how they (USAID) in Washington, D.C., he cleared his schedule and made it relate to the very worst off in society (reminding me of the veil happen.
of ignorance theory by late Harvard philosopher John Rawls). He said, “Trade unions represent trade union interests. Never forget More than anyone, he reminded me that social justice is the poorest of the poor” he quipped. Paul Farmer described him- in my family’s deoxyribonucleic acid (DNA). “You can’t avoid it” he self as a “cracker from Florida””.
would say. He made you feel like the most important person in the room and often stared through you - directly and without distrac- He used to come up to University of North Carolina tion (a technique he invariably picked up from Bill Clinton). Paul (UNC) from neighboring Duke and fell in love with the field of was wickedly funny, engaging storyteller, genuine, kind, humble, medical anthropology while auditing my mom’s classes. He also warm, irreverent, perennially optimistic in the face of an unfair fell in love with Haiti then and decided to go down there and vol- world, vivacious, raw, attentive, thoughtful, and decent. Moreover, unteer. If Paul were not a physician-medical anthropologist, per- a decent soul who walked this earth dedicated to a less crooked haps he would have been a missionary, a saint, maybe even a Chief world, never losing that faith, a faith rooted in humanitarian ethics. Executive Officer (CEO) in a boardroom. He certainly had the “The idea that some lives matter less is the root of all that is wrong with this gravitas and focus for that. Quiet in a room, you could always feel world”. Like Tracy Kidder, the author of Paul’s biography, “Moun- his presence, his power.
tains Beyond Mountains”, I also like to think that he died happy, al- though I know he also carried the pain of the life his one patient When I saw him this past November 2021, I was lucky he could not save to bed. Again, in his world of contradictions, he enough to joke about the old times in North Carolina (NC), agree was straddling the world of suffering and the world of hope. Rest to an imminent trip to West Africa, talk about his upbringing, and in Peace, dear brother.
keep it light in the face of global epidemics (and a pandemic). I told him I had lost my iPhone in a Harvard cab, and he smiled, -Nate Hughes, Senior Director, Business Development at Peachtree Biore- “Isn’t that great though, to be without it?” The last meeting, I reminded search Solutions him what our family likes to call him, “Saint Paul”. He beamed. His