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If you like Paul Farmer's story, you might also like:
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Related Links:
Partners in Health
Clinton Foundation
Global Health Equity
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Paul Farmer
Paul Farmer
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Paul Farmer Interview (page: 3 / 9)

Founder, Partners in Health

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  Paul Farmer

By the time you graduated, you had seen more than most medical students, because you spent so much of your time in Haiti. Haiti, you've said, was your best education.

Paul Farmer: Haiti's been my best teacher. In 2005, I went to Rwanda, and along with other people at Partners In Health. There are projects in Malawi and Lisutu, with a partner institution in Burundi. So from 2005 to now, I spent most of my time -- field time -- in Africa. But if I hadn't learned those lessons, and we hadn't learned those lessons in Haiti, then how would we know really what to do in rural Africa, because those are not culturally similar places, but they're structurally similar. So there's no cultural or linguistic tie between Haiti and Rwanda, but they're very poor, agrarian societies, much disrupted by political violence and with a history of heavy post-colonial burdens. So there are very significant structural similarities between those places. So of course, one hopes that the lessons learned in Haiti would be -- I guess the word is "transferable," and most of them are. So Haiti's been my best teacher in that sense. But I wouldn't want teachers at Duke and Harvard to think that I was saying that I didn't have the book knowledge that I needed, that I got that in Haiti. Really, I got that in the universities. But understanding its strengths and limitations of book knowledge, if I can -- or analysis in general -- you learn that in a place like Haiti. You find out how far that knowledge can take you, and where you need to generate new knowledge, and that comes from working with lots of other people, as I've said a couple of times.

[ Key to Success ] Preparation

It doesn't come from oneself and books. It comes from experience, learning to listen to other people, working with big teams of people.

Tell us about the beginnings of Partners in Health. How did you come to found this organization?

Paul Farmer: The idea to start something about it came to me in Haiti, of course.

I think part of it was that I saw just how many different groups had been in and out of Haiti over the years. I knew they were well-meaning, even if I was -- as sometimes young people are -- I'm sure I was hypercritical. That's okay. Everybody's a critic, and like I said, the diagnosis is easy and cheap to make, right? You know, you see all this aid money going in to Haiti. This is -- I'm talking about the '80s. Haiti's still in trouble. It's easy to say, "Gee, there's a problem here." There is a problem with the effectiveness of the aid, and there were missionary groups, and there were short-term medical missions, and there were tons of people from the United States and Europe. So I think back, then I said, "Well, we need to have long-term partnerships," hence the name. It's not gonna be someone coming from the United States, into Haiti saying, "Do this, do that." It's really about partnerships. So in many senses, certainly the idea for doing that came from Haiti, but also the start was in Haiti.

[ Key to Success ] Vision

Why did you start it in Boston? To be near Harvard?

Paul Farmer: Initially it wasn't in Harvard at all. I'm not sure that we would have anticipated that it would fit in a research university. I wouldn't have guessed that when I was a medical student. And so I'm afraid it was quite conventional to start with. There was the notion that you needed partnership. Again, it's not rocket science. The notion that it would need to be long-term? Not particularly rocket science either. The notion that you have to link a resource-rich setting like Boston or Harvard? That was obvious too, because all of us who were doing any kind of connection were living links between a world of great poverty and a world of affluence.

[ Key to Success ] Integrity

So those things were pretty obvious, I think. But building that into a series of institutions which would later span all these countries in which we've been working, the idea was...

What we need to do is build local capacity. Again, these are almost clichés now in development work. So that meant a Haitian organization, or in Rwanda that means a Rwandan organization, or in Malawi a Malawian organization, et cetera. And that's what we try to do, was to say, "It's not about us. It's not about our own quest for personal efficacy." And again, this may be a lesson that's worth sharing with people who would look at your web site is, "It's gonna feel like it's about you, and your own quest for personal efficacy, or discovery of yourself, but it isn't about you. It's really about the people that you're serving." Those are hard lessons to learn, because -- I don't think -- I'm not just talking about young Americans, but I'm saying, in general, young people who are achievers, who get to go to school, who could even have a computer or electricity, it really puts -- hopefully, I hope that we'll soon see laptops all over the world, and that poor people also have access to information technology. But right now we don't have that. We have this digital divide.

[ Key to Success ] Integrity

So to get back to your question about the seeds of PIH, the obvious stuff, it needed to be long-term. It needed to be about partnerships. It needed to be about local capacity-building. Those are still serious problems in the arena of development.

Who is Tom White, and what role did he play in starting Partners in Health?

Paul Farmer Interview Photo
Paul Farmer: Tom White is a Boston businessman who gave money to a local anti-hunger charity in Boston for Haiti work, probably in 1983. That was right around the time when I was going back, to interview at Harvard Medical School. I went to this charity and said, "We need to build a bakery in Haiti." That actually was probably not a good idea, but that's okay. We meant well. It's not okay to keep doing the wrong projects, but at that point, it seemed like a good thing to build a bakery. He had given this gift anonymously, and we went and built a bakery. He was the anonymous donor and that's how I met him. He's one of the founders of Partners in Health, and we're still working together to this day.

From the original project in Haiti, Partners in Health expanded, first to Peru, then to Russia and Africa. How did you become involved with Russia's drug-resistant tuberculosis project?

Paul Farmer: I went there on a mission myself in the late '90s. There weren't that many people in the world who were still focused on that clinical problem of drug-resistant tuberculosis. There's a few centers in the United States, one of them in Denver, but there are not that many. Tuberculosis is not a huge burden in the United States. There's a debate over how much TB there had been in Russia in the '80s.

It's clear that TB started making a comeback in Russia, after the collapse of the Soviet Union. It was a prison-seeded epidemic, just as we'd had in the United States, in New York for example, in the '80s. A lot of these epidemics of drug-resistant TB started in prisons or homeless shelters in the United States. The same thing happened in Russia, and I had that particular clinical training and interest, so that's how I got involved. How we got involved as a collective was -- we thought, "Wow. There's -- again -- people of goodwill here: the prison health officials, the doctors and nurses. There's a great need. Some of the tools that are needed to respond effectively are not available. Could we get them there? So all that came together to lead us to, to start another Partners In Health project there.

Russia wasn't the first place Partners in Health went after Haiti, but was Russia part of an expansion -- a globalization -- of your outlook on infectious diseases like drug-resistant tuberculosis?

Paul Farmer: We'd always had a globalized view of these epidemics. The question is, how much could we be effective globally? A lot of groups, I think, overshoot. They try to do too much, small groups. They try to say, "We'll do this for the whole country or district." We didn't want to do that ever. We still don't, as Partners In Health.

We knew that these were transnational epidemics, transregional, globalized epidemics. The same is true for lots of other pathogens. We knew that, but the question was, "How could we be effective?" And the way that we got started was working with the Open Society Institute, which George Soros founded. And then the Gates Foundation, in one of their first major delivery grants, started supporting our work in Peru. And we went back and said, "Look, you know, there's a very big problem in Russia as well. Do you think we could help there?" So we ended up re-formulating our support for the Peru project, to support Peru and Russia, to really scale it up in Russia. So yes, in a way that was an acknowledgement of what we always knew to be a globalized problem. How could it be otherwise? it's an airborne disease, so it's going to spread, globally, just like swine flu or SARS.

[ Key to Success ] Vision

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This page last revised on Sep 28, 2009 20:07 EDT
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