Paul Farmer Interview (page: 6 / 9) Founder, Partners in Health	Print Interview

In Rwanda, you encountered the phrase "Charity Industrial Complex." What does that mean?

Paul Farmer: I got that expression from a series of articles in the Rwandan newspapers. One of the Rwandan newspapers had a three-part series about the Charity Industrial Complex. It's a blistering critique of NGOs and foreign aid, looking at how it's structured and how there's a lot of overhead. And there's not enough local capacity-building, and there's not enough coordination. So it's a critique really of NGO performance in Rwanda, and I think they have the right to be critical of what's going on in their country. I think it's very important for those of us involved in working with NGOs to understand the critique that is being made of our effort. That's what the authors of that series of articles called it, "The Massive Rise of NGOs in Rwanda and Across Africa is the Charity Industrial Complex." Sobering.

What do you think is the chief barrier to developing healthcare in rural Rwanda?

Paul Farmer: The chief barrier? It's not lack of people to work. It's not lack of need. There's lots of unemployed people, or underemployed people. So you can't say, "There's no one here to work." That's not true. It's not lack of need, because there's clearly a lot of need. I would say that it is, if we can move some of these resources out of the cities, and into the rural areas, and into job creation, for example, for community health workers and community teachers and community agriculture agents. If we could move some of those resources out there, we'd really get a big leap forward in breaking this cycle of poverty and disease. That's what we're talking about, is a cycle of poverty and disease. People are trapped in it, right? Some people call that the poverty trap, but how do you spring that trap? How do you break that cycle? I think job creation's a big part of it. One of the things I see as the chief barrier is that we're not committed enough yet to job creation in these areas. Now initially what we've done is to create jobs in healthcare and education, but you also need generative jobs in manufacturing. It can't only be healthcare and education. There have to be other jobs as well.

Before I can create a job, if I'm an NGO, I'm contending with funding and cultural skepticism...

Paul Farmer: I think it's more funding. I don't think that "cultural skepticism" will work.

Get the Flash Player to see this video. Why would there be people in Rwanda writing articles called "the Charity Industrial Complex?" Because they've seen lots of development assistance, but it hasn't been effective enough. If we can make that effective, then that would go a long way to easing that skepticism. I'm not saying anything original. First of all, I'm echoing and amplifying the views that I hear in Haiti and Rwanda. I've heard these critiques many times. But there's also a book. A guy named Peter Uvin wrote a book called "Aiding Genocide" (Aiding Violence), I think is what it's called, "Aiding Genocide." And it's really about the way in which the development machinery helped set the stage in part for what would happen in Rwanda in 1994. It's not blame. The claims of causality, again, are important. He's not blaming the Charity Industrial Complex, but he's saying, this is part of the problem. So that has led to a lot of skepticism. But I'm an optimist. I think we can turn that around. We can make aid more effective, and have better metrics for assessing the effectiveness of aid. And I think that's an area that would be supported by everyone. It's not a partisan kind of problem. Everybody should want aid to be more effective.

It's really not only, it's a quest for funding -- there's a lot of money going into aid -- the question is, "Is it being used as wisely as it can?" Do we have the right ways of assessing its effectiveness? I don't think we have the right ways yet, and we can certainly develop them.

If Rwanda becomes self-sustaining in healthcare, what will we be looking at next? Where will we be developing healthcare ten years from now?

Paul Farmer: I think the public sector has a very big role to play. But we want the innovators and entrepreneurs, that's part of the reason I'm speaking to you here today. We need the young generation to be engaged, and they are engaged. They're engaged in public health and public good, much more than I saw in the '80s when I was a student. So we need that. They're the people, just in terms of the temporality, time-wise. We're not going to be doing it, it's going to be the people who are young now and studying this now. But they also have to find a way to engage the public sector, that is, the public health sector, the public education sector. That's not easy to do, because it's easier in a way just to be an NGO and go it on your own. But that's not going to be a long-term solution.

You became involved in these issues at such a young age. Going back to your childhood, where were you born and where did you grow up?

Paul Farmer: I was born in North Adams, Massachusetts, in the Berkshire Mountains, and I grew up mostly in Florida.

Didn't you spend a little bit of time in Alabama?

Paul Farmer: I did. I don't want to leave out Alabama. I lived in Alabama for a few years. I started elementary school there, in Birmingham.

What was school like?

Paul Farmer: I went to the public school in the neighborhood for the first few years, and then I went to a magnet school in fifth grade. It was really a great program. So I have all these very good memories of Alabama as well.

Could you tell us about your parents?

Paul Farmer: My parents met in North Adams, Massachusetts. My mother is from Williamstown, which is right around the corner, and my father was from North Adams. They met in college, in what used to be called Teachers College, where people train to become teachers. That's where they met.

What brought them to Birmingham, Alabama?

Paul Farmer: My father was looking for a job, and he had heard of something in Alabama. We were kids at the time, so we were not involved in the decision-making. And that didn't work, so he went back to teaching.

When you say "we" were kids...

Paul Farmer: I'm one of six kids, so it was the eight of us. I'm number two of six. I have an older sister.

When and why did the family then go to Florida?

Paul Farmer: It was a difficult time in that city. My father was a public school teacher, and he thought the environment was tense in Alabama, in the late '60s, early '70s. He just decided we would try again in Florida, so off we went.

As a kid in Birmingham, did you understand what your parents were trying to escape?

Paul Farmer: I didn't really sense too much of the trouble. I was eight or nine or ten years old. You're sheltered, even though you're in schools, so I wasn't alive to a lot of the tensions at that time, which were largely racial tensions around the civil rights movement. My father was a high school math teacher, and it was a difficult time for the United States. I think he wanted to shield his kids from that kind of tumult, so off we went to Florida, and I stayed there until I went away to college.

What kinds of things did you do in Birmingham, besides going to school?

Paul Farmer: Personally, as a kid? I was very interested in science and in reading. I was kind of a nerd. I was just doing what kids do in elementary school. I was going to school, hanging around with my brothers and sisters, spending time reading. I spent a lot of time reading.

Did you join clubs or Scouts or teams, or did you gravitate towards solo activities?

Paul Farmer: No, I didn't really gravitate towards solo activities so much.

Get the Flash Player to see this video. I did the whole sports teams. That was really not my bag, though. I really liked school work and reading a lot. I got really involved in reading in fourth -- fifth grade. That was really my escape, and what I liked doing most. But I was very gregarious. You live in a big family, with eight people around all the time, and you just, you become part of the social unit. Since my father was a school teacher, we had three months off. So he ended up buying a bus, which initially, we were going to go off in it. He made it into a camper. The first one he bought was a school bus. It looked like it was a yellow school bus. And he just literally spray-painted it and ripped out the seats and put in bunks. And so we would head off. We'd go to Massachusetts to see our grandparents. My father also went back to college to study more math at the University of Vermont. So we'd head up north, and then we got a bigger and better bus which was -- this is one of the ironies -- it was actually a bus used for screening tuberculosis. So it had an X-ray machine in the middle of it. I mean it seems bizarre that I would later become a tuberculosis doctor, but who knew then? I was only nine or ten. And the area where the X-ray machine -- they took out the X-ray machine, and that's where my father built bunks for the three boys. And then one year he just said, "You know what? We're not going to back to Birmingham. We're moving." And so we lived in the bus for years, eight people. So you asked about solo activities. Not too many when you're eight people in 28 feet of space.

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