Biography: Paul Farmer
Founder, Partners in Health

Paul Farmer was born in West Adams, in Western Massachusetts, the second of six children. When he was seven years old, his father, a salesman and high school math teacher, moved the family to Birmingham, Alabama, and five years later, to Brooksville, Florida, a small town north of Tampa, inland from the Gulf of Mexico. Here, the elder Farmer found jobs teaching, and working with developmentally disabled adults.

Farmer has described his father as "a free spirit." When they moved to Florida, he housed his family in an old school bus he had converted into a mobile home, replacing the seats with bunk beds. He wired the bus with electricity, but it lacked running water. In the bus, the family of eight migrated from one trailer park to another. When the father decided to try his hand at commercial fishing, he moved his family to a houseboat in the Gulf. Tiring of fishing, the elder Farmer moored the boat in an undeveloped bayou called Jenkins Creek. The family bathed in the creek, and brought their drinking water back from Brooksville in jugs.

Despite his unconventional home life, he excelled in school. Both of his parents enjoyed reading serious literature to their children, and encouraged them to take an interest in the wider world. When money was short one summer, the family picked citrus fruit alongside Haitian migrant workers. This was Paul Farmer's first encounter with Haitian people and their Creole language. It would not be his last.

Paul was elected president of his senior class at Hernando High in Brooksville, and won a full scholarship to Duke University in Durham, North Carolina. At Duke, he explored a variety of science courses before concentrating on medical anthropology. He spent half a year studying in Paris, where he attended some of the last lectures of the influential anthropologist Claude Lévi-Strauss. Farmer returned to North Carolina fluent in French; his skill at acquiring languages would serve him well in the years ahead.

At Duke, Farmer discovered the writings of Rudolf Virchow, the 19th century German physician and scientist who founded cell theory and pioneered the practice of public health medicine. Virchow's approach, which encompassed biology, anthropology and politics, inspired the young Farmer. Events in the outside world had a profound influence on him as well. As Central America was ravaged by civil war, Americans were learning more about the doctrines of "liberation theology" which informed the Catholic clergy's resistance to the region's military dictatorships.

Although Farmer had been confirmed in the Catholic Church as a teenager, his religious instruction had not dealt with the issues raised by liberation theology, and its emphasis on what the Church calls the "preferential option for the poor." This doctrine regards a concern for the physical and spiritual welfare of the poor as an essential element of the Gospel. As some interpret the doctrine, the Christian's first duty on earth is to aid the least fortunate of his fellows.

Paul Farmer's attention soon turned to the migrant labor camps not far from the Duke campus, where a Belgian nun, Julianna DeWolf, was working with the United Farm Workers to improve the living conditions of the laborers who harvested tobacco in North Carolina's plantations. Through Sister Juliana, he came to know many farm workers, including a number of Haitian migrants. Their poverty made the circumstances of his own childhood seem luxurious, but the misery they had left behind in Haiti was even worse. Farmer was fascinated by their stories and began to learn everything he could about Haiti, studying the Creole language, interviewing migrant workers and reading scores of books about the island nation's tragic history.

After graduating summa cum laude from Duke, Farmer completed a brief postgraduate fellowship at the University of Pittsburgh. He applied to Harvard Medical School, one of two institutions in the country to offer a joint-degree program in medicine and medical anthropology. In the meantime, he traveled to Haiti, where he planned to spend a year working in public health clinics, mastering the Creole language, and learning more about the country, the poorest in the Western Hemisphere.

The island of Hispaniola, discovered by Columbus, is today divided between Haiti in the west and the Dominican Republic in the east. The nation of Haiti was founded at the beginning of the 19th century, after a revolt by African slaves against their French colonial masters. Independence was followed by nearly two centuries of poverty, dictatorship and exploitation. Intervention by foreign powers -- including a nearly 20-year occupation by the United States in the 20th century -- had protected foreign business interests, but done nothing to alleviate the poverty of the majority of Haitians. When Paul Farmer first arrived in Haiti in 1983, the country was enduring the second generation of dictatorship by the Duvalier family. François "Papa Doc" Duvalier -- followed by his son, known as "Baby Doc" -- ruled by terror, suppressing all opposition through torture and murder.

From the capital of Port au Prince, Farmer traveled into the countryside, where he met well-intentioned health practitioners starved for resources. The best-equipped facilities were inaccessible to the poor, and facilities for training local doctors, nurses and public health workers were completely inadequate. In the company of a Haitian Anglican priest, Fritz Lafontant, Farmer traveled to the island's central plateau, where Father Lafontant had established a school and a rudimentary clinic in the town of Mirabelais. Beyond Mirabelais, Farmer visited the arid village of Cange. Here he found a community of squatters, displaced by the construction of the Péligre dam project, living in squalid huts with dirt floors and bark roofs, with no access to clean drinking water, education or medical care of any kind. Malaria, tuberculosis and typhoid were rampant.

In Cange, among the poorest and sickest of the poor, Paul Farmer found his calling. These were the people who needed his help the most. Father Lafontant had started a school in the village, and Farmer resolved to build a clinic there as well, one that would treat all comers, regardless of their ability to pay, and that would train and employ local public health workers.

Farmer was still in Haiti when he received word that he had been accepted at Harvard Medical School. He would simultaneously pursue a medical degree and a doctorate in medical anthropology. He returned to the United States to enroll, but having completed the formalities, he took his study materials back to Haiti. For the next three years, he would commute from Cange to Cambridge, returning to Harvard for exams and laboratory practice. The experience he was gaining treating the poor and sick in Haiti was more instructive than any classroom lecture. Despite his long absences, his grades were among the highest in his class.

In his first trip to Cambridge, Farmer secured funding from a small medical charity called Project Bread to build a bakery in Cange, assuring a supply of wholesome bread, a first step in addressing the chronic malnutrition afflicting the region. Along with Father Lafontant and Ophelia Dahl, a young Englishwoman who had also come to Haiti as a medical volunteer, Farmer founded a community-based health project, known as Zanmi Lasante.

In 1985, Paul Farmer and his colleagues opened Clinique Bon Saveur, a two-room clinic in Cange. That same year, Project Bread's principal donor, Tom White, read an article that Farmer had written for a Harvard Medical School journal and asked to meet him. A Harvard graduate and World War II veteran, White ran a large construction company in Boston. White visited Farmer in Haiti and became convinced that Farmer's project was worth all the support he could give it.

Facing a coup by his own army officers, Haiti's dictator, François "Baby Doc" Duvalier fled the country in 1986. The military attempted to cling to power, but they soon faced a full-scale revolt from the suffering people of Haiti. At the same time, health care workers in Cange identified the community's first cases of AIDS. The disease was already pandemic in Haiti's urban slums. In the midst of this turmoil, Farmer set out to form a permanent charitable foundation to fund his work in Haiti. With Ophelia Dahl and his former Duke classmate, Todd McCormack, Farmer founded Partners in Health (PIH) in Boston, in 1987. Dahl would serve as President and Executive Director. Tom White contributed a million dollars in seed money. Another Harvard Medical School student, Jim Yong Kim, soon joined them. Like Farmer, Kim was an aspiring medical anthropologist with a particular interest in formulating effective treatment strategies for impoverished communities, and in negotiating with pharmaceutical companies for the best deals available.

In 1990, finishing his medical studies and earning a doctorate in anthropology, Dr. Farmer carried out a year's residence at Brigham and Women's Hospital in Boston. With his medical training and residence completed, Dr. Farmer was able to remain in Haiti for most of each year, returning to Boston for a few months at a time, sleeping in the basement of PIH headquarters. While in Boston, Dr. Farmer served as an attending specialist on the senior staff at Brigham and launched a program in Boston's inner city to contend with rising rates of HIV and tuberculosis.

Back in Haiti, Zanmi Lasante's operation grew, in only a few years, from a one-room clinic to a complete hospital with a nursing school, operating rooms, satellite communications and a blood bank. It serves a community of more than 150,000 people, trains and employs local personnel as community health workers, dispensing food, water, housing assistance, education and other social services. Farmer's innovative therapies were curing infectious diseases, such as tuberculosis, for a hundredth of the amount that treating the same disease would cost in a U.S. hospital. Farmer's achievement was recognized by the MacArthur Foundation in 1993 with a $220,000 "genius grant," which Farmer immediately donated to PIH to start a research program, the Institute for Health and Social Justice.

By the end of the decade, Zanmi Lasante had built schools, houses, communal sanitation and water facilities throughout the central plateau. It had vaccinated all the children in the area, dramatically reducing malnutrition and infant mortality. It had also launched programs for women's literacy and AIDS prevention. It has been particularly successful in combating the spread of AIDS in Haiti, one of the original flashpoints of the epidemic. By 1999, the rate of HIV transmission from infected mothers to babies in the vicinity of Cange was less than four percent, half the contemporaneous rate in the United States. Zanmi Lasante became a global model for delivering public health services. The World Health Organization adopted its methods for controlling AIDS in over 30 countries.

In Cange, the organization successfully suppressed an outbreak of drug-resistant typhoid by reforming the water supply. Although tuberculosis (TB) was still the leading cause of adult death in the rest of Haiti, TB fatalities were virtually eliminated in the region served by Zanmi Lasante. Farmer and Zanmi Lasante enjoyed particular success in treating multiple-drug-resistant tuberculosis (MDR-TB), a potent strain of the disease that has evolved, in part, because of the previous misuse of antibiotics in underdeveloped communities. After their success in Haiti, Farmer and PIH were asked to develop community-based health programs in Peru and Russia, when MDR-TB outbreaks appeared there. In Peru, PIH efforts to fight MDR-TB achieved an 80 percent success rate, better than that of U.S. hospitals.

Meanwhile, Paul Farmer was sharing his message in a series of books, including AIDS and Accusation, The Uses of Haiti, Infections and Inequalities and Pathologies of Power. Pulitzer Prize-winning author Tracy Kidder told the story of Paul Farmer and Partners in Health in his 2003 best-seller Mountains Beyond Mountains. Farmer's work attracted the support of philanthropists, including George Soros and Bill and Melinda Gates. In 2002, PIH received a $13 million grant from the Global Fund for improvements in the Cange complex. In 2005 the William J. Clinton Foundation funded a Partners in Health AIDS program in Rwanda. As of this writing, PIH has projects in Haiti, Lesotho, Malawi, Peru, Russia, Rwanda and the United States, and supports other projects in Mexico and Guatemala.

As Partners in Health has expanded its activities, Paul Farmer spends many of his days flying from country to country, monitoring new programs and raising funds for Partners in Health. The rest of the year, he lives in Boston with his wife, the Haitian-born anthropologist Didi Bertrand, and their three children. He heads the Department of Global Health and Social Medicine at Harvard Medical School, where he is the Presley Professor of Medical Anthropology. In August 2009, it was announced that the United Nations' Special Envoy to Haiti, former U.S. President William J. Clinton, had selected Dr. Paul Farmer to serve as Deputy Envoy.

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