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Fri May 17, 2013
Paul Farmer's Vision for Health
Humanitarian doctor Paul Farmer explains how global health is rooted in community. Read his recent Atlantic article about the Rwandan health recovery here.
- Paul Farmer: co-founder of Partners in Health, professor at Harvard and Harvard Medical School, winner of a MacArthur Genius Grant, and author of “To Repair the World: Paul Farmer Speaks to the Next Generation.”
In 1987, a young doctor named Paul Farmer co-founded Partners in Health to help some of Haiti’s poorest residents.
Since then, Partners in Health has expanded all over the world, from Mexico, to Kazakhstan, to Peru. And as Partners in Health has grown, Paul Farmer has continued his devotion to caring for those who might never get quality medical care.
In 1994, the genocide in Rwanda captured Farmer’s attention. The tragedy inspired him to visit the country and do what he could — help minimize the spread of tuberculosis and infectious disease.
“The idea that a million people could be killed in 100 days, I just thought it couldn’t possibly be true — and it was true,” he remembers. “I had a lot of reasons I wanted to go there, and I finally did, and my colleagues at Partners in Health were on board. It has been one of the most wonderful experiences of my life to see the rapidity of that turnaround.”
In Rwanda, Farmer continued the model that Partners in Health first developed in Haiti. Over the decade that he has worked there, the country has implemented community-based insurance, created clinics that provide the bulk of health care, and trained members of the community to be health workers. The results have been dramatic — Rwandan life expectancy has doubled since the 1994 genocide, and mortality rates have dropped sharply.
Such improvements have moved many, including former President Bill Clinton, to call Partners in Health’s methodology innovative. But Farmer shrugs off the praise.
“The idea that it’s somehow innovative to serve the poor is kind of sad, right? Because it’s not a new idea,” Farmer says.
Commitment to Community
Partners in Health’s work in Rwanda is indicative of the change it hopes to promote worldwide. Today, innovations in preventative medicine, diagnostics, and treatments are developing in tandem with changes in information technology. But despite these exciting changes, Farmer says, one stubborn problem remains the same: access. Impoverished communities suffer from the inability to access existing medicine and technology. Farmer hopes to change that.
“But if we can build really strong delivery systems so that we have an ability to reach people who are in need … then [when there are new medical innovations] we’ll be able to deliver them,” he explains.
As in Rwanda, Farmer promotes strengthening health care delivery by supplementing care from physicians with care by community health workers. These local deputies can help improve patient outcome by supporting individuals through the treatment process — ensuring that they take their medicine in between visits to a clinic, for example. Farmer believes this supplementary care can be vital in treating AIDS, epilepsy, diabetes and other chronic illnesses prevalent in developing countries.
He points to a Johns Hopkins study focusing on the treatment of AIDS, a disease in which patient outcomes corresponded with patient affluence. When researchers focused on facilitating medical delivery to poor AIDS patients, they found they were able to erase the gap in outcome almost entirely.
“[It’s] a very powerful reminder that these are not some God-given, natural outcomes, that they are amenable to being addressed by improving our health care delivery system,” Farmer says.
Farmer also stresses the importance of a long-term commitment to a community. Government funding and nonprofit involvement is often sparked by major events, like the Haitian earthquake of 2010. But Farmer argues that remaining in the community after normalcy returns, or training members of the community to maintain services in your absence, is essential to effect real change.
“A lot of NGOs and charity groups who came down [to Haiti] after the earthquake, they’re gone,” he says. “And these are problems that take a decade, two decades to address. So this ADD approach to foreign assistance is not really the right one.”
And with work in health care, there is no “mission accomplished” — only evolution. Farmer has seen child mortality, death during childbirth, and tuberculosis mortality shrink over the decade he has worked in Rwanda. But in their place, new problems emerge. Partners in Health now treats more patients with diabetes, mental illnesses, and other chronic diseases. It’s the persistence of medical issues that makes health care a compelling problem we should all be invested in, Farmer argues.
“I think it’s everybody’s business,” he says. “It’s kind of like climate change. I wish I could discipline myself to find out more, and know what every citizen of the planet ought to know, because it’s not someone else’s problem. And that’s how I think of health care equity. It’s maybe even the ranking human rights problem of our time.”
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