What We Can Learn From Paul Farmer

11 minutes ago
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Paul Farmer was a doctor who spent his whole life trying to get poor people the same quality of health care that rich people get. He didn't just talk about it either. He grew up without a lot of money himself but still went to Duke University for college, and then got both a medical degree and a PhD from Harvard. Instead of taking a cushy job afterward, he went to Haiti and started treating people with little to no access to doctors. In fact, in 1987, he helped start an organization called Partners In Health with a couple of friends, and they built hospitals and clinics in places like Haiti, Peru, and Rwanda. By the time he passed away in 2022, Partners In Health was working in more than 12 countries and treating millions of people.

A lot of people treated him like some saint. There's even a book about him called Mountains Beyond Mountains by Tracy Kidder that makes him sound perfect. He wasn't perfect by any means, and he probably wouldn't have wanted people treating him like a legend either. But that's not the most important thing about him. What matters more is how he thought about problems because there are some real lessons in that for anybody.

The first lesson is that too expensive doesn't always mean impossible. In the 1990s, most experts said that treating drug-resistant tuberculosis in poor countries cost too much money and wasn't realistic. The medicine was expensive, and the treatment took a long time. A lot of people just assumed poor countries would have to settle for cheaper, less effective options. Farmer and his team ignored that advice and treated patients the right way in Peru. It worked so well that, according to Partners In Health, their "community-based MDR-TB treatment program sees an 80 percent cure rate, inspiring the World Health Organization to revise its treatment recommendations." In other words, he proved the experts wrong by just doing the thing they said couldn't be done, and then the World Health Organization itself had to change its advice. That's a good lesson for anyone: sometimes what’s not realistic really just means nobody has tried hard enough yet.

The second lesson is about showing up for people instead of just doing what's easiest, and this is what we always hear when growing up. Paul trained regular people from local communities, called accompagnateurs, to check on patients and make sure they were taking their medicine every single day. That takes a lot more time and effort than just handing someone a prescription and hoping for the best. It also costs more money and more staff. But it worked way better because he was solving the real problem. The real problem usually wasn't just the disease itself, it was things like how underserved populations were not being able to get to a clinic, not trusting doctors, or not having anyone to remind them to take medicine on schedule. Farmer built his whole system around fixing those problems.

That leads into the third lesson, which is that you don't always need some fancy degree to be an expert on something. Farmer trusted lots of people without medical training to do important work because they knew their own neighborhoods better than any outside doctor ever could. Partners In Health says these workers are "recruited from their communities," which is really the whole point. The people closest to a problem usually understand it best, even if they don't have the credentials to prove it on paper. If you're trying to fix a problem at a school, a job, or in a neighborhood, the people who actually deal with that problem every day probably have better answers than someone looking at it from far away.

But there's also a harder lesson here, and it's not as inspiring. Farmer worked extremely hard himself for decades, flying constantly between countries, barely sleeping, and spending very little time at home with his own family. People who knew him worried about his pace for years before anything actually happened. He died suddenly on February 21, 2022, at age 62, while he was in Rwanda teaching at a university he had helped start. Harvard Medical School said he died "in his sleep from an acute cardiac event," and it was covered by major news outlets like the New York Times too. I don't think the lesson here is "work yourself to death for something you believe in." If anything, it shows why burning yourself out isn't good even if it's for a good cause.

It's also fair to say his way of doing things wasn't perfect for every situation. It takes a lot of money and staff and time to do health care the way he did it. Some experts think that approach is too slow for emergencies where you need to help huge numbers of people fast, like during a disease outbreak that's spreading quickly. Farmer would probably say that it doesn't matter, that every single person still deserves real high-quality care no matter what it costs or how long it takes. His approach worked amazingly well for the people he helped directly, and it changed a lot of policies for the better. But it might not be the right model for every crisis everywhere, especially ones where speed matters more than anything else.

At the end of the day, Paul Farmer's story isn't really about him being some perfect hero who never made mistakes. It's about someone who refused to accept "that's just how it is" as a good answer, who actually listened to the people he was trying to help instead of assuming he knew best, and who pushed himself way too hard trying to do it all himself. There's a lot to learn from all of that, both the good parts and the harder parts, and you don't have to be someone special to do it.