Paul Farmer, the physician, anthropologist and visionary leader of the American non-profit organisation Partners in Health (PIH), defied sceptics who said poor countries are “health deserts”. Forging partnerships between governments, academic institutions and philanthropists, he made it possible for even the poorest communities to have world-class hospitals and astonishingly successful health programmes.
Farmer, who has died suddenly aged 62, co-founded PIH in 1987 and led its work in 12 countries, including Haiti, Rwanda, Peru and Sierre Leone, with 18,000 staff. A passionate believer in social justice and building local capacity, he said medical treatment is not enough if people are sick because they are starving and destitute. He said PIH had to be “the house of yes”, working with government partners to build wraparound care that met both short- and long-term needs, from cash so patients could buy food, to community health workers, sanitation, hospitals and schools.
Farmer’s ambition to found PIH was sparked while living in Haiti aged 23. Having studied anthropology at Duke University, North Carolina, he was working for a Haitian charity before going to Harvard medical school. It was a country scarred from centuries of exploitation, poverty and colonial rule. Following the construction of the Péligre Dam in the centre, displaced families were living in camps with little food, sanitation or running water, at the mercy of malaria, TB and typhoid. Spending time in this region, in the village of Cange, Farmer was appalled and wanted to set up a decent medical service.
In Haiti and later at Harvard, Farmer discussed his ideas with kindred spirits, Ophelia Dahl, then volunteering in Haiti, his Duke University friend Todd McCormack and fellow Harvard medic Jim Yong Kim, who became his co-founders of PIH. The project received a huge fillip when the Boston philanthropist Tom White read an article Farmer had written. White offered $1m funding, and in 1987 PIH began.
By now Farmer was a medical student. He would cram his studies into four days and fly on a Thursday night to Cange in Haiti (sometimes with medicines begged from the Harvard dispensary in his suitcase) to treat patients in the tiny clinic funded by PIH, which was the only medical centre for miles. Central to its success was a network of community health workers who could hike into outlying settlements and check up on patients at home.
After qualifying in 1990, Farmer worked his way up to become chair of global health and social medicine at Harvard Medical School and chief of global health equity at Brigham and Women’s hospital in Boston. Wiry, tall and always working at a furious pace, throughout his career he combined teaching and treating patients in Boston with writing books and continuing to provide the road map for PIH.
The organisation grew exponentially from the 1990s, helped by partners that included governments, corporations and charitable organisations such as the Gates Foundation. In addition, every time Farmer won an award (such as the “genius grant” of $200,000 in 1993 from the MacArthur Foundation) he funnelled it into PIH.
For decades Farmer was in perpetual motion, flying from country to country, furthering PIH’s projects. His ambitions to bring quality healthcare to Haiti culminated in the state-of-the-art university hospital in Mirebalais in 2013. In the recent earthquake in 2021, the first responders were the new cohort of doctors and nurses trained at Mirebalais.
In Peru, Farmer desperately wanted to tackle TB. It had come into sharp focus when in 1995 his friend the Catholic priest Jack Roussin died of a drug-resistant form of the disease contracted while living and working in the country. PIH set up programmes to help TB patients in Peru, with a success rate of 83%.
It expanded its remit in that country to run programmes in mental health, HIV and maternal and child health.
At an Aids meeting in New York, Farmer met Dr Agnes Binagwaho, later Rwanda’s health minister. As a result, PIH was invited to help rebuild Rwanda’s healthcare system, which had been wiped out by the genocide in 1994, and worked in the country from 2005. Some of the world-class initiatives included vaccinating 93% of girls against cervical cancer in record time, opening the Butaro Cancer Center in 2012 and creating the University of Global Health Equity.
Farmer faced one of his biggest challenges when he visited west Africa in 2014 to organise the fight against Ebola in Liberia, Sierra Leone and Guinea. He documented this fast-moving episode in his 2020 book Fevers, Feuds, and Diamonds: Ebola and the Ravages of History.
He wrote a dozen books and was the subject of a 2017 documentary film, Bending the Arc. His story was first told in Tracy Kidder’s book Mountains Beyond Mountains: One Doctor’s Quest to Heal the World (2003).
Farmer was born in North Adams, Massachusetts, the second of six children. His father, also Paul, was a teacher and his mother, Ginny (nee Rice) worked in a supermarket. They were a family of free spirits, encouraged to take risks and follow their dreams, which were all quite different; his younger brother Jeff, for example, became a professional wrestler. When Paul was seven, the family moved to Alabama, but, disliking the racist politics there, they moved on to Florida. Their home was a bus, which originally had been a mobile TB clinic, and for a short time they lived on a houseboat.
He went to school in Brooksville, Florida, before winning a scholarship to Duke University. He spent a summer in Paris, where he became fluent in French, and read the work of Rudolf Virchow and became fascinated with epidemiology and public health. While he was at Duke, Farmer met a nun, Sister Julianna, who was working with Haitians employed in the tobacco plantations and he became interested in their history. After he graduated in 1982, it seemed natural to visit Haiti while he waited to go to medical school.
Farmer’s long association with Haiti was further strengthened when he married Didi Bertrand, a Haitian medical anthropologist, in 1996.
He pushed himself constantly, always concerned there was another patient to treat, another paper to write. He died in his sleep from a cardiac event, after a day teaching students in the hospital he helped build in Butaro, Rwanda.
Farmer is survived by Didi and their three children, Catherine, Elizabeth and Sebastian; his mother, Ginny; his brothers, James and Jeffrey; and his sisters, Katy, Jennifer and Peggy.
• Paul Edward Farmer, physician and anthropologist, born 26 October 1959; died 21 February 2022
