Dr. Paul Farmer passed away earlier this week, working in rural Rwanda, doing what he loved most, which was teaching medical students and looking after patients. Paul was the co-founder of the organization where I work, Partners In Health (PIH), which provides access to health care for millions of people in under-resourced areas around the world.
One of the last patients Paul treated was suffering from an infection related to late-stage AIDS. Trying to save this young man, Paul consulted numerous doctors and specialists around the world, including Brian Remillard, a nephrologist at Dartmouth-Hitchcock Medical Center.
Paul treated this patient like all his patients, as if he were a family member, and so it was only natural that he would reach out to his vast network for ideas about how to solve this challenging case. Because he wanted the doctors at the Butaro District Hospital to absorb the learning, he copied them all in a WhatsApp thread, discussing possible interventions and therapies with Brian, who was back in New Hampshire.
Brian first met Paul in Haiti after the 2010 earthquake that killed more than 200,000. Brian had volunteered to go, knowing that there would be crush victims with renal failure, and so he procured a dialysis machine, packed supplies, and flew to Port-Au-Prince. Paul and Loune Viaud, who co-founded Zanmi Lasante, as Partners In Health is known in Haiti, met him at the airport. Brian remembers sitting with Paul on lawn chairs outside the badly damaged airport terminal for four hours: “Paul was texting the whole time, managing the entire country’s emergency medical activities on his Blackberry.” Brian later helped support the residency program at the University Hospital of Mirebalais, a 350-bed facility Paul and Partners In Health built in Central Haiti a few years after the earthquake.
As focused as Paul was on treating patients, his bigger goal was to train the next generation of health care professionals, whether he was in Rwanda, Haiti or at one of PIH’s other sites. He was tremendously proud of the residency program at University Hospital, which trained many of the Haitian trauma physicians who were on hand when another devastating earthquake hit Haiti’s southern peninsula last August.
Paul was equally proud of the University of Global Health Equity, which he helped establish with Drs. Agnes Binagwaho and Peter Drobac in 2014. In his last weeks, he was mentoring the university’s first cohort of medical students. Paul was on hand to celebrate their white coat ceremony, signaling the start of clinical rotations.
The last text Brian received from Paul just a week ago was a photo of a young woman in a new, white UGHE lab coat, one of Paul’s medical students: “Hey, get ready for your next gen nephrologists,” he wrote. Choking up, Brian told me that he wrote back, “looking forward to it!” just before telling his wife about his plans to help Paul set up a nephrology program in Butaro.
Brian and I worked together on another project in which Paul took a serious personal interest, an effort to save a critically ill Haitian patient who Brian treated at the University Hospital shortly after the earthquake last August. This patient, a young middle-school teacher with end-stage renal failure, needed extraordinary support, the kind of support that most hospitals in the Global South are unable to provide. When Paul learned about this patient and his exceptional needs, he made sure that Zanmi Lasante and Partners In Health were doing everything possible to get him what he needed. He texted us both from Rwanda, regularly, to check on our progress.
Paul’s last text to me from Rwanda was a reminder of why we had to save this patient: “This is such a big part of our mission. You know, an antidote to despair.”
As staff gathered earlier this week to remember Paul, one of his frequent refrains echoed in our heads, “The idea that some lives matter less is the root of all that is wrong with the world.” In an essay entitled Health, Healing and Social Justice, Paul wrote, “a truly committed quest for high quality care for the destitute sick starts from the perspective that health is a fundamental human right.” He believed that everyone deserved the right to be healthy, regardless of faith, ethnicity, or nationality, especially the poor. We are all drawing solace in knowing that he left us with a clear roadmap, and despite the magnitude of his loss, we are all determined to carry forward his legacy.
To learn more about Paul and Partners In Health, please visit www.pih.org.
Andy Wilson is Chief Development Officer at Partners In Health. He lived in Russia, Kazakhstan and Ukraine for 15 years, and he has been working in the international development field for more than 20 years. He holds a BA from Princeton University and an executive MBA from Georgetown University. He lives in Boston with his wife Vika.