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Appreciation

With Paul Farmer’s passing, the world has lost the gift of a rare man

Paul Farmer enjoyed a moment of singing and dancing in the HIV day-care center at Partners in Rwinkwavu Hospital in rural Rwanda in 2008.Eric Neudel for The Boston Globe/The Boston Globe

Paul Farmer was a Harvard medical student working in Haiti in the 1980s when he was dispatched to the Port-au-Prince airport to pick up Tom White, a successful Boston businessman who had come to look at one of his causes, Project Bread. White had been asked to build a community oven in Cange, a rural slum, so women would not have to walk 10 miles each way to buy bread.

White was 64, 40 years older than Farmer, who viewed the wealthy capitalist with some skepticism. Farmer, recalling the meeting many years later, said of White: “He was wearing bright checkered golf pants, red and other offensive colors, and some sort of golf shirt, and he had on a hat.”

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On the ride to Cange, Farmer peppered White with “all sorts of inappropriate questions a 24-year-old should not be asking a potential donor,” as Farmer later put it. How do you feel about unions? Who did you support in the last presidential election? And he was impressed with the answers: pro-union, and voted against Ronald Reagan.

Farmer was also impressed by White’s reaction to the grinding poverty he saw, and a lifelong partnership, and friendship, took root. “The inspiration for Partners In Health was born right then and there,” Farmer said. In 1987, PIH was established with a $1 million donation from White, whose construction business built Foxboro Stadium, the Charles River dam, the Park Plaza Hotel, and many other projects around Boston.

Farmer fell in love with Haiti – and with the daughter of one of his Haitian doctor friends. He and Didi Bertrand married and had three children. They moved to Rwanda when Partners In Health agreed to partner with the Rwandan government and its health ministry after the country was left in ruins following the 1994 genocide. In 2008, the Globe sent me on a reporting mission to Rwanda and I was lucky enough to spend some time with Farmer on his projects. He and Didi had a 10-year-old daughter, Catherine, a 6-month-old daughter, Elizabeth, and Sebastian, 2 months old.

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Elizabeth had been abandoned at Rwinkwavu Hospital as a newborn, and Didi, who was pregnant at the time, called and asked her husband if they could take her in. Of course they would. Rwinkwavu had been built by Partners In Health, along with other clinics in the most remote, impoverished pockets of the country.

I rode with Farmer in his Toyota pickup truck over roads that were little more than pot-holed paths. He wore a loud African print shirt, sewn by a grateful patient. Partners In Health’s services are free. “In Haiti they give me potatoes and carrots,” Farmer said. In Rwanda, it was often a homemade tidbit. Rwanda is the most densely populated country on the African continent, and one of the poorest.

From his truck, the landscape was grim: mud huts with dirt floors, no electricity, water or toilets. But Rwanda is called “the land of a thousand hills,” and the terraced mounds in the distance were green and beautiful. One of the first things Farmer did at all the Partners clinics was to build a fish pond, which he and his brother – a former professional wrestler – dug themselves and stocked with koi. “It’s about providing dignity and something of beauty to the poor,” he said.

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At Rwinkwavu, Partners included a malnutrition ward and a center for children with HIV/AIDS. I remember people lining up to speak to Farmer at his truck window, and he was patient with all of them, even though he was anxious to do his hospital rounds. Farmer loved the practice of medicine and insisted on staying hands-on, even though he was juggling so many projects in so many countries.

At Rwinkwavu, Partners also loaned land to farmers with HIV/AIDS so they could feed their families. PIH built a training center for medical workers in Rwanda and a dorm for visitors. Partners was also the biggest employer in the area, with its iconic “accompagnateurs,” or community health workers who check on homes and make sure meds are taken and food is available. “Good things happen when you create jobs,” Farmer said.

From the truck, he introduced me to a man whose father and brother were killed, and their home destroyed, in the Rwandan genocide. Partners In Health hired him, and Farmer was the best man at his wedding. “I gave him a cow as a gift,” Farmer told me. “It’s traditional for the best man.” The man jumped in the truck and we headed to an even more remote Partners clinic in Rukira. (Farmer insisted on Partners going into the most hopeless places that have no health care.)

At Rukira that day, he saw a patient who was raped and bayoneted during the genocide and was HIV-positive. He examined babies and toddlers, spoke to their mothers, and was disturbed by a listless child whom he suspected had tuberculosis. “Tell her the boy looks good,” he told the translator. “I don’t want her to panic.” She had already lost two babies to disease. Sometimes in Rwanda, Farmer would treat a victim of a land mine or a hippo bite.

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Farmer told me that his goal was to expand the Partners model to all 27 districts and 9 million residents in rural Rwanda, in partnership with the Ministry of Health and the Clinton Health Access Initiative, which PIH has worked with since its beginning. “We want to be an organization that says yes,” he said. That was 2008, and he figured the work in Rwanda would take at least 10 more years.

“I go to bed worried about all the promises we’ve made,” Farmer said. “And I get up each morning thinking we haven’t made enough promises.”

A few years ago, after having lost touch with Farmer, I e-mailed him asking if he could possibly help someone I’d heard about in Mali. The man, a driver for a human rights organization, had been shot and could no longer walk or support his family. He needed medical care but was afraid of the authorities. Farmer’s PIH had a quasi-affiliate in Mali, and the man got his treatment, and his life back. That’s who Paul Farmer was. The world has lost the gift of a rare man.

Bella English is a former Globe reporter and columnist.

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