As condolences and accolades continue to pour in since the death of Paul Farmer, leaders of the global health organization he cofounded are looking to the future with Farmer’s characteristic mix of optimism and pragmatism.
Dr. Joia Mukherjee, chief medical officer at Partners in Health, doesn’t hesitate, not even for a beat, when asked about the roadmap for the global nonprofit after the sudden loss of its iconic leader last week.
“There is no post-Paul era in Partners in Health,” Mukherjee said. “We all embody Paul and his teachings.”
And those teachings, which aim to bring health care to the most impoverished corners of the world, provide a blueprint to press forward, including plans for expansion.
Farmer, 62, died Feb. 21 in Rwanda from an apparent cardiac event while sleeping.
When Mukherjee joined Farmer in the late 1990s, the nonprofit was about a decade old and employed barely 200 people, mostly in Haiti. Now it has a staff of more than 18,000 in 11 other nations, including Peru, Rwanda, and Mexico. Adhering to Farmer’s mission of solidarity with those marginalized, the vast majority of staff is local to the countries where they are working, said Mukherjee, an associate professor in the Global Health Equity division at Brigham and Women’s Hospital. Farmer, in one of his many roles, was chief of that division.
In the weeks before he died, Farmer had been teaching in Rwanda at the University of Global Health Equity, a school launched in 2019 by Partners in Health. The school pairs medical training with education in human rights and social justice.
“It was the first time the medical students, who started two years ago, are doing their clinical rotations, and Paul wanted very much to be with them in this first period and inculcate them with the principles he cared so deeply about,” Mukherjee said.
“In many places, when you practice medicine, that’s when cynicism creeps in because you are tired, or overwhelmed, or you do not have enough nursing care,” she said. “But the idea of still focusing on the needs of the patients and still having joy in that, that’s what Paul wanted to be modeling for these young students.”
The nonprofit plans to build another school like the one in Rwanda. Partners opened a 300-bed University Hospital in Haiti after that country’s devastating 2010 earthquake. While it is a teaching hospital, there is no accompanying university, long a dream of Farmer’s.
“We built the University Hospital without the university and people would say, ‘There is no university here,’ and Paul would say, ‘Not yet,’” said Mukherjee. “We all feel that will be a very important piece of unfinished business we need to bring to fruition.”
Just as Partners in Health looks forward to continued growth, Farmer’s admirers share Mukherjee’s confidence that his mission will carry on.
“There’s no one like Paul. But that’s all right because he’s brought so many people along,” said Dr. Arthur Kleinman, a Harvard professor of medical anthropology who supervised Farmer’s PhD studies and considered him like a son.
Farmer’s “great contribution,” Kleinman said, was to make morality practical. He combined a steely commitment to human rights with a pragmatic ability to work with many different people to carry out his vision.
Partners in Health is fundamentally different from many other global health nonprofits, Kleinman said. “They go somewhere, they stay. They learn the language and become part of the people. And they train the next generation,” he said
Farmer inspired people to believe that everyone has a right to health care and that it can be delivered to even the poorest of the poor, said Allan Brandt, a professor of the history of medicine at Harvard Medical School who knew Farmer since 1984.
Farmer merged the fields of medicine and public health, arguing that providing the world’s most advanced medicines to people who don’t have clean water doesn’t accomplish much, that health care needs to include social and community supports, too. He also showed it was possible to bring quality care to the most remote places, whether delivering HIV medications to sub-Saharan Africa or treating drug-resistant tuberculosis in Peru, Brandt said.
“What Paul did was to create a structure that’s not really dependent on any single individual,” Brandt said. “Everybody has rededicated themselves to this approach to public health and global health.”
The organization Farmer cofounded has deep roots and long branches, with countless disciples now carrying on the mission far beyond Partners in Health, said Dr. Louise Ivers, head of Global Health Equity at Massachusetts General Hospital. Ivers worked at the nonprofit from 2003 to 2018.
“Paul was radically inclusive of his notion of global health,” she said. “It didn’t matter what specialty you were in, from architect to building contractor to nurse to community health worker. As far as Paul was concerned, there was a place for everyone in the fight for health equity and justice.”
Dr. Bisola Ojikutu, executive director of the Boston Public Health Commission, said that Farmer had been her mentor at the Brigham’s Global Health Equity Division. She embraces the Partners in Health model for teaching community members and then relying on them to help reach marginalized neighborhoods. She said the city worked with community coalitions during the pandemic to help build trust in COVID-19 testing and vaccines.
“If you know that supporting community coalitions works well, then we need to make sure that they’re part of the system,” she said. “It is building and emphasizing the need for the professionalization of that model, making sure that people feel like they really are part of the health care workforce, it’s building capacity, [and] it’s paying them.”
Farmer’s vision now has its own Twitter hashtag: #paulspromise.
This promise, said Lisha McCormick, chief executive of Last Mile Health, involves the belief that “the world is not just the way it is. We made it this way. We can change it. We can make it different.”
Last Mile Health, based in Boston, works with the governments of five African countries to train community health workers who bring care to remote areas. The agency was among numerous groups whose missions were shaped by Farmer’s views, McCormick said. He served on their advisory boards, where he relentlessly pushed the notion that “no life is worth more than any other life” and that it was possible to bring care to everyone.
Ten years ago, McCormick said, in a discussion of equity, “the question folks would have asked would have been ‘why?’”
Farmer’s legacy, she said, is that “people are not asking that question anymore. They’re asking, ‘how?’”
Or as Kleinman, Farmer’s PhD supervisor, put it:
“Now it’s the responsibility of a lot of people to carry [Farmer’s vision] forward. That’s going to be work for generations to come.”