Paul Farmer

Eight people lived in an old school bus his father had converted into a house, parked in Brooksville, Florida, and later on a houseboat in the Gulf of Mexico while his father fished commercially. There was very little money and a great deal of reading — the parents read serious books aloud to the children. Farmer went to Duke as a Benjamin N. Duke Scholar and came out in 1982 summa cum laude with a degree in medical anthropology, then went to Haiti and started volunteering at a hospital at Cange, on the Central Plateau. He was 23. Harvard gave him an M.D. and a Ph.D. in anthropology by 1990, but he kept going back to the plateau the whole way through, which set the pattern for everything after.

Partners In Health began in 1987 with four other people and money from a Boston contractor named Thomas J. White. Its Haitian arm, Zanmi Lasante, put a hospital at Cange and then schools, houses, clean water and latrines around it, and drove mother-to-child HIV transmission down to 4 percent — using paid community health workers drawn from the villages themselves, which was Farmer's real invention. The model went to Carabayllo in Peru for drug-resistant tuberculosis, then to Russia, then to Rwanda, where the University of Global Health Equity opened at Butaro in 2015 and admitted its first medical students in 2019. In 1999 the World Health Organization put Farmer and Jim Yong Kim in charge of building global programmes for multidrug-resistant TB. Harvard made him a University Professor on December 17, 2010.

The orthodoxy he attacked was arithmetic. Through the 1990s the settled position in global health was that treating drug-resistant tuberculosis in poor countries cost too much per life saved to attempt. Farmer treated it anyway on the outskirts of Lima, and then went after the price of the drugs. By 2001 the World Health Organization was announcing cuts of as much as 94 percent on second-line medicines. He named the underlying condition structural violence, and argued that cost-effectiveness settles in advance whose life is worth the money. He was not always on the right side of the argument he had built. In February 2022 he signed a letter to the Harvard Crimson defending a colleague accused of sexual harassment, then asked to withdraw his name after students filed suit. He was dead before the month was out.

He died in his sleep of an acute cardiac event on February 21, 2022, at Butaro, in the Rwandan hills where his newest hospital and his medical school stood. He was 62, about 8,000 miles from the town he was born in. Partners In Health now works in 10 countries and did not fold when he did, which was the test of whether he had built a man or a method. Tracy Kidder's Mountains Beyond Mountains, published in 2003, became a standard assignment on college and medical-school reading lists, and has probably recruited more doctors than anything Farmer wrote himself. The University of Global Health Equity is still graduating physicians at Butaro, a few hundred yards from where he died.

Paul Farmer's life against the full span of the corpus.

• Partners In Health company
  Now working in 10 countries 1987
• AIDS and Accusation: Haiti and the Geography of Blame book
  His anthropology dissertation, turned outward 1992
• Infections and Inequalities: The Modern Plagues book
  The case that epidemiology is a social question 1999
• Pathologies of Power book
  Where he set out structural violence at length 2003
• University of Global Health Equity company
  Butaro, Rwanda — first medical students admitted in 2019 2015
• Fevers, Feuds, and Diamonds: Ebola and the Ravages of History book
  On why the West African epidemic killed where it did 2020

• 1982 aged ~23 Graduates from Duke summa cum laude in medical anthropology
• 1983 aged ~24 Starts volunteering at the hospital in Cange, Haiti, at 23
• 1987 aged ~28 Founds Partners In Health Funded at the start by the Boston contractor Thomas J. White.
• 1990 aged ~31 Completes an M.D. and a Ph.D. in anthropology at Harvard
• 1993 aged ~34 Receives a MacArthur Fellowship and puts the money into a research institute
• 1999 aged ~40 The World Health Organization puts him and Jim Yong Kim on global drug-resistant TB
• August 2009 aged 49 Named United Nations Deputy Special Envoy for Haiti under Bill Clinton
• December 17, 2010 aged 51 Made a Harvard University Professor The highest honour the university gives its faculty.
• February 21, 2022 aged 62 Dies in his sleep at Butaro, Rwanda, at 62

• Bill Clinton b. 1946
  42nd president whose centrist politics, economic agenda, and impeachment shaped the post-Cold War era. served under him as UN deputy special envoy
• Bill Gates b. 1955
  Co-founder of Microsoft who, through the Gates Foundation, has donated billions to global health and education. funded the tuberculosis work
• Atul Gawande b. 1965
  Surgeon and writer who popularized surgical checklists and led global health work at USAID. Harvard colleague and fellow writing physician
• Anthony Fauci b. 1940
  Physician-scientist who shaped federal responses to HIV/AIDS, emerging infections, and the COVID-19 pandemic. counterpart in American epidemic policy
• William Osler 1849–1919
  Built bedside clinical teaching into American medical education as a founding Johns Hopkins professor. the bedside tradition he worked in