Who Lives, Who Dies: The Remarkable Life and Untimely Death of Dr. Paul Farmer

"Who Lives, Who Dies: Reimagining Global Health and Social Justice" was the title of a talk delivered virtually at the University of Hawaii on February 17th by renowned public health physician Dr. Paul Farmer. He was speaking from a hospital in Rwanda that he helped build along with Partners in Health, the global non-profit organization he co-founded in 1987. Paul Farmer talked of his life's work transforming healthcare systems worldwide, where too often access to care is reserved for the wealthy while the poor are left to die. With characteristic humility, he described healthcare as a human right and his years of what he called "pragmatic solidarity" in scores of countries. The clinics and hospitals he developed in the world's poorest regions have saved patients from tuberculosis, HIV, Ebola, cancer, and more. Four days after giving his talk, Paul Farmer died in his sleep, of an acute cardiac event. He was 62 years old.

Paul Farmer argued that equal access to healthcare was blocked by the neoliberal concept of healthcare as a commodity to be bought and sold.

"We are gutted by this loss," Dr. Joia Mukherjee, chief medical officer for Partners In Health, said on the Democracy Now! news hour. "Just a deep, deep sorrow, a sorrow for the whole world... he combined a very fierce intellect with just an absolutely expansive heart and generosity and a real enthusiasm and joy for service and fellowship that was unparalleled. At the same time, he had impossibly high standards--high standards for medicine, that everyone should get a very First World care, that there is no First, Second, and Third World, high standards for dignity."

Paul Farmer had an unorthodox upbringing, living with his parents and siblings in a converted bus in Florida. After college, he spent a year in Haiti, where he committed to helping Cange, one of Haiti's poorest communities. The people of Cange were destitute, driven from the region's most fertile valley after it was flooded for a hydroelectric dam to provide power to the capital, Port au Prince.

"I teach students, so I tell them, 'Look, you never know what's going to happen,'" Paul Farmer said on Democracy Now! in 2008, on one of the dozen times he appeared on the program over the years. "It was really a series of serendipitous accidents. I met a Haitian priest, and he was working in a nearby town, and he told me about this squatter settlement where people were living in lean-tos. He was focused on education and said, 'Look, you're going to be a doctor. Why don't you come and be part of this?' And so, that was 25 years ago..."

Paul Farmer argued that equal access to healthcare was blocked by the neoliberal concept of healthcare as a commodity to be bought and sold. He also spoke and wrote extensively on how health disparities are deeply rooted in racism and colonialism.

Who lives and who dies is too often determined by social station, by racism, by histories of colonial rule, by gender inequality. This can be countered and has been and will be when we come together to build a progressive social justice movement.

In his most recent book, published in late 2020, "Fevers, Feuds, and Diamonds: Ebola and the Ravages of History," he reflected on his experiences as a frontline physician responding to the 2014-2016 Ebola outbreak that struck the West African nations of Guinea, Sierra Leone, and Liberia.

"What European colonialism didn't bring to the region was health care," he wrote. "For centuries, a stream of commerce has moved commodities--initially, slaves and gold, and then rubber, iron ore, oil, bauxite, hardwoods, diamonds and more--from West Africa to the Americas and Europe... the natives, especially in the three most Ebola-affected countries, are still caught up in the aftermath of extractive colonialism."

He was also a fierce critic of health disparities here in the United States. In December 2020, he said on Democracy Now!, reflecting on how hard the U.S. had been hit by the coronavirus pandemic, "We are facing the consequences of decades and decades of underinvestment in public health and of centuries of misallocation of funds away from those who need that help most. All the social pathologies of our nation come to the fore during epidemics. During a pandemic like this one, we have shown the rest of the world how badly we can do."

Paul Farmer ended his University of Hawaii talk last week by describing a group photo recently taken at the Rwandan teaching hospital from where he spoke. He was pictured along with Rwandan medical students:

"I hope this image leaves you with some of the hope that I feel in part from working in places where, who lives and who dies is too often determined by their social station, by racism, by histories of colonial rule, by gender inequality, and that this can be countered and has been and will be when we come together to build a progressive social justice movement that reaches far from wherever we may live."

Paul Farmer, rest in peace and power, and may your work continue.