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Although he no longer walks with us, Paul Farmer’s legacy is very much alive.
Farmer died on Feb. 21, at the age of 62, in Butaro, Rwanda, where he was teaching at the University of Global Health Equity, which he co-founded. He opened a path to the future of health equity by pioneering a practice of medicine for those most in need that combines world-class clinical care with a holistic and deeply moral dimension to preventing illness.
The approach, which is based on social science research, also promotes wellness and takes into account the social, cultural, economic, and environmental context of each individual, a type of medicine that promises to serve as a crucial benchmark for all who seek to build a healthier, more just world.
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That was the central message of a daylong event at Harvard University’s Sanders Theatre on Oct. 1 that combined a memorial program and an inaugural academic symposium to celebrate Farmer’s life and work and honor his pioneering achievements.
Farmer was the Kolokotrones University Professor and chair of the Department of Global Health and Social Medicine in the Blavatnik Institute at HMS, chief of the Division of Global Health Equity at Brigham and Women’s Hospital, and co-founder and chief strategist of Partners In Health.
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Faculty, colleagues, students, mentees, and friends of Farmer looked to his words and deeds for guidance into how to continue the work to which he had dedicated his life. The event, organized by Harvard Medical School, was open to the public. A video will be available soon.
The day began with a memorial program celebrating Farmer’s accomplishments as a doctor, a scholar, an educator, and a leader who helped launch a growing movement to build community-based, global-scale solutions for an equitable, human rights-based approach to health care.
While Farmer was a great light that shined across the world, each person has that same light within, noted Emmanuel Akyeampong, the Ellen Gurney Professor of History and of African and African American Studies at Harvard University and minister for worship and formation in the Harvard Memorial Church.
“Let us leave here resolute that our light will drive away the dark shadows of despair wherever our feet may carry us,” said Akyeampong, who delivered the opening and closing remarks at the memorial.
Harvard University President Lawrence Bacow welcomed Farmer’s family, colleagues, friends, students, other members of the community in attendance, and those who joined from around the world via livestream. Bacow spoke of Farmer’s impassioned commitment to the value of every person, no matter where they lived or under what circumstances, as a powerful inspiration.
“My time with him was a gift that I will treasure forever,” Bacow said. He noted that there is a Jewish tradition that holds that each generation includes 36 people whose righteousness justifies the existence of the world. While the identity of those 36 righteous individuals remains a secret unknown even to themselves, Bacow said, Farmer was a candidate for inclusion.
“Paul, I believe, was a person who walked among us for a time to remind us that none of us travels alone,” Bacow said. “We proceed through life alongside one another, and every step that we take together, as individuals and through the institutions we build, should bring us closer to our ideals.”
The program also included personal reflections from Farmer’s colleagues, family, mentors, students, and friends, including Bryan Stevenson, founder and executive director, Equal Justice Initiative; Bill Gates, co-chair, Bill & Melinda Gates Foundation; and Jim Yong Kim co-founder, Partners in Health and former head of the World Bank and of the HMS department of global health and social medicine.
Farmer’s wife, Didi Bertrand Farmer, spoke about the deep sense of loss her family and Farmer’s closest friends shared not only with each other but with the many people around the world who have been touched by Farmer’s work. When news of Farmer’s sudden passing spread in Haiti, Bertrand Farmer’s native country, many people used a common expression spoken to mark the passing of a pillar of the community, a Creole phrase that means “a great, sacred tree has fallen.”
Farmer, who was widely known for his love of trees and gardening, spent many hours over the years planting trees around the world. Farmer also planted the seeds of a better future in the clinics and educational programs he founded, the lives he saved and shaped, and the many friends and students he left behind, Bertrand Farmer said.
“While we all mourn our great tree that has fallen, we take great joy at all the others that have grown up tall around it,” Bertrand Farmer said.
Paul Farmer
The speakers shared memories of many different aspects of Farmer’s work. He was a physician who saw patients in their homes in remote mountain villages, built community health clinics from the ground up, and formed deep, lasting relationships with community members, local leaders, and members of national ministries of health and international organizations to establish and strengthen health systems, the speakers recalled.
George Q. Daley, dean of Harvard Medical School, highlighted the importance Farmer placed on the types of research, education and service that are possible at universities and academic medical centers that strive for equity and justice. Daley noted that Farmer was adamant that research universities like Harvard “must re-orient their centers of gravity to support global health as a core value and practice — not as an ancillary pursuit.”
“To live up to Paul’s vision, we have a major task in front of us — a responsibility to see patients, all patients, as people with complex sources of pain and suffering,” Daley said.
He introduced members of Farmer’s family (including his sister Peggy Farmer and Farmer’s daughter Catherine Farmer), and friends, (including senior and junior faculty members, students, and trainees, and leaders from Harvard and from HMS’s affiliated hospitals). All took turns reading excerpts from Farmer’s writing.
Following a lunch break, the program continued with an academic symposium exploring several of Farmer’s key intellectual contributions to the fields of social medicine, global health, and moral philosophy.
Salmaan Keshavjee, a professor of global health and social medicine in the Blavatnik Institute at HMS, opened the symposium with a telling episode. He said he and Farmer were sitting in the shade of a tree in a cultivated space outside of a clinic in Haiti, and Keshavjee commented to Farmer that it was nice for the patients to have a comfortable place to sit while they waited. Farmer said that he had planted the trees when the clinic was built specifically with the idea of providing future patients with shade.
“It was part of the plan from the beginning,” Keshavjee recalled.
That kind of long-term thinking, working today to build success for tomorrow, was a hallmark not just of Farmer’s gardening, but of all his work, Keshavjee said, noting that one way of thinking of Farmer’s profound intellectual contributions across many fields was to consider them as another of his elaborately planned, patiently cultivated gardens.
And while it’s tempting to focus on the trees and gardens that Farmer planted, of which there were many, Keshavjee said, Farmer wasn’t just planting trees, he was also diligently working to change the very soil so that entirely new ecosystems could grow and thrive.
Farmer’s 17 books and hundreds of articles and chapters are “the soil of a verdant garden that has instilled in so many a desire for equity and a desire to build an entirely different moral ecosystem,” Keshavjee said.
Over the years, the speakers noted, Farmer’s work made concrete differences in the way care is delivered to people in underserved communities where he and his partners worked. But Farmer also reshaped the way physicians, governments, nonprofits organizations, social movements, scholars, and educators everywhere think about what is possible in global health while highlighting the crucial connection between the social sciences and successful health care delivery.
The afternoon program featured three panel discussions, each focused on one of the crucial academic contributions Farmer made. The first examined how Farmer made the concepts of structural violence and health equity central to global health research, in a way that aimed to challenge the social structures that perpetuate violence against women, children, ethnic minorities, the poor and other populations.
The second panel examined how Farmer used tools from anthropology and other social sciences to reconnect medicine and care delivery with the social context.
The third panel explored the foundations and implications of Farmer’s moral philosophy of health care, which called for care to be distributed based on need and on the dignity of each human being.
Throughout the day, many speakers noted that while Farmer’s academic work focused on the complex interplay between clinical care, public health, and the broad spectrum of social forces.
Megan Murray, Ronda Stryker and William Johnston Professor of Global Health at HMS, examined Farmer’s life and work through the lens of Isiah Berlin’s essay contemplating ancient Greek poet Archilochus’s observation that a fox knows many things, but a hedgehog knows one big thing.”
While at first glance, Farmer might seem like a quintessential fox, dancing from discipline to discipline to weave ideas together irreverently. He pioneered cutting edge care delivery for complex diseases in resource poor settings, he designed hospitals, planted gardens, she said.
“If knowing many things makes one a fox, Paul was as foxy as they come,” Murray said.
But a closer look, Murray contended, revealed in Farmer a hedgehog-like dedication to a single big idea.
“The one great thing that Paul knew was the power of accompaniment,” Murray said.
Originally Farmer used the term to refer to the act of sharing the lives of the people he was caring for, often literally walking along with them on their journey through life.
Eventually, Murray said, Farmer adapted the concept to include all of the important aspects of his life: breaking bread with family and friends, building relationships between great universities and community health organizations, and mentoring students, all the while bringing these disparate actives and sometimes-siloed academic fields together to serve the singular purpose of improving the lives of the sick and the destitute, Murray said.
Farmer himself often said that the core principles at the heart of the work of global health equity were simple and straightforward.
One of Farmer’s quotes — read by Wilfredo Matias, an infectious diseases fellow at Massachusetts General Hospital and a mentee of Farmer’s — captures the notion plainly:
“I would argue that a social justice approach should be central to medicine and utilized to be central to public health. This could be very simple: the well should take care of the sick.”
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