In Conversation with Dr. Paul Farmer

I was very inspired by Haiti. I spent the better part of a year there before I went to medical school. So, I would put Haiti up there, but to go to Haiti, I had to be interested in Haiti. It sounds somewhat unglamorous to say I was inspired by a lot of the stuff I learned in college and I got very interested in a number of topics that I’m still interested in today. For example, migrant farm workers, you know, and many of them are Haitian, as I went to college in North Carolina. So, in college, and after, I just met inspiring people or read about them. Maybe they’re not around anymore, right, but you can still read about them. I don’t want to sound corny but, you know, since [it was just] Mother’s Day, living in a bus and feeding eight people every day and having a job at a grocery store, a crappy job, that’s pretty inspiring too. You don’t necessarily work that out as a kid. I’m not sure – I mean, Martin Luther King, Dorothy Day . . . I could go through that list.

I had mentors but I needed different and complimentary mentors. Like Victor Dzau. Arthur Kleinman was my PhD supervisor and I would not be a professor if not for him. Then I had a lot of mentors in Haiti and all the other places I went. Like Peru, there was Gustavo Gutierrez. I’ve written a book with him all those years later.

There were Haitians who taught me lot, you know, and it’s not like I don’t know their names; they’re not nameless people. I’ll give you an example. One of the patients in this film (Bending the Arc), that I didn’t make of course, his name is St. Ker François and he’s still a great friend to me. But, what he went through in the late 90s and when he was dying of AIDS and tuberculosis and then got the right therapies.  He’s still a spokesperson, not just for people living with HIV, he was elected later, or more recently actually – I think he’s the mayor of that little town. So, I mean, that’s pretty inspirational, right? He didn’t have a chance to go to high school and almost died leaving behind a wonderful family. But, he didn’t and he’s not just inspirational because he didn’t die, because of medical care, but he engaged in a fight on behalf of other people. Some of them he would never meet, on another continent.

I was just in Mumbai for the first time and I was seeing patients with an eminent Indian TB specialist named Zarir Udwadia. I find him very inspiring. I’ve known him for a long time and seeing him with his patients, on my first visit to Mumbai, was even more inspiring. So, being able to pick it up and you know, you have to be open to inspiration, of course. That’s how it’s worked for me.

The motivation part is not as interesting to me because you can’t really know someone’s motivations. I think it’s perfectly fine to say “Well, I want to help people.” What’s wrong with that, right? “I want to save the world.” What’s wrong with that? It’s in some ways so much closer and intimate – I’m referring particularly to the internet as a platform that did not exist when I was 22. But, the real fungible gift is really their enthusiasm. So, even if it were just enthusiasm, that would be great because the topics that we’re talking about; global health, which is really about global health equity as much as anything, it’s about disparities and addressing them. They need human attention, they need writers and managers and school teachers and the list goes on and on. The obvious part is they need health professionals who can deliver care and researchers.  But, whatever draws them, if it includes enthusiasm, then they might be back. Maybe they’ll go off and do something that seems unrelated, completely unrelated to global health, but really you can link almost anything into global health. So, if they remain enthusiastic then they kind of – they snared their part of it.

I think the most important thing is to remember that it’s not just for health professions, especially for undergrads or grad students who are not nurses or doctors or in nursing or medical school. But, the rest of it goes for everybody. I mean, these are human dilemmas, they’re not for experts to resolve alone because we know expertise changes and some experts aren’t interested in this big question of health disparities – [though] many are. Everybody should be involved in this and you don’t have to be a health professional. In addition to that, you can be doing just about anything and still make a contribution in some way even if it’s just almost a stance of solidarity or generosity around this project of addressing health disparities. Needless to say, basic scientists have a big role to play; they generate a lot of the tools that we use.

People in this country have a lot to contribute and I don’t mean just financially. You can’t do this work without staff and stuff and space and systems.  And it’s usually local staff – we try to train staff, meeting supplies, space, even if we have to build things from scratch, a teaching hospital in Haiti for example. And then some system – part of our system is to acknowledge that we work in places that are part of a global system that was historically constructed. You know, it does link us together and it also opens the door to a lot of unlikely partnerships. A lot of learning that can go on both ways. Like Canada can learn a lot from Rwanda and its health system. Certainly the United States can. So, that is pretty exciting, the idea that is not that old school model, top down, you know, a Colonial or post-Colonial model – it was something different and the students I think are excited about that too. They sense that, whether or not they choose to use those terms

I’m going to give just one example. But, first of all, imagine how many friendships we have because of Haiti with people who live in Montreal. Just this really freakishly wonderful example is the band Arcade Fire. Now they worked with us in Haiti but in 2007 or 2008, I never heard of Arcade Fire, I must be honest. But the lead singer, Régine Chassagne, born and raised here – her parents are Haitian. She identifies as Haitian but she’d never been, right? And they had already done things for us and remember I’m not just talking about a Dollar or a Pound of every concert ticket going to Partners in Health (PIH); they did that too. So, you can imagine as they became famous, what happened? Which is good. They also recruited a lot of students and activists to the cause so that at every Arcade Fire concert there would be a PIH table. I was just thinking, our emergency room in that same hospital in central Haiti; that was a Canadian who made it happen, Gary Slaight. Just one gesture. Then we’ve had faculty from Montreal institutions in Medicine, Nursing work together in Haiti because of these historical connections and linguistic connections. And I mean, that’s just for starters.

May 18, 2018