The first time I met Paul Farmer, I was in my last year of medical school and attending a conference in Havana, Cuba. He bought mojitos for some of the medical students and expressed interest in our careers in global health. I was young. I was studying clinical medicine and public health. I wanted to change the world. And here was this Harvard giant in infectious disease and medical anthropology invested and nurturing young minds. This was before Tracy Kidder’s book Mountains Beyond Mountains (required reading for all students interested in medicine) was published in 2003 and launched Paul Farmer to celebrity stratosphere status.
I had read his book Infections and Inequalities in which he proposed a provocative hypothesis that poverty and structural inequalities are at the fundamental foundation of the plagues that infect civilization. Most disease is preventable by looking at social determinants of health. And now, here we are, two years into a pandemic that has disproportionately impacted communities of color and the working poor living in densely populated, intergenerational homes while working public-facing, essential jobs without access to health insurance or sick leave. Farmer’s legacy must continue.
In my career working in Haiti, Guatemala, Honduras, Uganda, South Sudan, Democratic Republic of Congo, the Middle East, the Navajo Nation, and here on the streets of Santa Barbara, my ideological philosophies continued to intersect with Farmer’s. His books and lectures inspired me — the provocative, insulting, hypothesis that investing in nutrition, education, drinking water, access to basic health care, and human dignity ultimately results in better health outcomes. Treating people like human beings is good medicine.
Whether I was immersed in emergency humanitarian aid in conflict zones, participating in collaborative development projects, or working in a community emergency department, his name continued to emerge. Quoting Paul Farmer while sipping warm beer around the hurricane lamp after a grueling day in the hospital or clinic was a nightly ritual. He was my hero. He embodied the idea of the activist physician who heals sick patients at the bedside, educates students in the lecture halls, launches coordinated public health campaigns in the community, and influences policy in the world arena. He embodies the archetype physician I aspire to be.
Paul Farmer once visited Santa Barbara to speak at a UC Santa Barbara Arts & Lectures event. He gave a shout out to Doctors Without Walls — Santa Barbara Street Medicine (www.sbdww.org) as an example of local humanitarian action — a small group of conscientious philosopher healers who refuse to accept the realities of structural inequalities, and consistently show up to meet people where they are, to provide the highest standards of medical care. To have my hero give a glowing complement to our humble organization was magical. He gave me a copy of his book To Repair the World: Paul Farmer Speaks to the Next Generation with a note inside the cover thanking me for being part of our movement for change. We had a nice chat and compared notes on how to inspire students to go into humanitarian medicine and public health. He had this way about him of radical inclusion. We. Together. Me, him, all of his students, all of my students, would make our world a better place.
I learned on Monday that my hero has fallen. His watch is ended.
We live in a world that desperately needs heroes. Heroes are an endangered species in these uncertain times. Paul Farmer is the hero that all of us in clinical medicine can look to for inspiration. He had his flaws, like any mortal. He got wrapped up into Haitian politics more than he should have. He put his signature in places that in retrospect did not belong there. But he always tried, in good faith, to follow the science, invest in human potential, and try to make the world healthier, more just, and better. He invested in students. He recognized that the future leaders in health care will be the ones to solve the problems, and they should be nurtured and mentored.
I am indebted to the impact he has made on my career. I only met him twice. I read dozens of his books and articles. He left a mark. I am a better physician because of him. I quote him often to my students:
“The idea that some lives matter less is the root of all that is wrong in the world.”
“It is very expensive to give bad medical care to poor people in a rich country.”
“Human rights violations are not accidents; they are not random in distribution or effect. Rights violations are, rather, symptoms of deeper pathologies of power and are linked intimately to the social conditions that so often determine who will suffer abuse and who will be shielded from harm.”
“So I can’t show you how, exactly, health care is a basic human right. But what I can argue is that no one should have to die of a disease that is treatable.”
“For me, an area of moral clarity is: you’re in front of someone who’s suffering and you have the tools at your disposal to alleviate that suffering or even eradicate it, and you act.”
“The idea that because you’re born in Haiti you could die having a child. The idea that because you’re born in Malawi your children may go to bed hungry. We want to take some the chance out of that.”
“If you’re asking my opinion, 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.”
I recommend that every student who is interested in a rewarding career in medicine or public health start reading the works of Paul Farmer. We, who have been working in the trenches of pandemic for the last two years, are exhausted, burned out, and in need of heroes and inspiration. In his heroic career he cared for thousands of sick patients, trained tens of thousands of physicians, inspired hundreds of thousands of students. He sparked something important that we in clinical medicine have a moral responsibility to continue. Who is with me?
Jason Prystowsky MD, MPH is a Santa Barbara community emergency physician. The thoughts and opinions expressed in this article are his own and do not represent any organizations or institutions he is affiliated with. Thank you to all of those in clinical medicine, public health, first response, EMS, social work, education, mental health, law enforcement, community organizing, and public service. It is an honor to serve our community alongside you.