Paul Farmer: Building a Health Care Movement
ANN ARBOR, Mich.---Paul Farmer charmed a packed Rackham Auditorium Feb. 12, telling funny stories and witty asides while defending the cost of treating HIV patients in Haiti and Rwanda and challenging research universities to do more outreach to communities.
Farmer, co-founding director of Partners In Health, was the special guest at a lecture sponsored by the Ross School of Business and the William Davidson Institute. In addition to nearly filling the 1,100-seat auditorium, Farmer’s talk – “Building a Health Care Movement: From Haiti to Rwanda” – also drew large crowds to eight locations around campus, Ann Arbor and Detroit to view the live video feed.
Sporting khakis, a blue blazer and a new blue-and-gold striped tie for the occasion, Farmer knew about the university’s “obsession with football” so he decided to kick off his talk with his “Tom Brady story.” Farmer met the former Michigan quarterback and three-time Super Bowl winner backstage at a concert a while back. The two talked, with Brady quizzing Farmer on his work.
Finally, Farmer - a world-renowned medical anthropologist and physician but no sports fan - asked Brady, “So what is it you do?” After the laughter at Rackham died down, Farmer admitted that he feels “more comfortable at a university where I don’t make egregious errors like that.”
Farmer, the subject of the New York Times bestseller, “Mountains Beyond Mountains” by Pulitzer Prize-winning author Tracy Kidder, talked first about his work in Haiti. He has worked in the Caribbean island nation since 1983, living in a squatter’s settlement.
Partners In Health (PIH), an international charity organization that provides direct health care services and undertakes research and advocacy activities on behalf of those who are sick and living in poverty, now works in nine regions across the country and ranks as one of the largest nongovernmental health care providers in Haiti. It is also the only provider of comprehensive primary care, regardless of ability to pay, for more than half a million impoverished people living in the mountainous Central Plateau.
He recalled the day he returned to Haiti after attending an HIV/AIDS conference in Vancouver where researchers announced a new effective HIV therapy had been developed. The Haitians asked Farmer when they would get the new drugs. It took two years.
Farmer’s group had been promised some money to rebuild a clinic and begin dispensing anti-retroviral (ARV) drugs. But when the money didn’t come right away, PIH took out a bank loan and rebuilt the clinic on time.
This decision likely saved many lives, including a man named Joseph. Farmer showed a photo of the severely emaciated man, his body wracked with HIV and tuberculosis (TB). Joseph “had given up,” Farmer said.
But he convinced Joseph to take the new medicine. Within six months, Joseph had gained weight and was healthy again. Farmer showed a photo of a smiling Joseph, who now speaks at PIH events about his transformation.
“He’s just no longer sick,” Farmer said, “he’s involved in our efforts to prevent HIV infection.”
Farmer took issue with medical journal articles that said it was more cost effective to prevent HIV than treat it.
“What is the cost of inaction? What is the cost of morale on your staff of not having these medications?” Farmer asked. “Are we really good at measuring cost?”
PIH’s success in Haiti led to invitations from several African countries. “I said we couldn’t in good conscience say yes unless we found partners,” Farmer said.
PIH, with help from the Clinton HIV/AIDS Initiative and private donors, began working in two rural districts in Rwanda in April 2005 to launch HIV care and treatment. In a 2006 Fortune magazine article, former President Bill Clinton predicted that Farmer would one day win a Nobel Peace Prize.
When they arrived in Rwanda, the first hospital they were sent to had doctors, an X-ray machine, and was clean. When he told the government health ministry officials that they could handle rougher conditions, the officials found a more dire location for his work.
“There are moments where you wish you kept your mouth shut,” Farmer said with a smile.
He showed slides of the rundown facility, with blood and graffiti left on the walls from the genocide. He then showed photos of the refurbished clinic, freshly painted wards and a lush green entrance.
“Rwanda is a very inspiring place,” Farmer told the crowd. “With the right help we knew what to do. Rebuild this place. Train local people to do the work as we had done in Haiti. Take care of the sick from the beginning and it can’t be for one disease or two like tuberculosis.”
He also had before-and-after photos of a patient they treated for HIV and TB. Like Joseph in Haiti, John’s ribs and bones protruded from his skin. A few months after treatment at the PIH clinic, John sported a round belly.
“He went from Skeletor to someone needing a little Lipitor,” Farmer joked. “I have to talk to him about losing that gut.”
But Farmer said even with thousands of great transformation stories like John’s and Joseph’s, some think treating HIV is too expensive and a “gold-plated model.” But he said cost analysis shows it is no more expensive than prevention measures.
Farmer then challenged research universities like Harvard, where he teaches, and U-M to do more. He showed how the budgets at each university are heavily tilted towards research and teaching. A small sliver of money is allocated for service.
“Teaching and research are noble vocations but it’s very difficult to intervene effectively if we don’t have a major service component,” Farmer said.
He said while there are new resources to fight HIV, the old bottlenecks still remain.
“There is no system in place to deliver these deliverables without community health workers,” he said.
To end his talk, Farmer showed two final images. The first was of schoolchildren in Kenya, most of whom have lost their parents to AIDS. Farmer said a friend asked why there weren’t more AIDS orphans in Haiti.
“I said, ‘Because we take care of their mothers,’” Farmer said.
These days, Farmer said, the question about the cost of inaction can be asked. Twenty years ago “we could ask about what the cost is of this epidemic, what’s the cost of poverty. Now at least we have some of the tools we need.”
The final image Farmer showed was a map of Africa drawn on a chalkboard at the same Kenyan school. Under it the teacher had written “Save” in big letters, which Farmer assumed meant “don’t erase.”
“Of course I saw something very different,” he said, “and I’m sure you will too.”
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