Health As A Birthright

Dr. Paul Farmer improves treatment among the poor in blighted regions

Haiti is one of the world's poorest nations, and one of the sickest. Some 80% of the population is illiterate, the average life span is less than 50 years, and half its children die by age five. But Dr. Paul Farmer has proven that it doesn't have to be that way. In 1984, while still a student at Harvard Medical School, he founded

Zanmi Lastane, a clinic in Haiti's desperately impoverished central plateau. There he showed that the health of a population can be significantly improved through such basic interventions as replacing straw roofs with tin, delivering clean water, and providing community-based health care. He also came up with a novel and affordable method for treating multidrug-resistant tuberculosis and AIDS that developing countries around the world have adopted. Farmer and the Boston-based nonprofit he started, Partners in Health, have since established similar clinics in Peru, Siberia, and, most recently, Rwanda.

The 46-year-old doctor regularly challenges the world's policymakers to view health care as a basic human right, rather than a luxury available only to those who can afford it. "Social inequalities, where they exist, relate to who gets care and who does not," says Farmer. His mission "is less about assisting the distant needy and more about repairing a broken world."

In 1993, Farmer won a MacArthur "genius" award for his innovations in treating the poor. He gained greater fame three years later when author Tracy Kidder wrote a book about him, Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World. Kidder portrays a man whose sense of purpose was bred into him at an early age. He and five siblings were raised by unconventional parents in a converted school bus with no running water on Florida's Gulf Coast, where they were taught to be self-sufficient and open-minded. Paul won a scholarship to Duke University and spent summer breaks picking fruit alongside Haitian migrant workers. The experience inspired a lifelong love of that nation and its people.

The summer before starting medical school, in 1983, Farmer flew to Haiti with the vague notion that he would try to do some good. Over the next six years he spent far more time in Haiti than in the classroom, setting up the Zanmi Lastane clinic -- and still managed to graduate from Harvard at the top of his class, simultaneously receiving an MD and a PhD in anthropology. He is now on staff at Brigham & Women's Hospital in Boston but continues to devote most of his time to Haiti and other developing nations.

Early on, Farmer determined that the island nation would be best served with community-based solutions to its health problems. That meant, for example, training local residents as doctors, technicians, and outreach workers who could diagnose and treat their neighbors. It meant using standard drugs to treat TB, but with close observation to make sure the patient sticks to the regimen. Through dogged campaigning, Farmer eventually got the World Health Organization to endorse this method.

Haitians working with Partners in Health built and equipped hospitals, operating rooms, labs, and schools. And Zanmi Lastane expanded from one small building into a health complex that now includes a primary school, surgery wing, 104-bed hospital, women's clinic, and a pediatric care facility.

Farmer's newest focus is Rwanda, still recovering from years of war and genocide. Working with the Clinton Foundation, Partners in Health has started training health-care workers, reopened a hospital, and improved the treatment of people with AIDS and TB. "We are committed to doing whatever it takes" to improve health care in Rwanda, he says. First, it takes Paul Farmer.

By Catherine Arnst

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