Remembering Dr. Paul Farmer

Dr. Paul Farmer, a Harvard-educated doctor who devoted his life to serving the health needs of the poorest, most remote, and sickest of the world, died of an “acute cardiac event” earlier this week at a hospital in Rwanda he had helped establish. He was 62 years old. He was a huge hero of mine.

Dr. Paul Farmer, co-founder Partners In Health

The term “saint” gets thrown around pretty easily at times to describe people who seem to be perfect in a moral/religious sense. That’s a tough standard, and I don’t think many people, especially actual saints, can live up to the idea of being perfect.

As Fr. James Martin has written, the canonized saints have been egotistical, difficult, impatient, struggle with their faith, and struggle with the world. Saints can also have a sense of humor about themselves and their responsibilities. They have not led blameless lives. What they have done is devoted their life to carrying out God’s will the best they can.

Fr. Martin writes that Dorothy Day, founder of the Catholic Workers Party, is in the early stages of being considered for sainthood and might seem like an unlikely candidate. She got pregnant out of wedlock and had an abortion. She later had a common-law husband with whom she had a child. But what mattered most in her life was her devotion to the lives of the poor and the church’s commitment to them. That was how she directed her life after an adult conversion to Catholicism. She saw her call to “work among the poor and marginalized in the big cities.”

In my mind, Dr. Paul Farmer, who died at age 62 earlier this week, was a saint. He was far from perfect. He was egotistical, impatient, and demanding. But he also insisted that people who were poor or lived in remote areas still deserved high-quality medical care for difficult diseases like HIV/AIDS or drug-resistant tuberculosis. He co-founded  Partners In Health, a non-profit designed to build sustainable clinics in the poorest, most under-served areas.

I first learned about Farmer from Tracy Kidder’s book Mountains Beyond Mountains that told of Farmer’s campaign to bring care to the hardest to serve – people living in the mountains of Haiti or in Russian prisons. Kidder’s book got started as an article for The New Yorker 22 years ago called “The Good Doctor” that has been a staple for years for my feature writing class. As an example, Kidder tells of Farmer treating a young man with AIDS in a remote area of Haiti:

“My situation is so bad,” the young man said. “I keep injuring my head, because I’m living in such a crowded house. We have only one bed, and I let my children sleep on it, so I have to sleep under the bed, and I forget, and I hit my head when I sit up.” He went on, “I don’t forget what you did for me, Doktè Paul. When I was sick and no one would touch me, you used to sit on my bed with your hand on my head. I would like to give you a chicken or a pig.”

When Farmer is relaxed, his skin is pale, with a suggestion of freckles underneath. Now it reddened instantly, from the base of his neck to his forehead. “You’ve already given me a lot. Stop it!”

In another case, Farmer was working with a sick teen-aged girl:

A thirteen-year-old girl with meningitis had arrived by donkey ambulance. The young doctors on duty hadn’t done a spinal tap, to find out which type of meningitis, and thus which drugs to give her. “Doctors, doctors, what is wrong with you?” Farmer said. Then he did the tap himself. Wild cries from the child: “Li fe-m mal, mwen grangou.” Farmer looked up from his work and said, “She’s crying, ‘It hurts, I’m hungry.’ Can you believe it? Only in Haiti would a child cry out that she’s hungry during a spinal tap.”

Farmer routinely worked in clinics serviced by a “donkey ambulance” – literally sick people brought in by donkey. Not where you would expect to see someone with a Harvard medical degree and doctorate in antrhopology and two faculty appointments at major US universities.

In a remembrance of Farmer for the New York Times, Kidder wrote:

Paul’s basic belief was that all human beings deserve equal respect and care, especially when they are sick. His dream, he once told me, was to start a movement that would refuse to accept, and would strive to repair, the grotesque health inequities among and within the countries of the world. When I first met him — in Haiti, in 1994 — he had already created a growing health care system in a desperately impoverished area. I thought he’d done a lot already. Now, looking back, I realize that he was just getting started.

When Farmer was a medical intern, he would sometimes get his paycheck and immediately sign it over to an AIDS patient who was in danger of becoming homeless. He did not come from a wealthy family and by normal standards, he could not afford to do this. But Farmer says he was never in any danger of going homeless himself by giving away his pay. There was always be someone who could loan him money. (You can view this whole conversation between Farmer an Kidder that aired on C-SPAN back in 2003 in the video embedded below.)

Farmer was, as I mentioned at the beginning, far from perfect. Kidder told wonderful stories about his impatience with the world. He could be harsh toward those who weren’t trying hard enough, who were cutting themselves too much slack.

Little sleep, no investment portfolio, no family around, no hot water. On an evening a few days after arriving in Cange [Hatie], I wondered aloud what compensation he got for these various hardships. He told me, “If you’re making sacrifices, unless you’re automatically following some rule, it stands to reason that you’re trying to lessen some psychic discomfort. So, for example, if I took steps to be a doctor for those who don’t have medical care, it could be regarded as a sacrifice, but it could also be regarded as a way to deal with ambivalence.” He went on, and his voice changed a little. He didn’t bristle, but his tone had an edge: “I feel ambivalent about selling my services in a world where some can’t buy them. You can feel ambivalent about that, because you should feel ambivalent. Comma.” 

This was for me one of the first of many encounters with Farmer’s use of the word comma, placed at the end of a sentence. It stood for the word that would follow the comma, which was asshole. I understood he wasn’t calling me one—he would never do that; he was almost invariably courteous. Comma was always directed at third parties, at those who felt comfortable with the current distribution of money and medicine in the world. And the implication, of course, was that you weren’t one of those. Were you?

Farmer was responsible for one of my favorite concepts/catch phrases – one that has spread throughout my family: the “H of G.” Kidder writes:

“An H of G” was short for “a hermeneutic of generosity,” which he had defined once for me in an e-mail: “I have a hermeneutic of generosity for you because I know you’re a good guy. Therefore I will interpret what you say and do in a favorable light. Seems like I’m the one who should hope for as much from you.”

The H of G says that we should always be looking for the best in people or a situation, even if it isn’t necessarily earned.

I must admit I have felt inadequate trying to write about Farmer. He was such a complex character who demanded so much of himself that his actions serve as a challenge to us. Kidder admits that he was at one point reluctant to write about Farmer because he knew it would challenge his own privileged life. “I knew if I followed this guy around, it would disturb my peace of mind.”

Fr. Martin did not call Farmer, a devotee of Catholic liberation theology, a saint, but it was his writings that convinced me that this funny, prickly, demanding doctor was emphatically one. In a prose poem/prayer, Martin writes:

Help me to believe that your Spirit can do anything: raise up saints when we need them most, soften hearts when they seem hardened, open minds when they seem closed, inspire confidence when all seems lost, help us do what had seemed impossible until it was done.

If Farmer hadn’t done the things he did, it would have been easy to call them impossible. I know that Farmer would have been uncomfortable being called a saint. He was just doing what he needed to do, comma…

Click on this image to view a C-SPAN book talk by Tracy Kidder and Dr. Paul Farmer.