Reviews | For Paul Farmer, the poor come first
Farmer was a beacon in the sense that he showed the way – but from afar, ahead of him. He was smarter than most of us. Raised by an eccentric father who repeatedly housed his family in a converted school bus and on a boat anchored in a bayou, he earned a full scholarship to Duke University. He became a Harvard University Professor, the highest honor bestowed on faculty members, and received honorary degrees from several of North America’s most venerable universities.
What’s more important is Farmer’s use of his intelligence gift. Moved by the experience of befriend and working alongside Haitian migrants during his unconventional youth and his undergraduate years, Farmer trained as a doctor and opened a clinic on Haiti’s central plateau. With colleagues, he founded Partners in Health (PIH), a transformational organization that puts the humanity of the poor at the center of its work.
Stop there for a moment, please. One way for humans to deal with suffering is to put psychic space between us and the afflicted. We could say that people are poor because they are deficient in some way, lack initiative, creativity, or good parents – or simply lack luck. We could say that people are sick because they lack discipline or hygiene – or, again, they are unlucky.
Farmer and PIH insist that those who suffer are no different. Societies are structured in a way that thwarts them, and if the structure is changed, they will thrive. Curing physical illnesses without attempting to restructure society in a liberating way is insufficient, even inhumane.
In this vision of God’s creation, the poor are not an afterthought. They come first. To borrow the language of the movement, there is “a preferential option for the poor”. Liberating those who suffer from structural oppression is God’s first—preferred—choice: “The last shall be first,” as Jesus explains in the Gospel of Matthew.
A preference for the poor meant, in practical terms, that Farmer did more for his patients than he could have if he treated Harvard students and professors, for example. In poor communities, it is not enough to open a clinic and wait for patients to come through the door. Medical providers must break down the structures that prevent poor people from accessing care.
As PIH itself explains: “A mother cannot undergo cancer care and lose her job without receiving economic support. A tuberculosis patient cannot stand strong drugs on an empty stomach. And a patient with symptoms of covid-19 cannot take public transport to get to her local testing site. A patient may need food, money, child care and a car ride before the drugs or surgery are worth anything.
Farmer’s work has produced tangible results that he has documented in dozens of peer-reviewed articles in leading medical journals. Partners in Health has grown rapidly, adapting its programs to the specific needs of communities. For example, in the Navajo Nation, which covers parts of New Mexico, Utah and Arizona, PIH has identified poor diet as a major health issue. The economic structure of the region needed to change to create access to more nutritious food.
The solution: Navajo Nation clinics now write “prescriptions” for fresh fruits and vegetables. When grocery stores and trading posts “fill” prescriptions, they are reimbursed by Partners in Health, just as pharmacies are reimbursed for pills. Community health workers offer the same recipes and encouragement wealthy families receive from neighborhood juice bars, personal trainers and subscriptions to cooking magazines.
A tenet of liberation theology is that the shepherd lives among the flock. This is how Paul Farmer was not in Cambridge, Mass., but in a district hospital in Rwanda when his vast and demanding heart broke on February 21. He was only 62 but far ahead of the peloton. He stays there in front, beckoning the world to follow him.