No one was expecting Dr. Paul Farmer to leave us as soon as he did. He spent his final weeks doing what he loved in a place he loved dearly—teaching medical students at the University of Global Health Equity in northern Rwanda, a world class institution reimagining health education to transform how healthcare is delivered across the globe.
Outside of the classroom, Paul would spend his days going on rounds with medical students just across the valley at Butaro Hospital. To Paul, there was no difference between the value of his life versus the value of the lives of the patients he saw in any one of the hospitals he visited regularly around the world. He never for a second believed that he was more important than the patients he saw, their caretakers or the nurses who cared for them tirelessly day in and day out. In his words, "The idea that some lives matter less is the root of all that’s wrong in the world.”
Due to the preciousness of healthcare, Paul saw that much of the world viewed it as a privilege versus the right that it is, and he did everything he could to change the status quo ever since he first witnessed the harmful reality which such a misconception could cause for the world’s most vulnerable communities.
He passed away in a building in northern Rwanda that may not have been constructed without his unrelenting Paul-like self which inspired him to float seemingly impossible ideas into the universe and then tell his closest friends and colleagues how they were going to make it happen. In July 2014, a few years before opening the medical school in Rwanda, Paul hiked with his daughter and a group of his colleagues up the valley across from Butaro hospital, stopped at the top, and said, "We will build it here.” Just like that, with such conviction that no one questioned the notion’s feasibility. Paul simply did not believe anything was impossible when it came to equitable access to quality healthcare and education.
In January 2019, thanks to the Government of Rwanda, Joyce & Bill Cummings, Melinda & Bill Gates, and other supporters and dedicated staff, the University of Global Health Equity (UGHE) opened with a ceremony attended by Paul’s dear friend, His Excellency President Paul Kagame, and many others. Over the course of that weekend, Paul wept tears of joy, and he continued to shed a tear or two every time he came to the university to teach the growing student body over the years.
When Covid-19 hit the following year, Paul and fellow Partners In Health (PIH) co-founders reached out to Massachusetts Governor Charlie Baker floating another idea which could have seemed impossible to many given the state of the pandemic. While others were exploring digital contact tracing solutions, PIH made the recommendation for states across the US to invest millions of dollars in order to create armies of contact tracers to accompany patients by calling every single Covid-19 patient to ensure they had the resources–from food to temporary housing–to follow public health guidelines, just as PIH would recommend when responding to Ebola in West Africa or tuberculosis in Lesotho.
To Paul, whether you live in Boston or Monrovia, there was no difference in the required public health response and very rarely (if ever) was it a solution that did not involve a human connection to accompany patients to their recovery no matter where in the world they lived. In his words, "Somebody needs to say to people who are worried and not feeling well, ‘We got you. If this is Covid-19, we got you. And we’ll look out for your contacts, your spouse, and your children.’”
Governor Baker agreed and led the charge; from there, PIH trained thousands of contact tracing staff–including me, in my role as PIH’s Deputy Director of MA Covid Response–to help establish the Contact Tracing Collaborative in partnership with the State of Massachusetts, encouraging other states to follow suit. I still cannot fathom what this initiative, not to mention the diverse team which came together nearly overnight, was able to accomplish during one of our lifetime’s most trying periods. Listen to any account from the contact tracers and you can see the powerful impact which contact tracers had in caring for those with Covid-19 in the state of Massachusetts.
Paul Farmer joins Munyah Karvah and Esther Clark, along with PIH’s Remy Ntirenganya Pacifique and Katie Letheren in the newly constructed hospital dispensary.
Paul never underestimated the value of human connection. He did not cross paths with anyone without seeing them and letting them know that he truly saw them, without holding their hand and bringing them in. As the medical school grew over the years, so did the student body, yet Paul always knew and addressed every student by name whether in the classroom or later that evening in the dining hall. This is why millions right now are mourning the loss of not just a mentor and a visionary leader, but a friend. Paul provided us with a roadmap to be able to do something about the gross injustices in the world transforming feelings of helplessness into effective action, and this is why so many, including myself, are so incredibly grateful for Paul.
Whether fighting for global health equity or social justice, Paul was not afraid to be emotional. He loved everyone and maintained such joy and optimism that you could feel this a mile away as he passed through the halls of any PIH-supported hospital around the world. At J.J. Dossen Memorial Hospital in rural Liberia, where Partners In Health worked with the ministry during the 2014 Ebola outbreak to help strengthen health institutions over the long term and where I first met Paul, he would pause at the bedside of a patient, reviewing treatment plans and teaching the staff for hours while holding the patient’s hand. When he left Liberia for Rwanda, Haiti, Boston or wherever he was going next, his attention to seeing that patient’s case through did not stop when his plane took off. He would message with the staff for weeks or months until the patient improved or, sadly, passed away, always devastating Paul. He saw every patient as a sister or daughter, a brother or son, a mother or father.
And now, from the hillsides of Rwanda and Haiti to the streets of Boston and San Francisco, we are mourning the loss of a dear friend and mentor while trying to figure out what to do next.
Paul passed us all the torch. We feel it more than ever, through recalling encounters with Paul, reading his many works, working on the movement for global health equity, and crossing paths with others he inspired.
When in the presence of Paul, the contagious energy that filled the air was always palpable, and this can be felt in the thousands of remembrances which have been published around the globe since his passing on February 21, 2022. He never lost hope, even in the face of the countless deaths he witnessed over the years, and similarly, Paul would not want us to lose hope over his passing which came as a shock to all that knew and loved him.
When others saw horror, Paul saw room for optimism. At a Time Global Health Summit on November 1st, 2005, Paul gave a talk entitled "The Case for Optimism” and in it he shared the following:
"According to a U.N. study published last month, "More than 500,000 women died from complications related to pregnancy or childbirth in 2000, but 99% of those maternal deaths were preventable.” If you’re looking for optimism in the middle of this horror show, there it is: virtually all of these deaths are preventable.”
He knew we have the tools to prevent these deaths and that we just need to convince all with power to utilize these tools creating what he called "a preferential option for the poor”. This brought Paul hope, as well as those around him. He gave us the roadmap in the fight for global health equity and social justice. We now know collectively–the key word being collectively–what to do, and we are not afraid that the work will stop, because we have the roadmap and in the words of PIH’s Chief Medical Officer, Joia Mukherjee, "we have each other.”
To effectively pick up the torch and run with it from milestone to milestone, we must do it together and, I believe Paul would say, we must love each other. Partners In Health staff often sign off emails with "Ekip Solid,” which means "Strong Team” in Haitian Creole. The team must now get bigger. We must carry on the movement he started and unite across all industries.
We need writers to shed light with stories that inspire those near and far to both feel and act for the greater good. We need pharmaceutical companies that prioritize equity and humanity first and profits second. We need world leaders who do not serve their own populations three times over before they look outside to help countries that have not yet been able to serve their populations once. We need to build societies that love and care for strangers like they are your own siblings. We need everyone to care about Black Lives Matter as if it’s their children who risk being shot, excuse me, who are being shot while going out for a jog.
We all need to be outraged about issues happening both in our backyard and across the world in communities we may have never heard of as if it were happening to us personally. We need to inspire today’s youth to enter into careers that can benefit the greater good and leave this world better than we found it.
Life is incredibly short and incredibly precious. Paul Farmer has been training us all for this moment and together, we are ready to carry through with what the leadership of Partners In Health is calling "Paul’s Promise.”
In the words of Dr. Joe Rhatigan of Harvard Medical School at the close of the vigil held for Paul just last weekend in Boston, "Let us now go out with a renewed sense of purpose.”
And from Professor Agnes Binagwaho, UGHE Vice Chancellor, at the University’s memorial services held in Butaro, "A life so beautifully lived deserves to be beautifully remembered! The best way to honor Prof. Paul’s legacy is to continue the efforts of equity, social justice, love of and kindness to the very poor and vulnerable within our societies.”
We love you Paul. We will not let you down.
About the Author: Katie Letheren is an experienced operations director and nonprofit cofounder with more than a decade of overseas employment excelling in complex and fast paced global health, education and pandemic response throughout Africa, Asia, Europe and the US. She worked for Partners In Health for five years in Liberia, Lesotho and the US, as well as the University of Global Health Equity in Rwanda.