Healing the World by Curing the Poor
By CLAUDIA DREIFUS
BOSTON - Like the champion of jet lag he is known to be, Dr. Paul Farmer dashed into town recently to give a seminar at Harvard Medical School. He had arrived in Boston via Haiti and Rwanda, the central African nation where he has been organizing an campaign to fight AIDS with money from the William J. Clinton Foundation.
Dr. Farmer, 45, is a founding director of Partners in Health, a nonprofit agency based at Brigham and Women's Hospital in Boston. The organization provides medical services to the poor of Haiti, Rwa
nda, Peru, Russia and, yes, even Boston.
In the 2003 best seller about Dr. Farmer's life, "Mountains Beyond Mountains," the writer Tracy Kidder described him as "a man who would cure the world."
But sitting with a reporter over a beer and a basket of French fries at a Tremont Street pub, Dr. Farmer, tall and gangly, seems a lot less grandiose than that. "As I ricochet around the world, I see a lot of idealism," he said. "I see it in American high school kids raising money for health care in Haiti. I see it in Haitian health workers willing to go to Rwanda to battle the AIDS epidemic in Africa. These things are motivating."
Q. If the great humanitarian physician Dr. Albert Schweitzer were alive today, what would he think of your work?
A. If he walked into our hospital in Cange, in central Haiti, I think he'd be impressed. I mean, our patients are really poor, and this is a really decent medical center. There's no utility infrastructure in rural Haiti - few land line phones, hard
ly any passable roads. But at Cange, we've got a blood bank, laboratories, a modern operating room.
Q. How can you offer modern health services in places so poor that there is no electricity to power equipment?
A. We buy our own generators. And that's another thing: I think Dr. Schweitzer would be fascinated by the ways we use technology. He'd probably say, "E-mail, wow!" But we also do things he'd probably be uncomfortable with. We try to address the deeper causes of the diseases we see in countries like Haiti and Rwanda.
A while ago, an official from this giant development bank came to central Haiti. I took him to see kids with typhoid. At that time, there'd been embargo aid and development money for Haiti. So I took him to a kid who was not going to make it because of typhoid. "I want to know why your institution is blocking clean water loans to Haiti," I asked. Somehow I have the feeling that Dr. Schweitzer would have thought this outside of the purview of a good "humanitarian"
Q. Haiti is the poorest country in the Western hemisphere. Do you ever feel overwhelmed by all the suffering you see?
A. Sure. But you can't allow yourself to be overwhelmed for long because that's going to leave you ineffective. Instead, you say, "Gee, with the help of some talented doctors, nurses and engineers, we could do a lot here."
When I first went to Haiti in the 1980's, there was a moment that clarified this for me. With a young Haitian man who later became a health worker, we went to see a 7-year-old girl with malaria. The only doctor in the region didn't make house calls. She had 105 fever and was shaking like a leaf. Later, as we walked back many miles to the squatter settlement where we worked, I asked, "What can we do?"
"About the little girl or the problem of malaria?" he asked me.
I said, "Both."
That moment stays with me. Even in situations that seem overwhelming, you try to focus on the individual patient. At the same time, you deve
lop strategies to change the larger picture. You get others involved, go to people with power and try to get their help. One mustn't assume that people with great power won't help.
Q. How have technological advances of the last decade changed your ability to serve the poor?
A. Certainly the Internet has made all kinds of new things possible. Central Haiti, as I mentioned, is a place of poor communications. But hey, we've leapfrogged the lack of infrastructure with satellite dishes and laptops.
So the other day, we heard about a woman in a remote area who was dying in childbirth; we sent e-mails out to try to get help to her. The Internet has been useful for consults, too. We can now get input from specialists from all around the world.
Just yesterday, I got an e-mail from Cange with a digital photograph of a lesion that the doctor there couldn't identify. Did I know what this was?
I recognized it immediately as a Kaposi's sarcoma, which we saw frequently at the begin
ning of the AIDS epidemic. It's become so rare now that this young doctor had no experience with it. Well, thanks to e-mail, I was able to say, "Start that patient right away on antiretroviral medications." Of course, this should be confirmed with a biopsy. We couldn't have done this 10 years ago.
Q. Antiretroviral medications are expensive. How can your patients afford them?
A. We buy Indian generics mostly, and we give them out. We don't sell them. If we're confident that the Indian knockoff is as good, and we can get it at a tenth of the price, why on earth wouldn't we use it?
With these lifesaving medications, you start thinking there ought to be another way. AIDS drugs exist. But the people we serve are too poor to be consumers and thus patients. Trying to help them makes you think that health care ought to be thought of as a human right - like the right to free speech or the right to vote.
Q. Genomics is transfor
ming health care in much of the West. Will your patients be able to be helped by it?
A. Whenever there is some new scientific breakthrough, we start scheming right away about how to use it. Cervical cancer? It's a major killer of women in poor countries.
It's routine to screen for cervical cancer with Pap smears. But, the test is problematic in an underdeveloped region because you have to collect specimens, get them to a pathologist, obtain the results and then find the patient again. Because of poor transportation and communications, that's hard.
There's this new test out, a DNA serology that can identify the strains of HPV virus that cause the cancer. So now, thanks to technology, there's no need to rely only on Pap smears.
Right now, we don't have this test. But six months from now, I'd like to tell you we're screening Haitian women with the HPV/DNA test. We're going to call the company who makes the test and find out if they'll consider giving it to us. If that does
n't work, we'll try to get it at a reduced rate.
Q. Do you ever get tired or angry?
A. Not long ago, I was coming back to Haiti from Rwanda. I'd had a great time at the new project in Africa - all these committed people, all this optimism. But in Haiti, the road to Cange had changed hands, and now there were all these guys with guns everywhere. I started thinking, We've been living with guns in Haiti for some 20-something years. When's it going to end? It got me down. Plus, when I arrived at the hospital, there was a gunshot wound to tend to.
Q. So how did you break your mood?
A. I read Adam Hochschild's new book about the abolition of the slave trade. The abolitionists, they were pretty effective. Learning that cheered me right up.
Copyright 2005 The New York Times Company