U.S. News and World Report
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Wiping out TB and AIDS
By Michael Satchell
As one of six kids who spent part of his boyhood without running water in a converted passenger bus in a Florida trailer park, Paul Farmer has come a lot further than his untraditional beginnings might have predicted.
Farmer may have been born with a plastic spoon in his mouth. But his hardscrabble childhood forged a quicksilver intellect and unstoppable drive. Exposed to the miseries of the world's poor, he turned his formidable focus, coupled with a genius for innovation, to solving their health problems.
Farmer's heroes are not towering figures; they are "the mothers of families in Haiti or wherever who get up
in the morning without any food or water or wood for the fire and somehow feed their kids, plant a garden, go to the market."
"We've proven that people in poor settings with very complex diseases can be treated and cured," Farmer says, but he is far from satisfied. "We've had some victories," he says. "But if I were truly influential, everyone in the world would have the right to healthcare, food, clean water, other basics. That's the goal."
"What set him apart as a young man was his ability to envision things that no one else could. A lot of young people go to places like Haiti and see the desperate conditions, but they feel stymied when it comes to doing something. Paul saw an opportunity, drew up a plan, and saw it through," says Ophelia Dahl, who went to Haiti with Farmer in 1983 and is now president and executive director of Partners in Health.
Son of a rootless, restless father who bounced from salesman to fruit picker to would-be commercial fisherman, Farmer is a physician and m
edical anthropologist with a MacArthur "genius" grant on his resume and two Harvard doctorates simultaneously earned. The seeds for his lifework, however, were planted when he was an undergraduate at Duke University, volunteering at Duke's hospital and in local migrant labor camps where Haitians worked the tobacco and vegetable fields. After graduation, he enrolled in Harvard Medical School and headed to central Haiti, volunteering to work in Cange on the central plateau, a collection of tin-roofed hovels in the poorest region of the poorest country in the West.
Global model. In Cange, he studied medicine at Harvard long distance, applying what he was learning to his Haitian patients. To support his work, he founded a small, Boston-based charity called Partners in Health in 1987 with fellow Harvard medical student Jim Yong Kim. PIH set up a clinic called Zanmi Lasante, Creole for "partners in health," which became the settlement's first community-based healthcare delivery
Today, the well-equipped facility, with its operating rooms, blood bank, satellite communications, laptops, and other components of modern medicine, is a global model for delivering public-health services. PIH fights tuberculosis, AIDS, malaria, and other infectious diseases afflicting millions of the poor in Haiti, Peru, Russia, Mexico, Guatemala, Rwanda, and Boston's inner city. And its approach is unique. Patients receive not only lifesaving medicines and surgical care but also food, clean water, housing, education, and other social services, all delivered by locals trained in nursing skills and paid as community health workers.
This holistic approach by PIH, coupled with revolutionary drug protocols Farmer and Kim developed, proved that patients with drug-resistant tuberculosis could be cured rather than die by the hundreds of thousands each year. PIH's success in this and in treating AIDS patients has been so impressive that the World Health Organization has reversed long-held po
licies and now uses PIH treatment models in more than 30 countries.
To the self-deprecating, 46-year-old Farmer, it's only a modest start. "A small group of British abolitionists in the [19th] century began a movement that said, 'Slavery is wrong, and we're going to change it.' And they did," he says. "I believe we can convince people that it's wrong for the destitute sick of the world to die unattended. We can change that, too."
The bus to Duke. Farmer considers it a privilege, not a deprivation, that when he was 12 his family took up a peripatetic residence in an old school bus. When the bus was wrecked in an accident, the family moved into a campground tent and then into a jury-rigged houseboat moored in the Gulf of Mexico. Still, says Farmer, his family bonds were loving and strong, and the high school senior class president won a full scholarship to Duke.
Inspired by the writings of Rudolf Virchow, a 19th-century German medical pioneer whom he discov
ered at Duke, and pushed by his own Roman Catholicism to help the poor, Farmer went to Haiti in 1983, planning to spend a year there. He stayed much longer. When he received his Harvard M.D. and Ph.D. degrees in 1990, the 31-year-old had treated more types of illness and injury than many doctors see over a career.
By the early 1990s, his Haitian clinic had become a well-equipped center, with trained community health agents serving 100,000 people around Cange. Farmer and his staff enjoyed mounting success in treating infectious diseases, spending $150 to $200 to cure TB patients in their homes compared with $15,000 to $20,000 in a U.S. hospital setting. In 1993, the MacArthur Foundation recognized his work with a $220,000 grant that he plowed into his burgeoning program.
Several people shared credit for PIH' s growing success, none more than co-founder Jim Yong Kim, who was born in South Korea and grew up in one of the only two Asian families in Muscatine, Iowa. Like his friend and fellow Harvar
d student, Kim was a physician and medical anthropologist with M.D. and Ph.D. degrees. Kim focused his energy on helping Farmer design better treatment protocols and badgering U.S. and foreign pharmaceutical companies to cut deals for cheaper and more-effective drugs.
In 1996, PIH faced an outbreak of patients with drug-resistant TB in a Lima, Peru, shantytown. Instead of trying the usual frontline antibiotics, which didn't work, PIH administered a carefully calibrated regimen of as many as seven other drugs to patients in their homes, along with needed social services. Cure rates exceeded a stunning 80 percent--better than in U.S. hospitals.
Now Farmer and Kim--who later received his own MacArthur genius award--had a larger goal: to wipe out TB throughout Peru and in other developing countries. And they saw no reason that their successful PIH treatment model couldn't be applied to other catastrophic infectious diseases like HIV/ AIDS and malaria. That required serious money. Kim had been buil
ding a relationship with the Bill and Melinda Gates Foundation, and in 2000, the foundation gave PIH $45 million.
That was enough to allow PIH not only to launch a nationwide TB offensive in Peru but to establish a pilot project in Russia as well. More funding soon followed. In 2002, PIH received a $13 million grant from the Global Fund for new facilities and equipment for improvements at the Cange medical complex. Last April, the William J. Clinton Presidential Foundation launched a $10 million HIV/AIDS initiative, and PIH is responsible for establishing the first phase in Rwanda. And in September, PIH was awarded the 2005 Conrad N. Hilton Humanitarian Prize of $1.5 million for significantly alleviating human suffering.