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Living the Legacy of Dr. Paul Farmer

On the first anniversary of the passing of Dr. Paul Farmer, we gathered to celebrate the enormous impact of his work in global health equity — and his deep sense of joy.

In February, we came together for a Fellows Friday conversation to celebrate the work, life, and legacy of Dr. Paul Farmer, renowned humanitarian and co-founder of the groundbreaking global health organization Partners In Health. Farmer started Partners in Health in 1987 with the mission of providing direct health care services and advocacy for those in resource-poor settings; now the organization is active in 11 countries and continues to function as a model for equitable healthcare around the world. Farmer’s emphasis in his work on equity, justice, and the health and rights of the poor have shaped clinical teaching and practice, influenced policies, and inspired generations of students, teachers, and leaders. 

In this conversation, Emerson Collective’s Director of Global Health Equity, Cassia van der Hoof Holstein, leads a discussion with three Dial Fellows who embody Farmer’s legacy in their own work: Dr. Sheila Davis, the CEO of Partners In Health; Nedgine Paul Deroly, Ed. M., who worked closely with the Partners in Health team in Haiti and is now executive director of Anseye Pou Ayiti, an organization working to deliver on the constitutional right to education in Haiti; and Dr. Sri Shamasunder, a physician who worked with Partners In Health and went on to found the global healthcare nonprofit HEAL Initiative.

Cassia van der Hoof Holstein: Sri, Sheila, and Nedgine, could you each introduce yourselves and reflect on what you have learned from Paul and your work with him?

Sheila Davis: This has been a hard week for all of us at Partners In Health. We've gathered in communities around the world to rejoice in all that Paul has done, and to spend time together in community. Paul started Partners In Health with a small group of motivated young people in the 1980s; now we work in 11 countries and we have over 19,000 employees around the world. The basic mission has stayed the same 35 years later: to bring the benefits of modern medicine to communities that are often forgotten or neglected. We see all of the Partners In Health sites as models that can be replicated and disseminated far beyond our own ecosystem. A “preferential option for the poor” is very much an underpinning of our philosophy. As well as accompaniment: the importance of walking side by side with the people that we care for, for as long as it's deemed necessary. 

We all miss Paul very much. Spending time with him was certainly a gift that I'll cherish. I'm very happy to be again with all of you today and know that the strength of Paul will continue far beyond all of us here, and we have a lot of important work to do. 

Nedgine Paul Deroly: I cherish the time I worked with the Partners In Health team, especially with the team in Haiti. I now lead Anseye Pou Ayiti, which is a movement helping a network of Haitian civic leaders create our own education system as a lever towards liberation. What we're looking to do is reclaim what is ours — our power, our agency, and the assets that make our people so mighty. We hope to equip 50,000 civic leaders for education justice. 

As I reflect on what I learned and what I continue to carry with me about Paul's teachings and the work of Partners In Health, I wanted to highlight three things. The first being that he very clearly said that Haiti was his greatest teacher. As a Haitian-led and Haitian-run movement, we also consider Haiti to be our greatest teacher. At Anseye Pou Ayiti, we believe it is so important to understand our history, our culture, our customs, and the assets that flow through our communities so that they can be integrated into how children learn and how they are growing up to be the leaders that we need today and tomorrow. 

The second thing I wanted to highlight is the power of people in proximity. We believe, as I know Dr. Paul Farmer did, that we need to bring those who have breathed the inequity and lived the injustice to the forefront of these movements to dismantle oppression and dismantle injustice. 

Third, we also believe that light attracts light. We must redefine leadership as rooted in collective action. We hope that with every year that our network grows bigger and brighter and more powerful, that we really live into that spirit of working together in partnership. 

Sri Shamasunder: One of the gifts that Paul brought us are these noble friendships across place and time and disciplines, all of us moving towards equity. What Partners In Health is doing is creating a language around global health equity. From pragmatic solidarity, to accompaniment, to this idea that we are “socialized for scarcity” [a term coined by Farmer to describe the normalization of the idea that we have insufficient resources to provide care to all people].  

I helped start an organization called the HEAL Initiative, which stands for Health Equity Action Leadership. We support, train, and transform a healthcare workforce that will serve poor populations for life. Our workers deliver care in the Navajo Nation, in Haiti, in Liberia, in Oakland. Some of the language of Partners In Health has led to our work, particularly this idea of a preferential option for the poor.

Cassia van der Hoof Holstein: How has Partners In Health helped change the vocabulary and language around health and health equity?

Sheila Davis: Paul called out language that focuses blame on those whom we are caring for. He changed the way we think about comprehensive care — that it is not just the right medicines or the right labs, but includes the social and economic factors of food, of water, of education, of transportation. At Partners In Health, we talk about the five S’s: staff, stuff, space, systems, and social support; you can't have one of those things without the others. The care we deliver is complex, but Paul was able to hone in very simply on what was needed for the patient in front of him. He could cut through the noise and just say, "What's best for this woman or this child or this man in front of us right now?" I think that changed the dynamic of how care has been delivered. 

Nedgine Paul Deroly: Inequitable systems were created by design, not by chance. So we have to be very diligent about questioning word choices. I would also mention that communications and storytelling must be made accessible to all.

“So much of our time cannot be focused on the pain and the suffering and the trauma, we must make room for the worthiness that is joy.”

Nedgine Paul Deroly

Cassia van der Hoof Holstein: What is one thing about Paul that you think people don't talk about enough?

Sri Shamasunder: He’s often thought of as the lone charismatic figure taking on global health. Obviously he was a huge figure in the movement, but he was connected to this massive Partners In Health network and all of us that are part of this work, which is less talked about.

I remember him talking about Rwandan med students who were giving a presentation on the kidney. He said: "I know that we're supposed to say that evolution made this kidney as beautiful as it is, but it's hard to not imagine the hand of God in the midst of such a beautiful organ as the kidney." He was a very deeply spiritual person, a religious person, and I think that grounded his ability to hold joy in the work.

Cassia van der Hoof Holstein: Our final question from the audience: This work must be so physically and emotionally taxing. Did Paul share ways for folks who are deep in this work to recharge? How did he model self-care?

Sheila Davis: Gardens and planting and flowers and beauty were Paul's self-care, and it had the dual purpose of also creating a beautiful place for patients to heal. He found solace and healing in plants and greenery around him.

Sri Shamasunder: His joy in taking care of patients — both that act of service and tenderness and then, also, being around people that had the same purpose. Those noble friendships really sustained him. 

Nedgine Paul Deroly: The last thing I'll say is just two words: joy heals. So much of our time cannot be focused on the pain and the suffering and the trauma, we must make room for the worthiness that is joy.