To Paul Farmer, healing the poor meant meeting their basic human needs

Farmer was a beacon in the sense that he pointed the way — but from a distance, up ahead. He was brighter than most of us. Raised by an eccentric father who housed his family, at various times, in a converted school bus and on a boat anchored in a bayou, he earned a full scholarship to Duke University. He became a University Professor at Harvard, the highest honor given to faculty members there, and received honorary degrees from many of the most venerable universities of North America.

What is more important is the use to which Farmer put his gift of intelligence. Moved by the experience of befriending 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.

Pause a moment over that, please. One way humans cope with suffering is to put psychic space between ourselves and the afflicted. We might say people are poor because they are deficient in some way, lacking initiative, or creativity, or good parents — or they are just short on luck. We might say people are sick because they lack discipline or hygiene — or, again, they lack luck.

Farmer and PIH insist that those who suffer are not different. Societies are structured in ways that thwart them, and if the structure is changed, they will flourish. To treat physical diseases without attempting to restructure society in liberating ways is insufficient, even inhumane.

In this view 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 might have done were he treating the students and faculty at Harvard, say. 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 impoverished people from accessing care.

As PIH explains itself: “A mother cannot undergo cancer care and lose work without receiving economic support. A tuberculosis patient cannot endure strong medications on an empty stomach. And a patient showing symptoms of covid-19 cannot take public transportation to her local testing site.” A patient might need food, money, child care and a car ride before medicine or surgery can be of any value.

Farmer’s work produced tangible results that he documented in scores of peer-reviewed articles in leading medical journals. Partners in Health grew 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 identified poor diet as a major health problem. The economic structure of the region needed to be changed to create access to more nutritious foods.

The solution: Clinics in the Navajo Nation now write “prescriptions” for fresh fruits and vegetables. When grocery stores and trading posts “fill” the prescriptions, they are reimbursed by Partners in Health — just as pharmacies are reimbursed for pills. Community health workers offer the same recipes and encouragement that wealthy families receive from their neighborhood juice bars, personal trainers and subscriptions to cooking magazines.

A principle of liberation theology is that the shepherd lives among the flock. So it was that Paul Farmer was not in Cambridge, Mass., but at a district hospital in Rwanda when his vast and demanding heart gave out on Feb. 21. He was just 62 years old but far ahead of the pack. There he remains, up ahead, beckoning the world to follow.