The quest for equitable treatment

On Monday, the 21^st of February, a few days before we saw yet another conflict, the world lost a very special person. Paul Farmer, who is being remembered as not just a pioneer in medicine and global health, a scholar and a prolific author, but one of the foremost humanitarians of our time, died suddenly in his sleep. He had been working in Rwanda for a few weeks, a place that, among many, benefitted from his work, his vision, his kindness and his scholarship.

Paul’s loss is personal. I met him a few times and will always remember that the first time I met him, he gave me his personal mobile number, and told me to call him or text him anytime I needed anything. I did text him a few times, asking for guidance and insight, and he helped me every time. I read his work, thought about his mission, and tried to incorporate the values of dignity, decency and dedication in my work. Well before I had met him, I knew about him (of course, everyone in my field knew about him). The book, Mountains Beyond Mountains, has been high on my list of gifts to give to anyone passionate about equity and global health. My last interaction with him was a few weeks ago, when he reached out and asked if he and I could work together on issues of refugee health, and support African students. He did not have to do that. In his orbit and network were people far more qualified, experienced and resourceful than I can ever be. But he reached out because he believed in working with everyone who he thought could help others. It is among my great regrets that his time ran out before I could really work with him.

I am not the only one who has felt a personal loss at Paul’s passing. From the world leaders (President Kagame of Uganda, former President Clinton and former secretary of state Hilary Clinton) to leaders in global health (including Dr Tedros of the WHO, Melinda Gates, Dr Anthony Fauci), to countless colleagues around the world and tens of thousands of his current and former patients, have all felt a deep sense of personal loss. Right before a meeting late last week, a university staff member whom I had never met came to me and told me that she had worked with Paul, and she was unable to stop her tears.

What made Paul special was not simply his brilliance, the breadth of his knowledge, or his hard work, but his ideals. He refused to accept the status quo that just because someone was poor, they should not be provided with quality healthcare. He was certainly not the first one to make this argument, but he was certainly among the most determined practitioners in the recent memory to implement this ideal in his medical practice and in the high quality institutions he built (through Partners in Health and other programmes) in some of the most impoverished places in the world including Rwanda and Haiti. His books reframed our understanding on how inequity, injustice and poor access to care, and not necessarily pathogens, lead to deaths of the weak and the vulnerable. But this was not simply a theoretical framework, his work took these ideas to provide care and build institutions that would challenge the systemic injustice that is a lived experience of the poor in so many parts of the world.

Much has changed in the days since Paul’s passing. Today, there are tens of thousands of innocent displaced persons needing our support in Ukraine and its neighbouring countries. At the same time, the hypocrisy and dual standards of the West and the US in treating those in Europe (and are white) versus those who are in other parts of the world and are non-white is on public display. At this time — I am reminded once again, what Paul often said: “that some lives matter less is the root of all that is wrong with the world.” We need many more Paul Farmers today.

Published in The Express Tribune, March 1^st, 2022.

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