Partners in Heath-Global Health Equity

author: Paul Farmer, Department of Global Health and Social Medicine, Harvard Medical School
published: July 23, 2013,   recorded: November 2007,   views: 2631

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Don’t foolishly advise Paul Farmer that his bold projects can’t succeed. For the past 20 years, Farmer’s been toppling orthodoxies concerning the delivery of health care to people of developing nations, and to our country’s inner city poor. In a talk full of insights and anecdotes, Farmer brings his audience up to date on his groundbreaking work and methods.

In the early 80s, Farmer was a Harvard medical student studying infectious disease in Haiti. HIV was taking a deadly toll there and in the U.S., but Farmer was struck by the inequity of treatment. “The idea of a different standard of care for people 1 ½ hours from Miami didn’t strike me as a good idea.” Health care, Farmer came to believe, is a basic human right.

In the early 90s, antiretroviral drugs emerged in the U.S. as a powerful treatment for AIDS -- but were priced beyond the reach of developing countries. Farmer and his colleagues began a public battle against such global inequalities. They demanded affordable drugs, and support for community-based health care initiatives, viewed by international funders as unsustainable and cost-ineffective.

With a loan from a commercial bank in Boston, Farmer set out to prove everyone wrong. Starting with one facility, Farmer established community medical clinics across Haiti, run by and for Haitians, securing and disbursing affordable drugs for HIV and TB, and educating the community in preventive medicine. Local workers spread out into neighborhoods, to initiate and follow up on care. Farmer used his AIDS programs “as a battle horse to ride into the fight against poverty, and to talk about education, food security and housing.”

Farmer’s support broadened to include such powerful funders as the Clinton Foundation. This has enabled him to take his program into Africa, first to Rwanda and more recently to Lesotho and Malawi. Farmer’s Partners in Health group rebuilds medical infrastructure weakened by war or years of neglect; takes care of the sick; and then trains hundreds of local citizens. Haitians, whom Farmer describes as his teachers, have been spearheading much of the work in Africa. The costs of scaling up come less from labor, than from basic goods like food, and bumps in the supply chain. But the biggest obstacle of all, says Farmer, is “nay-saying, low expectations, a certain undertow of censorious opinion. As if it weren’t hard enough to do the work, you have to fight a lot of skepticism, not from patients, coworkers or family members, but from your peers.”

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