Remembering Dr. Paul Farmer

By Molly Strzelecki - April 04, 2022

April 2022_8

When most medical students were thinking about their next clinic or rotation, Paul Farmer, MD, was thinking about how to change the face of medicine.

It’s not certain that he actually knew changing medicine for the good would be his legacy, but in 1983, when volunteering in Haiti, Dr. Farmer, along with Dr. Ophelia Dahl, Todd McCormack, Jim Yong Kim, and Tom White, founded Zanmi Lasante, Haitian Creole meaning Partners in Health, a small clinic that provided healthcare to an impoverished area of Haiti. Zanmi Lasante was the launch point for Dr. Farmer and his colleagues to eventually establish the Boston-based Partners in Health, which has become the foremost name in global health.

What Dr. Farmer saw on that initial trip to Haiti as a medical student struck a chord and stayed with him throughout his career. There was an utter dearth of access to medical care for so many; for those who did have care, the scarcity of supplies and needed testing was stark. Dr. Farmer saw a desperate need for help, and that drove the motivation of both Partners in Health and Dr. Farmer himself. “There’s always somebody not getting treatment. I can’t stand that,” Dr. Farmer said in a New Yorker article.1 Partners in Health has worked for decades to change that, not just in Haiti, but all over the world. The work he has done has heavily influenced how global health is practiced. Often described as highly intelligent, kind, and witty, Dr. Farmer used this mix of traits to the benefit of global health, whether it was raising money for healthcare in underserved areas, or helping others who worked in the global health space to better understand the need at hand, and how to fulfill it.

“Thanks to Paul I learned to appreciate and understand the pathologies of power, so I could better navigate the how to help the poor, without strengthening the power systems that created suffering and tragedy,” says Mark Connolly, UNICEF Representative to Honduras, and close friend of Dr. Farmer. “His scholarly works educated me, while in person, his unedited comments and sense of humor let me appreciate how global health could be improved, but we constantly had to check ourselves…. and laugh at ourselves too.”

Dan Milner, MD, MSc(EPi), FASCP, is the Chief Medical Officer for ASCP, and leads ASCP’s Center for Global Health, which focuses on improving laboratory practice by identifying challenges, exploring innovative approaches, and forming partnerships to implement sustainable solutions in underserved countries around the world. Dr. Farmer was a mentor for Dr. Milner, and encouraged him to pursue global health work.

“He would constantly cultivate that passion and it helped me figure out how to move forward to benefit our patients,” Dr. Milner says. And it wasn’t just Dr. Milner that Dr. Farmer mentored, encouraged, or supported, he adds—Dr. Farmer was well known for passing notes to people during meetings, whether in a lecture hall or the White House, congratulating them on an achievement, or simply conveying a kind word. “He found the value in every human being, and would let them know. The value was to encourage them and to build their enthusiasm and their passion,” Dr. Milner says. The value that Dr. Farmer found in every human, he adds, extended well beyond his colleagues and was seen most obviously in the patients he treated.

“With rare exceptions, all of your most important achievements on this planet will come from working with others—or, in a word, partnership.”

Dr. Paul Farmer, To Repair the World: Paul Farmer Speaks to the Next Generation

A friend of the laboratory

The early days of Partners in Health focused on patients with HIV/AIDS, but as their work continued, they saw more and more patients coming to them with various cancers. Initially, says Dr. Milner, biopsies brought back to the U.S. in a volunteer’s luggage, and later were reviewed and diagnosed by a pathologist. As an increasing number of patients came to them with potential cancer issues, this system was not sustainable, nor was it ideal—Dr. Farmer wanted patients to be able to access diagnosis and care where they lived, not on the other side of the world.

In 2012, Dr. Farmer built a laboratory in Rwanda to address the growing need for laboratory services in that country, a process that Dr. Milner was a part of. Within six months, he notes, they had a fully functioning pathology laboratory, with help from collaborations with other organizations, grants, and donations, and the needed personnel to help train the laboratory workforce.

“That lab has been going for 10 years,” Dr. Milner says, “and has diagnosed thousands and thousands of patients, all of whom have been treated locally.” That, he adds, was one of the stories that Dr. Farmer would frequently share to help people understand the value pathology brings to the table in global health.

This work dovetailed with the global health work ASCP has pursued for the past decade. ASCP’s work with the Botswana Ministry of Health in 2013 on cervical cancer prevention helped build in-country capacity and create a sustainable model to ensure cancer care for patients. Under the leadership of ASCP CEO Blair Holladay, PhD, MASCP, SCT(ASCP)CM, an ASCP-led coalition of more than 30 cancer organizations (which included the support of the Director of the National Cancer Institute) Partners for Cancer Diagnosis and Treatment in Africa was formally launched in 2015 at the White House under the Obama Administration. Since that time, millions throughout a multitude of countries within sub-Saharan Africa now have access to cancer diagnostics. Dr. Farmer helped ASCP navigate, negotiate, and prioritize the initiative, both from the White House and into the field.

“Every time we got together, we talked about access to tissue so we can actually get diagnostics done, and treat the patients who need it most,” says Dr. Holladay. Dr. Farmer strongly believed that the laboratory is the linchpin to advancing care in underserved populations, he adds, and that getting a biopsy in Rwanda, for example, would be near impossible without outside help to develop the resources to do so. Dr. Farmer’s understanding of that key point helped bolster pathology and laboratory medicine to the fore in global health.

A keynote speaker at the ASCP 2011 and 2016 Annual Meetings, Dr. Farmer understood and highly valued the integration of pathology and the laboratory. “Tissue is the issue,” he stated, insisting that cancer care cannot be delivered without pathology diagnostics. And in his 2016 keynote, Dr. Farmer noted that, “Without help from pathologists, we cannot do anything meaningful at all.”

Continuing to change the face of global health

In his decades of work, Dr. Farmer taught the global health community more lessons than seems reasonable for one man to be able to do. As the community moves on without this giant of healthcare, those lessons are some to lean on in navigating what comes next.

“Read all of his books. Think more about liberation and what it means. Always ask ourselves who is being left behind and why,” Mr. Connolly says. That is how the global health community can take what Dr. Farmer started, and ensure it continues.



Molly Strzelecki

ASCP Director of Communications + Editor of Critical Values