Dr. Farmer’s Remedy For World Health

The great innovators of our time are said to be the titans of technology – the inventors of the microchip, the founders of Microsoft, the guys behind Google. But far from Silicon Valley another great thinker and innovator is changing the world with far less fanfare. His name is Dr. Paul Farmer.

As Byron Pitts reports, more than 20 years ago Dr. Farmer and a few other great minds created a charity called “Partners In Health.” In the years since, they revolutionized the delivery of healthcare worldwide, saving millions of lives in places where no one thought there was any reason for hope.

“The idea that because you’re born in Haiti you could die having a child. The idea that because you’re born in you know Malawi your children may go to bed hungry. We want to take some of the chance out of that,” Farmer tells Pitts.

Farmer invited 60 Minutes to central Haiti, where he discovered his life’s work 25 years ago. The invitation meant a three-hour, jaw clenching, teeth rattling ride on an unpaved road from the capital city to the hospital.

If the ride doesn’t break your back, what you see when you arrive will break your heart: the squatter settlement of Cange is one of the poorest parts of the poorest country in the Western Hemisphere.

The desperate need Paul Farmer saw in central Haiti as a young man inspired him and four friends to create Partners in Health. They raised money and built what’s become the largest hospital in central Haiti.

Asked how many lives he thinks Partners In Health has saved, Farmer says, “In medicine, we say ‘TNTC,’ too numerous to count.”

What began as a small, understaffed and ill-equipped clinic in 1985, today has 100 inpatient beds, an array of specialists, and three operating rooms. They have nearly two million patient visits a year. And the medical care at the clinic is free. For Farmer, healthcare is a human right. He wants to show the world that children for example don’t have to die of treatable illnesses like tuberculosis or malaria, diseases which they treat every day.

“Do you have any idea how many people around the world die from treatable diseases?” Pitts asks.

“Well probably about ten million a year,” Farmer estimates. “Well, let me just give you some numbers. Just from AIDS, tuberculosis, malaria and women who die in childbirth, I bet that’s six million.”

Haitians are so desperate for medical care that each night people sleep on the ground, outside the hospital, just waiting to get treated. 60 Minutes was there when Farmer got word that a woman dying in childbirth was being prepared for an emergency c-section.

The surgical team was made up entirely of Haitians. Partners In Health staffs its hospitals with as many locals as possible, so they are not dependant on Americans. In this case, the baby was delivered alive. For the mother who’d lost a lot of blood, it was touch and go.

Dr. Farmer checked on her after the operation. “She’s gonna make it, thumbs up,” he remarked later.

“That same woman, same circumstances, 25 years ago, what would have happened?” Pitts asks.

“Well, she wouldn’t have made it,” Farmer says.

Asked what that tells him about his work, Farmer tells Pitts, “It tells me that if you set your sights high and if you stick with it, you can make real progress. That’s what it says to me.”

In fact, Farmer has made astounding progress: Partners In Health has expanded and now works in nine countries, including Peru, Russia, Mexico and three countries in Africa. With 6,000 employees worldwide, their budget of $50 million dollars is barely enough to keep it going.

Farmer spends most of his time commuting between the hospitals in Rwanda and Haiti. One of his priorities is to train a new generation of doctors to follow in his footsteps, physicians like David Walton.

“I look at you, 31 years old, medical degree from Harvard, could make a gazillion dollars back in the States, and you’re in Haiti. What do you get out of it?” Pitts asks Walton.

“There’s nothing I’d rather be doing with my life,” the young doctor says. “Absolutely nothing.

And it’s a hard life: seven-day work weeks, including house calls. And a house call in Haiti can mean a hike up the side of a mountain.

“You walk for 30 minutes, walk for an hour, walk for four hours. The patients do it every day, why shouldn’t I do it?” Walton explains.

On the day 60 Minutes was there, Walton was visiting 10-year-old Cledene, who is suffering from a damaged heart valve. Her family and neighbors showed up with their list of ailments. There are no short lines in Haiti. Some of Cledene’s siblings were also sick from sleeping on a muddy floor. Including the parents, 12 people sleep in one room.

“In the scheme of poverty in rural Haiti, this is pretty bad around the lower end of the spectrum, 10 kids living in a place like this, no material possessions and a very, very sick child,” Walton remarks.

Even for the well-trained this is difficult. “I can’t imagine, sorry, turning my back on something like this,” Walton says. “Maybe some people can, but I can’t and I won’t. This is my life’s work.”

There was no happy ending for this story. Cledene died not long after Dr. Walton’s house call.

“There are always whispers about programs like this that they can’t outlive the people that founded the place. That when the Paul Farmers move on, Partners In Health will be done,” Pitts says.

“Paul, part of his genius is that he has set up a system that doesn’t depend on his presence or absence. Haiti is run by Haitians physicians. In Rwanda the Rwandan hospitals should be run by Rwandan physicians,” Walton says. “And so when the Paul Farmers of the world aren’t around anymore, this place will still be here providing great care.”

Asked if he knows that or just hopes that, Walton says, “I know it.”

But there’s no question that Farmer has been a driving force. Take AIDS, for example: in the late 1990s the disease was ravaging the people of Haiti. Conventional medical wisdom was there is no point in giving AIDS drugs to the poor in Third World countries. But Farmer wouldn’t give up on his patients. He raised money and gave them drugs anyway.

Patients, like a man named Joseph, went from being very ill to feeling better. The same kind of transformation happened in patient after patient.

“When Paul started treating people in 1998 in Haiti, everyone said he was absolutely nuts. ‘Impossible. Can’t be done. Forget about it,'” says Dr. Jim Kim, a professor at Harvard Medical School and one of the co-founders of Partners In Health.

“And here we are, you know, not even a decade later, where the goal is to treat every single human on the planet who needs HIV treatment with the right drugs,” Dr. Kim says.

They saved the life of a man stricken with tuberculosis and thousands like him. Farmer and Kim figured out not just a new way to treat multi drug-resistant TB, but a cheaper way to provide the medicine. Their breakthrough has become the new standard and has saved the lives of people around the world.

“You were able to lower drug prices. How is that possible?” Pitts asks.

“I realized very quickly that these are all old generic drugs. There’s no reason for them to be so expensive. So we did some very simple things. We talked to drug procurement specialists who had contacts in India who said, ‘We can make these drugs for 100th of the price,'” Kim explains.

But drugs only work if people take them, so Partners In Health came up with the idea of hiring community health workers. The workers, fellow villagers, visit the sick at home every day, making sure they take their medicine. The result, says Farmer, is that their patients with AIDS and TB stay healthier longer than many patients in the U.S.

“Yes, there are people here in central Haiti who get better care for certain diseases than they would in parts of the United States,” Farmer says.

“Come on,” Pitts says.

“No, I’m absolutely serious. I’ve seen it,” Farmer replies.

It’s a program so successful, Partners In Health has exported the model of using community health workers to American communities like Roxbury, Mass.

Farmer’s success has made him a celebrity in the world of global healthcare; he won a MacArthur genius award.

It’s heady stuff for a man from humble means. His mother was a grocery store cashier, his father a school teacher who chose an unconventional lifestyle for his family.

Farmer grew up on a bus. “It was actually a bus that had been used to take x-rays in a tuberculosis screening program. You see, this is why I don’t like talking about my biography, because that sounds so neat, right? I lived in a bus,” Farmer tells Pitts.

“Neat?” Pitts asks. “It sounds pretty hardcore to me. Grew up on a bus.”

“Well no, but I mean it was a tuberculosis bus and then later I became a tuberculosis expert,” Farmer explains.

He came from a family of eight. And he said that even though it was crowded on that bus in Florida, he didn’t feel deprived, but rather adventurous.

From the bus, they moved onto a boat, with “a tent in between,” as Farmer explains.

“How did that kind of upbringing shape who you are now, do you think?” Pitts asks.

“Well, you know, when you grow up in those conditions surrounded by affection, but not having a lot of things, ’cause you can’t put a lot of things for eight people in 28 feet on space, then you get pretty resilient,” Farmer says.

He went from the bus to a scholarship at Duke University, and then to Harvard Medical School where he’s on the faculty. He married a Haitian woman and they have three children.

Though he travels the world, Farmer insists Haiti is home. His services are free, but he still accepts gifts like an occasional rooster.

“Give me the laundry list, the kind of gifts you’ve gotten over the years,” Pitts asks.

“Yesterday I got two roosters, I got probably about a dozen and a half eggs, I got some milk,” Farmer says.

Before Pitts left Haiti, Farmer insisted we meet one last patient, Yolette Sanon, a 35-year-old cancer survivor. The chemotherapy worked, and her leukemia is in remission.

“It’s awfully good news for her, so she looks a million times better,” Farmer remarks.

And this was the one place the normally in control, even-keeled Paul Farmer revealed that sometimes his work does get to him. It happened when he read Yolette’s thank you letter.

“I want to take this time to show my gratitude to you. If as for me…,” he reads, getting emotional. “I’ll read it to you later.”

“This is hard for you sometimes,” Pitts asks.

“You know, it’s a lot,” Farmer admits. “I mean, everybody should have access to medical care. And, you know, it shouldn’t be such a big deal.”

For the sick, the poor, the forgotten in Haiti, Paul Farmer is a big deal. There is a Haitian expression some of his patients use when he’s away: “We miss him,” they say, “like dry earth misses the rain.”

Originally posted on CBS News/60 Minutes

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