Problem: Doctor to the Poor

"Education wasn't what he wanted to perform on the world . . . He was after transformation." -Kidder (2003, p. 44)

When Paul Farmer graduated from Duke University at 22, he was unsure whether he wanted to be an anthropologist or a doctor. So he went to Haiti. As a student, Paul had become obsessed with the island nation after meeting many Haitians at local migrant camps. Paul was used to the grittier side of life; he had grown up in a family of eight that lived in a converted school bus and later on a houseboat moored in a bayou. But what he observed at the migrant camps and learned from his discussions with Haitian immigrants made his childhood seem idyllic. In Haiti, he volunteered for a small charity called Eye Care Haiti, which conducted outreach clinics in rural areas. He was drawn in by the deplorable conditions and lives of the Haitian people and determined to use his time there to learn everything he could about illness and disease afflicting the poor. Before long, Paul realized that he had found his life's purpose: He'd be a doctor to poor people, and he'd start in Haiti. Paul entered Harvard University in 1984 and, for the first two years, traveled back and forth to Haiti where he conducted a health census in the village of Cange.

During that time he conceived of a plan to fight disease in Haiti by developing a public health system that included vaccination programs and clean water and sanitation. The heart of this program, however, would be a cadre of people from the villages who were trained to administer medicines, teach health classes, treat minor ailments, and recognize the symptoms of grave illnesses such as HIV, tuberculosis, and malaria. His vision became reality in 1987, thanks to a wealthy donor who gave $1 million to help Paul create Partners In Health (PIH). At first it wasn't much of an organization-no staff, a small advisory board, and three committed volunteers. But its work was impressive: PIH began building schools and clinics in and around Cange. Soon PIH established a training program for health outreach workers and organized a mobile unit to screen residents of area villages for preventable diseases. In 1990, Paul finished his medical studies and became a fellow in infectious diseases at Brigham and Women's Hospital in Boston. He was able to remain in Haiti for most of each year, returning to Boston to work at Brigham for a few months at a time, sleeping in the basement of PIH headquarters. It wasn't long before PIH's successes started gaining attention outside of Haiti. Because of its success treating the disease in Haiti, the World Health Organization appointed Paul and PIH staffer Jim Yong Kim to spearhead pilot treatment programs for multiple-drug-resistant tuberculosis (MDR-TB). Paul's attention was now diverted to the slums of Peru and Russia where cases of MDR-TB were on the rise. In Peru, Paul and P encountered barriers in treating MDR-TB that had nothing to do with the disease. They ran headlong into governmental resistance and had to battle to obtain expensive medications.

Paul learned to gently navigate governmental obstacles, while the Bill & Melinda Gates Foundation stepped in with a $44.7 million grant to help fund the program. In 2005, PIH turned its attention to another part of the world: Africa, the epicenter of the global AIDS pandemic. Beginning its efforts in Rwanda, where few people had been tested or were receiving treatment, PIH tested 30,000 people in 8 months and enrolled nearly 700 in drug therapy to treat the disease. Soon, the organization expanded its efforts to the African nations of Lesotho and Malawi (Partners In Health, 2011). But Paul's efforts weren't just in far-flung reaches of the world. From his work with patients at Brigham, Paul observed the needs of the impoverished in Boston. The Prevention and Access to Care and Treatment (PACT) project was created to offer drug therapy for HIV and diabetes for the poor residents of the Roxbury and Dorchester districts. PIH has since sent PACT project teams across the United States to provide support to other community health programs. By 2009, Partners in Health had grown to 13,600 employees working in health centers and hospitals in 8 countries (Partners In Health, 2013), including the Dominican Republic, Peru, Mexico, Rwanda, Lesotho, Malawi, Navajo Nation (U.S.), and Russia. Each year the organization increases the number of facilities and personnel that provide health care to the residents of some of the most impoverished and diseased places in the world. Paul continues to travel around the world, monitoring programs and raising funds for PIH in addition to leading the Department of Global Health and Social Medicine at Harvard Medical School.

Questions: 1. Would you characterize Paul Farmer as a servant leader? Explain your answer.

2. Putting others first is the essence of servant leadership. In what way does Paul Farmer put others first?

3. Another characteristic of a servant leader is getting followers to serve. Who are Paul's followers, and how did they become servants to his vision?

4. What role do you think Paul's childhood had in his development as a servant leader?