Dr. Paul Farmer Spends Day at Vanderbilt, Sharing Perspective on Global Health and Service
“How does a university engage in [global health in] an ethically sound and meaningful manner?” asked Dr. Paul Farmer, M.D., Ph.D, on the heels of a 20+ hour trip from Sierra Leone, to open the 2018 Philip W. Felts Lecture in Humanities on Monday, February 19 at noon. Later that day, he conversed with Dr. Ted Fischer, Professor of Anthropology at 4pm in the Langford Auditorium followed by a meet-and-greet reception. Both talks are available on Mediasite via the Flexner Deans’ Lecture Series webpage.
Dr. Farmer currently holds several titles at the Harvard Medical School, including the Chair of the Department of Global Health and Social Medicine. He is a co-founder of Partners in Health, a non-profit that provides medical service to those in poverty, and he also serves as a UN Special Adviser to the Secretary-General.
During his noon lecture, he paralleled his flight path from Sierra Leone to Nashville to the long-standing interplay between West Africa, Europe, New England, and the United States. These connections include not only forced migration but also health issues, such as the spread of Ebola.
“These connections are ongoing and important when we think about standard of care,” said Dr. Farmer. “Meaning, how do we take care of people who are sick and living in conditions of poverty?”
He then shifted his focus to universities, highlighting the three pillars of medical education: research, medical training, and service delivery. He emphasized the importance of tackling all three, and especially of service delivery, the most frequently neglected pillar, without which global health would “not be an ethically sound venture.”
He called for universities to arm their students not just with medical knowledge, but also with the tools to understand and improve health systems and service delivery. Providing proper healthcare, Dr. Farmer said, requires “staff, stuff, space, and systems.”
Later that afternoon, he engaged in a one-on-one conversation with Dr. Fischer at the Langford Auditorium.
They began with a discussion of the early stages of his journey, from growing up in “materially but not culturally humble” childhood in Florida, to majoring in anthropology at Duke University, to doing an MD and a PhD in anthropology at Harvard Medical School.
Dr. Farmer shared that before medical school, he was denied a Fulbright Scholarship, which led him to work in Haiti with funding from Duke. He was attracted to Haiti for the culture, especially in the arts and the history of political revolution. His experience motivated him to fly back and forth between the States and Haiti throughout medical school, and start Partners in Health with medical school classmates.
In response to an audience member’s question about the financial feasibility of global health research and intervention, Dr. Farmer explained, “Anything less than equity of aspiration leads to trouble…Sure, it’s idealistic, but what’s wrong with idealism?” Dr. Farmer continued, “We have them on behalf of ourselves and others we care about. How hard is it to project that sort of thing to someone who’s never had that outside of their immediate family? And I think it’s a better exercise than saying, it’s not really feasible.”
He cited his own personal experience of being the same person that would tell patients in Boston that they have to take these medicines, and then traveling only three hours to Haiti to tell patients that they could not have these medicines, nor should they wish for them. “It’s intellectually and morally a joke to be that person in one day,” he said.
Dr. Farmer expressed frustration over using tropes such as sustainability and feasibility having become “robbed of meaning” as excuses for inaction.
Dr. Fischer then asked Dr. Farmer about humility in medicine, to which he responded “What is more humbling than knowing someone on one end of the trajectory? What is more shameful than knowing that if only we had this there, that person wouldn’t die?” He drew on the example of having surgical infrastructure in place to deal with tragedies like the Haiti earthquake, where patients died despite being pulled from the earthquake rubble because of the lack of proper infrastructure.
The conversation turned towards how Dr. Farmer is able to have the large impact that he does. He cited the importance of not only having the ability to acknowledge the reality of inequality, but also to still strive for the first principle, or “doing good.”, recognizing that the rate-limiting step is still financial.
The talk ended with both anthropologists agreeing that unlike the hard sciences, anthropology entails describing and revising of the social processes, and in that way is uniquely important to public health.