Curing Systemic Diseases: The Story of Paul Farmer
The desirable disadvantages, extraordinary opportunities and his characteristic grit are the cornerstones of the doctor’s success.
By Callie Thielke | Neuroscience Major
Paul Farmer sauntered calmly through the blazing heat towards the metal gates of Carnage Hospital. Thick crowds of Haitians gasped his name in anguish, “Dokté Paul! Dokté Paul!” hoping their cries will draw him over to inspect their ailment. It’s a brisk 7 a.m. but the patients have been anxiously crowding the gates since long before Farmer was even out of bed. Sweat from the morning sun seeps down the faint wrinkles of the 23-year-old doctor as he calmly scans the diseased and the dying for the most urgent case. The cost to be seen is $0.80, but he often waives the fee to ensure patients are treated. Farmer’s eyes fall to a young girl sitting against the cool concrete pillar near the entrance. She looks up at him in distress, skin stretched tightly across her exposed stomach. Her cough is dry and deep, shaking her whole body down to her toes. At first glance he diagnoses her with the late stage tuberculosis. He pauses and squats down next her, her eyes meet his gaze and she murmurs, “I’m hungry” (Kidder, 2011).
Assessing life or death patients is a daily occurrence for doctor and medical anthropologist Paul Farmer. As a MacArthur Genius Grant recipient and Partners in Health founder, Harvard professor Paul Farmer dedicated his life to revolutionizing the way infectious diseases are treated around the world (Paul Farmer, 1993). Author and journalist Malcolm Gladwell writes in his book, Outliers: The Story of Success“If you work hard enough and assert yourself, and use your mind and imagination, you can shape the world to your desires (151).” This is exactly what Paul Farmer is doing. The desirable disadvantages early in his career, extraordinary opportunities and his characteristic grit are the cornerstones of Paul Farmer’s success as a medical professional, an educator and world changer.
In his book Outliers, Malcolm Gladwell illustrates that certain disadvantages can have desirable outcomes on the path to success. Gladwell presents the story of Joe Flom, a Jewish immigrant, who possess a strange appearance and a successful law firm. Flom didn’t have the appearance of most Wall Street lawyers, with his large nose and short stature. It was impossible for him to get a job when he didn’t look the part, so Flom was forced to create his own opportunities. Flom’s disadvantages on Wall Street forced him to take risks and chase after what he was passionate about. He was willing to put in time and energy into work that the big firms thought were beneath them, and when the opportunity presented itself, he was ready. Flom had put in the time and the energy to care about something that the big firms didn’t waste their time with, and he was able to capitalize off of that opportunity with his own firm. He started his own law firm and was able to capitalize off of his disadvantages by leading a firm, rather than stepping into a mold that had already been set at an existing firm (Gladwell, 2008).
Paul Farmer took a small risk after graduating from Duke University and found himself in a less than desirable situation. Farmer traveled to Haiti with a passion for Haitians and a love for anthropology and medicine (Wikipedia, 2019). In 1983 Farmer took a volunteer position with Eye Care Haiti, where he spent his days in mobile outreach clinics while most of his classmates took paid summer internships or entered right into the career field. He traveled, learned Creole, the native language, and lived alongside the Haitians for a year.
When he fell ill with dysentery Farmer curled up on one of the small, wire-framed cots that lined the cement wall in the hospital. A small fan in the corner oscillated to circulate the damp heavy air that hung over his head. Flies buzzed around his limp body as American doctors pleaded for Farmer to go back to the states for proper treatment. He couldn’t get over the fact that the country where dysentery was most common didn’t have proper treatment for the thousands suffering every day (Kidder, 2003).
Having dysentery in a third world country with sketchy, sub-par medical treatment is a less than desirable situation. Farmer spent a year of his life falling in love with a culture of people and then fell ill and was horrified by the way the people he loved were being treated. The facilities were over populated, the cost of care exceeded the on average $1 a day income that the majority of Haitians made, and the few medical professionals were stretched far too thin (Kidder, 2003). He was shocked by the lack of Haitians working or training alongside foreign medical volunteers. In that hospital bed Farmer saw a failing system that was not sustainable or affordable for the Haitian people. He sought to establish a medical center in Haiti where treatment was affordable, Haitians were being trained as doctors and nurses to provide care and create a sustainable facility, and community members were taught preventative medical practices. His dreams were massive and unheard of, but Farmer saw a gap in the field and decided it needed to be filled, and he was going to fill it (Kidder, 2003)
Farmer’s less than desirable disadvantage was similar to Joe Flom, not because he was chubby or funny looking, but because both men found themselves in a situation where they couldn’t be a part of what was currently available. Flom wasn’t able to get a job because he was short and odd looking, and Farmer got dysentery in Haiti and realized he couldn’t step into the third world medical field as it currently stood. Both men saw a space for change and implemented what they knew the community needed. Paul Farmer used his experience as a patient in Haiti to fuel the revolution of health care in Haiti and become the successful, influential doctor he is today.
Before he was a successful doctor, Paul Farmer practiced medicine in Haiti for eight months out of the year while attending Harvard Medical School. He received this opportunity due to his outstanding academic performance and his sheer lack of desire to do school any other way. It was, no doubt, an opportunity he worked hard to earn, but not all opportunities occur so neatly.
Opportunities arise in everyone’s life that are created with hundreds of hours of practice and preparation. Some opportunities are a far shot that is made and it works out, and then there are the few rare opportunities that are just dumb luck. Tom White was just dumb luck.
Tom White, a 65-year-old construction CEO from Boston, had heard of Farmer and after donating the rest of the funds for Farmers hospital, he flew down to get a look at Farmer in person. He was horrified, broken and utterly frustrated when he saw the conditions Farmer was working with as he griped, “For Christ’s sake, put a tin roof on and pour a concrete floor I’ll give you the money. Jeez” (Kidder, 2008). And just like that, Tom White was hooked. Later, when Farmer wanted to start Partners in Health, an organization that institutionalized his passion for healthcare, Tom White put up $1 million in support of the project (Marquard, 2011).
The extraordinary opportunities in Farmer’s life are similar to those experienced by the richest man in the world. Gates attended a private school that was one of the few schools, colleges included, to have a computer on campus in 1968 (Gladwell, 2008). Gates was given the opportunity to program for hours, coding and exploring his future field. Some opportunities are really lucky and going to one of the few schools in the country with a computer was a pretty lucky opportunity for Gates. But it was also pretty lucky that he lived within walking distance of the University of Washington, and even luckier that the university had a computer free and available at 2 a.m. each night (Gladwell, 2008). These opportunities gave Gates an intricate knowledge and passion for an up and coming field and laid the foundation for his success in the future.
Farmer’s work ethic earned him the ability to work in Haiti while attending medical school, but no amount of work earned him a Tom White, whose desire to help the poor financed Farmer’s life work.
Farmer and Gates both received extraordinary opportunities that helped propel their careers forward. In Outliers,Gladwell states, “People don’t rise from nothing…But in fact they are invariably the beneficiaries of hidden advantages and extraordinary opportunities” (Gladwell, 2008). Farmer’s work ethic earned him the ability to work in Haiti while attending medical school, but no amount of work earned him a Tom White, whose desire to help the poor financed Farmer’s life work. Gates was giving an extraordinary opportunity to have a computer available at his school, and just down the road from his house that enabled him to put in his countless hours of practice before he was even in his field. Success is collections of extraordinary opportunities that build off of one another and perpetuate more success. In the case of Paul Farmer, meeting Tom White was a moment that go the ball the rolling in the direction of success.
Paul Farmer put every ounce of himself into starting Partners in Hope. He spent 8 months of the year practicing in Haiti and the remaining 4 in Boston or visiting his wife and daughter in Paris. He lived in a small apartment near the hospital, and in Haiti he had a one room cement home. As a doctor making $125,000, his humble living quarters matched those loving below the poverty line (Paul Farmer, 2019). He put as much of his six-figure income as possible into Partners in Health. Once when he went to swipe his credit card it bounced and he had to call his banker who chuckled and said, “You are poorest rich person I know” (Kidder, 2003). But Farmer lived for the sacrifices he was making, saying, “If you’re making sacrifices, unless you’re automatically following some rule, it stands to reason that you’re trying to lesson some psychic discomfort. So, if I took steps to be a doctor for those who don’t have medical care, it could be regarded as a sacrifice, but it could also be regarded as a way to deal with ambivalence” (Kidder, 2008). Farmer saw a system that was broken and inefficient. A system that brought him discomfort, enough so that he felt called to act, and called to make drastic changes. He used his passion and desire to care well for others to fuel his drive for both academic success, and humanitarian success.
Ten years into his practice, Farmer found himself faced with another extraordinary opportunity, monumental in the journey of establishing and revolutionizing healthcare systems across the world. In 1993, Farmer was a doctor of infectious diseases at Brigham Hospital in Boston, running the hospital in Cange, Haiti and a founding member of Partners in Hope (Kellogg Institute, 2016). Among all the chaos he was recognized for an award celebrating those with extraordinary originality and dedication to their field. Paul Farmer won the MacArthur Genius Grant. In line with the prestigious title, the award also gave the recipient whopping $220,000 (MacArthur Institute, 1993). The award celebrated his grit and determination to serve and treat the worlds sickest patients. Every penny of Farmer’s award money went to the Partners in Health Treasury, further demonstrating his passion and drive to spread his mission further.
Psychology Professor Angela Duckworth from the University of Pennsylvania studies grit and its relation to successful careers similar to Farmer. She conducted a study with school-aged kids and their ability to perform in a spelling bee, measuring what drove the subject to perform in the competition. Duckworth’s research showed that students who put in more time to practice and sacrifices other activities to devote time to the subjects they were interested in were more successful. In the case of her study, those were the students who enjoyed spelling and English class (Duckworth, 2011). In the same regard, grittier students are more likely to graduate on time, grittier cadets are more likely to complete their full first year at West Point, and grittier teachers will withstand the stresses of teaching in low income districts (Duckworth, 2011).
Grit is crucial when trying to change a system that is heavily intrenched in a single way of thinking. As Paul Farmer sought to revolutionize the care and treatment of infectious diseases in third world medicine, he was faced with obstacles and asked to make sacrifices. He spent minimal time with his family, lived a frugal lifestyle, and donated all that he had to a cause that he believed in. He put his full self, his full bank account and his full life into curing and caring for patients in dangerous conditions with dangerous, life-threatening illnesses.
Paul Farmer sits quietly behind his desk in an office buried down a Harvard hallway with a wall full of plaques, awards and diplomas behind him. The wall reminds him of the opportunities he’s been given, the disadvantages he’s faced and the small steps that landed him to the very office he sits in now. It is easy to wonder at what point he “made it,” but each patient who walked out of the temporary hospital tents, each treatment series, and each PIH board meeting was a stepping stone in along his path to fulfillment. “Success is not a random act. It arises out of a predictable and powerful set of circumstances and opportunities…” (Outliers, 2008). Farmer’s powerful journey in revolutionizing third world healthcare was just that: a powerful set of opportunities, combined with grit determination and a passion for treating the world. Farmer collects his lecture materials from his desk, glances one last time at the wall, and heads off to educate the future generation of world changers.
REFERENCES
Duckworth, A., & Gross, J. J. (2014). Self-Control and Grit: Related but Separable Determinantsof Success. Current Directions in Psychological Science, 23(5), 319–325.
Gladwell, Malcolm. Outliers. New York: Little, Brown and Company, 2008. Print.
Kellogg Institute. [@kellogginstitute]. (2016, April 27). Paul Farmer: Taking up the Challengeof Poverty. Youtube Video. https://www.youtube.com/watch?v=JwWT2WylbP8.
Kidder, Tracy. Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World.Random House Publishing Group, 2009. Print.
Paul Farmer. (April 09, 2019).Encyclopædia Britannica. Retrieved April 09, 2019 fromhttps://www.britannica.com/biography/Paul-Farmer.
Paul Farmer. (n.d.) Wikipedia, the free encyclopedia. Retrieved April 11, 2019 fromhttps://en.wikipedia.org/wiki/Paul_Farmer.
Paul Farmer. (1993) MacArthur Foundation. Retrieved May 5th, 2019 fromhttps://www.macfound.org/programs/fellows/
Marquard, B. (2011). Rich beyond counting with compassion. Retrieved May 5, 2019 from http://archive.boston.com/bostonglobe/obituaries/articles/2011/01/08/tom_white_one_of_bostons_greatest_philanthropists_dies/
ABOUT THE AUTHOR
Callie Thielke, a junior from Hudson, Wisconsin, seeks to attend graduate school and study human behavior. Thielke loves the lilacs in the spring time, canoeing on the St. Croix River, and doing her devotions with the sunrise.
WHAT I’VE LEARNED
The success paper showed me that my best work does not come at 2 a.m. the night before the due date, but it does come from weeks of revisions and edits. My classmates eyes can catch mistakes that I have breezed over a dozen times without catching.
Researching for this paper taught me the value of alternative sources. All of my research in the past has been purely scholarly articles and I have learned the value of information outside of academic research.
Giving speeches in this class has given me opportunities to improve both the content and delivery of my speech. I have learned that a speech is about engaging the listener, telling a story, and potraying information, and my delivery is only a small piece of the puzzle.
Naming the dogs is crucial in hooking the reader and getting them engaged in what you write. Being specific and detailed in the story you are telling is important in any writing, not just creative writing. Naming dogs in research will encourage people to engage in your hard work.
Group edits were a blessing. Having people sift through a paper that you’ve stared at for hours helps catch the most glaring mistakes.
Small group circles to discuss the readings were a great opportunity to clarify points that I did not understand.
Selfies seemed unnecessary at the time but they forced us to get together and get our work done in a more collaberative setting.
Meeting with Scott allowed me to get really good insight into why this paper and this writing style was so important in my field. I don’t want to be a journalist, and research doesn't require story telling, but it does allow readers to engage with your writing.
Malcolm Gladwell was wildly engaging in his efforts to explore success by using all of the narratives of successful people.
Seagulls writing guide taught me more about APA format than any of my other writing resources have before this. It was so comforting to have one uniform place to go look for answers.
(Editor’s note: This paper was written as part of a GES160 Inquiry Seminar class at Bethel University in St. Paul, Minn.)
