Partners in Health, its founders, and its affiliates, have published a large volume of literature about their continuing struggle against world poverty and deprivation. Partners in Health as an organization has published a number of articles and pamphlets meant both to inform spectators and to facilitate practical implementation of their models. PIH also publishes a quarterly bulletin and a monthly Internet newsletter that keeps supporters up-to-date on their international endeavors. An archive of these, and a sign-up for a prescription to the bulletin can be found at the official PIH website.
Mountains Beyond Mountains
Paul Farmer and his mission first came into the spotlight with the publication of Tracy Kidder's biography, Mountains Beyond Mountains . Abraham Varghese for the New York Times calls this story of the earthy beginnings of Partners in Health an inspiring, disturbing, daring and completely absorbing" tale that will "rattle our complacency; it will prick our conscience." Highly recommended to any who wish to learn more about the Partners in Health operation or the stethoscope behind it all, this book made each of us want to complete this website; we know it will affect you, too. Any interested persons are encouraged to visit the official PIH website here, where 15% of a purchase made through amazon.com will fund PIH's efforts.
AIDS and Accusation: Haiti and the Geography of Blame
AIDS and Accusations is the first of many articles by Dr. Paul Farmer about the health crisis in Haiti. In it he explores who is to blame for the high number of AIDS patients in Haiti. Rather than blaming Haitians for the disease, he theorizes that AIDS was brought to Haiti be Americans. One reviewer commented that Farmer "brings Haitian culture powerfully to life" in this article. Randall M Packard of Science said that "Farmer's sensitive exploration of the lives and deaths of the people at Do Kay give his study a distinctly human face" and Arthur Kleinman of Harvard University called it "one of the most impressive works in the new wave of ethnographies in medical anthropology".
NY Times Criticism
Pathologies of Power: Health Human Rights, and the New War on the Poor
Published in 2003, Pathologies of Power relates harrowing life and death situations to examine our understanding of human rights. Farmer argues that the most important human rights struggle of our time is promoting the social and economics rights of the world's poor. Loic Wavquant, author of Prisons of Poverty called Pathologies of Power "that most rare of books: one that opens both our minds and hearts." Author Tracy Kidder called the book "an eloquent plea for a working definition of human rights that would not neglect the most basic rights of all: food, shelter and health."
Infections and Inequalities: The Modern Plagues
When he published this book in 1999, Paul Farmer hoped it would serve "a pragmatic end by calling into question the logic that promises a future in which health equity will play in a shrinking role." Infections and Inequalities gives accounts of AIDS and TB as well as their presence in Haiti and Peru. Farmer uses his experience working as a doctor in the fight against AIDS and TB to provide a passionate account of these diseases in poor areas of the world. The Lancet called Infections and Inequalities "unapologetically passionate...but well reasoned." The Times Higher Education Supplement calls it a "moving and angry book".
Interview With Donna Barry
Q: So we wanted to know what you, as an advocacy director, do?
A: So I spend a lot of my time with what sounds like pretty boring things - sending a lot of emails and going to a lot of meetings, and speaking at a lot of events, student groups, college groups, high school groups, other groups of my colleagues who work in healthcare internationally. So that's it as far as the physical stuff I do. So what we're trying to do...one overarching goal of what we do with our advocacy work is to try and get more people involved in the fight against global poverty and hunger...and related to that, we have work on four specific issues which will be on the website when it's updated. One is malnutrition and hunger. The second is socio-economic rights for Haiti. The third is the healthcare worker crisis around the world. The fourth is in general increasing funds for global health, not specifically for any disease, but in general.
Q: Do you talk to people in government?
A: Yeah, we try to do it at different levels. We try to do it at a congressional level, senators and their staff, and members of the House of Representatives and their staff, as well as more, like, administrative level people in some of the big agencies that work with health. And then also at the global policy level like the World Health Organization and some of the other big UN agencies that are involved in health.
Q: How many years have you been working at PIH?
A: Almost six, but I started out running the project in Russia working on drug resistant TB. So I did that for about three and a half years. Then I left for a little bit. Then I came back and for about a year I worked on our women's health projects in Haiti and then I moved into more of the advocacy and policy work.
Q: Going back to what you said about government, how responsive are different governments to your advocacy?
A: Well we really target just the U.S. for now so we haven't been really engaged in any kind of efforts in any other countries. And I've only been doing this for about a year, and we think we've been really successful in the past year [with] getting some legislation passed along the lines of what we support. So, for instance, the reauthorization of the president's emergency plan for AIDS relief so it was called (incomprehensible) is up for the five-year renewal...in that there's some really good language on paying community health workers which we feel really strongly about, and that was [what] we think hopefully as a direct [way] of us talking with some congressional members about this. There is some really good language about [...] being able to build new buildings for healthcare, which was prohibited in the old bill, but now hopefully the House [of Representatives] version has that in it too. And then the Jubilee Act - we weren't that responsible for it, but we had a lot of discussions with our local Congress people about it, and once they introduced the Haiti [bill] on the House side, we had a lot of people make a lot of phone calls to try and get that passed. So I think we may have had a little influence on that, not a ton, 'cause we were following the lead of other organizations. So I think we've got some Congress-people in the Senate and in the House who have been very responsive to a lot of our asks.
Q: Can you tell us why you decided to work for PIH?
A: It was just kinda fate. I had been working in international health before and then 10 yrs ago I moved to boston, I had my masters in public health but I wasn't actually a nurse, so I moved to Boston to go back to school and do a nurse practitioner program and I did that here in Boston. And then, about six months before I graduated I heard Paul Speak and then he introduced me to the medical director (couldn't make out his name), and then eventually I met Jim and they offered me a job. I was very lucky at the time that I just had the right mix of skills they were looking for with a health background plus fact that I spoke Russian. I didn't really plan on doing that again, I'd been to Russia before and I'd spent a lot of time working there and I didn't really plan on getting back into that so quickly after I got my degree but it was the right thing to do. It was lucky, there was no formal position announced that I applied for, I just met the right ppl at the right time.
Q: We also wanted to ask you about future plans for PIHand where PIH is heading in the next 5-10 years?
A: We've actually in the last five years expanded enormously, our budget's gone from 20 million dollars to close to 50 million dollars in about 5 yrs. SO we've doubled our budget and we've clearly more than doubled our outreach. So because of how quickly we've expanded in the last 5 yrs, essentially to Africa to Rwanda and to Malawi, I think what we will likely do is really concentrate on expanding our programs in the countries that we're working in right now and improving them. Maybe expanding the care and improving the care that we provide at each site. So if we take Haiti for example, it's our biggest project, we've got the most patients on treatment, the most patients that we're following for HIV for TB, and we do do a lot of child health services and a lot of women's health services but we need to strengthen those programs a little bit more. So I think what we'll end up doing is doing a lot of strengthening our programs outside of HIV and TB where we do a pretty good job of providing the services now, but we certainly could do a much better job if we had more resources. So I think it will be a period of improving the care that we're providing now but also expanding within the countries that we're working (in). I doubt that any other country expansion to any new countries, although you never know.
The other really exciting thing that's going to happen...is that in collaboration with the Clinton Foundation and the government of Rwanda it looks like they're going to try to scale up our model across the country.
...so that's gonna take up a lot of people's time, energy, fundraising and really making sure that it's done well. It's critical that it's done well, because it would be our first country model...and if it fails it would be really bad for everybody.
Q: Do you know Paul Farmer well?
A: I know him pretty well, yeah
Q: How would you describe as a person?
A: He's really without a doubt one of the smartest, most grounded and caring I've ever met in my life and it's an absolute pleasure to work with him. I'm really lucky to be here, and it's not just Paul, there's so many wonderful ppl that work here. There's no bs at all, it's really always most importantky about how do we help other ppl and make their lives better. He can joke around and we can have a glass of wine and have fun but it's always focused on how we are pushing the window and how we are making it better for other ppl.
Q: How much time does he spend in other countries?
A: He spends maybe 60-70 percent of his time overseas right now, and he's mostly in Rwanda so he's far away. ...mainly he's working in the clinics with our staff there to make our programs the best they can be. He does do a lot of meetings when he's over there, but he also does a lo of clinical work and he does a lot of on the ground planning with the team over there.
Q: Where's Mr Kim now?
A: Jim is back here. He heads up ...PIH can't do it all by themselves.
Q: What does Ophelia Dahl do in PIH?
A: She is the Cheif Executive officer, she made a coupe trips to Haiti. She is very involved in the program work, and in all the meetings that we have..everyweek each of te projects has a meeting to keep up with what's going on in the different projects and she's really invovled in those. She is really involved in fundraising and does a ton of meetings with new possible funders as well as new foundations that we're approaching. She's kind of like our guide from Boston.
Interview With Tom White
Tom White: When I met Paul Farmer down in Haiti, I became very involved, but I did not chuck the other organizations. I still am very much involved in Sojourner house, St. Francis, places for all those families and shelters...and education for poor people and stuff like that. I did a lot of stuff in Roxbury helping certain parishes...Tracy Kidder wrote a book about Paul and he got some things wrong. I went to Haiti because Project Bread asked me to build a bread oven in Haiti to save women from walking twenty miles every week to get their bread. So I said yes, and the people at Project Bread said, "Oh you've got to go see Paul Farmer." So I met Paul about twenty-five years ago, we hit it off right away, so I started doing things with him but I didn't drop the other things. New involvements, but I kept a lot of the ones. My philosophy basically is, if something doesn't need me, like Nativity Prep developed a list of people who give, you know, like, ten-thousand a year - when I get to be sufficient, I leave. It's Paul Farmer's philosophy - we had the same philosophy - is to start with the poorest of the poor because they have nothing. Paul and I hit it off right away. He was still in med school but he'd started a one-room clinic in Haiti. He came back, and he was in Cambridge, and we started right away to finish the one-room clinic, more personnel, more diagnosis, more building, more everything, more feeding programs. So that's about the way it ran.
Ben: About how much have you donated to Partners in Health over the years?
Tom White: I couldn't give any specific data. But, Paul and I started the budget with three, four, five-hundred thousand, and then I gave him a million and I was able to do the whole thing for awhile, but then we went public in '87 and we were able to get money from other people, and now the budget's over fifty-million. It was simple, Paul and I would sit down at my place in Cambridge and discuss the needs and so forth and I'd just take care of it, whether in installments or [in] any way he wanted. I trusted him completely, that's what made it work. I knew that he gave up making money and he was very compassionate and a genius and he was going to be a great doc even though he was still in med school. He worked at the Brigham and Women's before he became a full-fledged doctor. [He] wanted to keep every single one of them, you know, surgery, and psychiatry, the whole works. But he went for anthropology because that's what's most needed in places like Haiti and Africa.
Ada: So we wanted to know, why PIH? And what did you find different about PIH that attracted you?
Tom White: Well I went to Haiti to see the bread oven I built. And I saw the extent of the poverty. I just felt that they needed my help more than anybody else...I chose PIH because the potential for growth, to treat so many people, you know, each year we treat around 4 million patients a year, that's a far cry from a one room clinic [...] Paul was not a difficult decision, because first thing I knew [was that] he cared nothing about making money, he didn't have a nickel in his pocket, and also, he was an obvious genius. He'd pick up a book and look at a page and he'd have it. He turned to be not just a great doctor, but a great organizer of hospitals and we picked up four more in Haiti and now I think we're probably going to do all of Rwanda, which means more hospitals there.
[...With] Naomi leaving for med school, Paul needs a new assistant. Going to Africa is a twenty-three hour flight with five plane changes.
Ben: Can you tell us about Mr. Farmer, Ms. Dahl, and Mr. Kim, the original partners?
Tom White: Ophelia met Paul in Haiti, before I even met them. But I think she went back to London to study. Paul and I were first [in Haiti] in 1983. Twenty-five years ago, we were getting PIH off the ground and expanding and going into Peru, building more buildings, getting more doctors. She was not much involved but she came back a couple of years after I met Paul.
Jim, of course, was his classmate in medical school. They were very friendly from the beginning. Paul was ahead of everybody in studies, so Jim had to spend more time catching up and catching up to Paul. But the minute he got his final degree, he joined us. He was the guy that did most of the work down in Peru with the drug resistant TB we found down there. I remember [when] he and I went over to St. James the Apostle in East Boston. There was a Diocesan priest from Central or South America. And Jim went over and say "Hey listen, I want to spend some time in these poor countries." They already had a building in Lima, Peru; in the poor section - the slums, I guess. They let us take it over. We fixed up and started in there. It just went like that, but Jim was very involved, constantly. He went to the World Health Organization for three years but he came back a couple of years [ago] because he was "number-two" man there, but he was frustrated by the red tape that exists in those organizations. He couldn't get things done. That's one of the things that made PIH able to work because most organizations say "Well, we'll consider it, or we'll take it under advisement. We need more information, etc, etc." It goes on, it seems like forever. You know, I'm no Bill Gates. [I] probably gave thirty to forty million to PIH over the long run. But the main thing was that I gave it immediately when they needed it and they had to have this or that. I said "Yes go ahead." because if I said no, [then] people were going to die. So it was an easy decision for me.
Jim came back - he's got 3 hats. He's got a big job at Harvard Medical school, one at PIH and one at, and one at (incomprehensible), i think it is. I can't keep up with Jim.
Ada: You started out with PIH, and we wanted to know, when you started PIH, you probably had a vision and we wanted to know how far you've come in that vision and how far you think you'll go in the next 5 to 10 years.
Tom White: Well, it's funny you ask that question because we never put any limits on where we'd go. We just went as fast as we could and went as many places as we could, and the only question was getting the funding to expand where we wanted to. I think if you look at most organizations like it, well there's nothing like PIH, I think, but if you look at other organizations, quite often they set themselves a goal, and when they reach that goal, they stop. And I know right now that we'll never stop...I know in my heart that he and Jim and Ophelia will never stop, they'll just keep going. They'll get the money somewhere [...] like taking a chance...I just say "You know, gotta give it the world" and that's the way PIH runs. Not to say they're not very intelligent with their monetary decisions, but they just are not going to stop going. They'll keep on going, and they will get the money somewhere. They'll get it from Bill Gates, or other people. There are a lot of other people that are considering major gifts like five million or ten million. As the years go on, they'll get more publicity and as they do get more publicity, more people will want to help. The funny thing about rich people is - it's not always true - but, if something gets very well known [or] "attractive", they don't want to be left out.
I was very lucky to meet Paul. But that story in Tracy's book is not correct. I said "Paul who the hell put that in there?" It says that Paul sent a message to me [saying] that if I wanted to meet him, I'd have to go to Haiti. What happened is, when I built the bread oven, they kept pushing for it, so I went over, and then I met Paul, and when I met him, he was kind of cold at first. He thought I was typical establishment...found I was pro-union and anti-Reagan, I was his kind of guy.
I don't understand these people who have billions of dollars and sit there making more money, and do nothing with it. Actually they miss a lot of joy because there is a lot of joy in seeing some of the people who were starving to death blossom into a well-fed, well-educated person, and they miss that. I think it's a tragedy. Money is their god.
It's 8:30 PM in room 307 at the Boston Latin School, and three exhausted Seevakers are typing away at their respective computers. Lost somewhere among the Bertucci's rolls, piles of paper, and books is...our sanity. Just kidding - it's actually Ben's USB drive.
After completing last year's Seevak website on Darfur activist Gloria White-Hammond, we were looking forward to nights without sleep, research on human rights, and spending time with each other. However, we were now faced with the terrifying obstacle of choosing the topic of this year's website. Names were proposed, Olivia and Ada nearly got into a fistfight, but the choice was not so difficult in the end.
We were all pretty big fans of Paul Farmer, a social anthropologist and physician who was working to provide health care to patients in some of the world's most impoverished nations. In October, Ada and Olivia had met up in Harvard Square to hear Paul Farmer and other activists speak at Partners In Health's annual symposium. What they heard opened their eyes to many of the difficulties that other people in the world are enduring: negligent governments, lack of health care and education, and poverty. But more importantly, we learned that progress is being made, and that the future for global health and social justice is very bright, thanks to organizations like Partners In Health. We especially liked the idea of health care as a basic human right -that it is a necessity, not a privilege, to receive health care. And so, the two enlightened ones proceeded to bully Ben into agreeing to Paul Farmer and Partners In Health as the topic for this year's Seevak prject.
As we read more and more about the work that PIH has done, we found it harder to understand why problems such as lack of health care seem to come second to others. It is so easy to disregard the suffering of others because we rarely have to worry about things like getting enough food or medicine ourselves. For the next few months, we typed, read, thought, and talked to other people about this. We found a great source of inspiration in Paul Farmer and PIH because they had proved that ridiculous dreams could be played out realistically. This is probably the most valuable thing we have taken from Seevak - the encouraging feeling of optimism that seems to surround Partners In Health and Paul Farmer. One of us was especially lucky. Olivia and Ben both got crazed calls from Ada during vacation starting with: "OMG, I just met Paul Farmer." Yes, she did. While walking to school to work on Seevak, Ada was almost given a heart attack when she bumped into the Paul Farmer on his way to solve a parking problem, which reminded us that the people who are indeed saving the world are just ordinary people working at their greatest capacity to help others. Paul Farmer, Ophelia Dahl, and Jim Yong Kim were only a few years older than us when they began to make changes, which taught us that being students does not prevent us from making a difference.
It takes audacity to place oneself in dangerous positions and to fight back when others lend only discouragement. Although Paul Farmer was met with the incredulity when he first proposed his health care plan for Haiti, he, with the help of his colleagues, fought until every patient could receive the necessary care. It takes an unimaginable amount of faith to approach something in a way that the world has never seen before, let alone accepted. And it takes a lot of guts to stand up to powerful institutions and push them to accept change. Paul Farmer and PIH have done all of that - they have fought for those who do not have the means to fight for themselves.
We would like to thank all the amazing people at Partners In Health, in particular, Donna Barry and Tom White for talking to us about PIH and what they do. We also wish to thank Andrew Marx, Kate LaMonaca, Zoe Agoos, Naomi Rosenberg and Amy Bischoff for providing us with resources, materials, and lots of encouragement when we visited PIH's Longwood office in April. We couldn't have finished this project without the help of Maribeth Macaisa and Ari Klickstein, our technology advisors, Mrs. Freeman (because she's Mrs. Freeman), Sarah Onofri, continually tireless, helpful and encouraging, and our wonderful Seevak advisor, Dr. William Carroll.
We would also like to thank one last person. Last year, Mr. Sheldon Seevak, the Boston Latin School alumnus whose generosity has allowed students to take the Facing History course and participate in the Seevak Website Competition, passed away. We wanted to take the opportunity to thank him for all that he has done. Mr. Seevak knew that students should learn to think about and question what they're taught, and understood that young people have the ability to make profound changes. Mr. Seevak - we would like you to know that we will not remain silent as long as we have this ability and we promise that we'll make you proud. Thank you so much. God Bless.
~ Ben, Ada, and Olivia