Farmer, Sachs Discuss Global Health

Over 500 people crowded into Low Library’s rotunda for the Earth Institute’s Global Health Equity event last night, with people spilling into the aisles and even standing for over an hour.

Featuring two giants in the field, renowned medical anthropologist, physician, and global health and infectious disease expert Paul Farmer, who teaches anthropology at the Harvard Medical School, and Earth Institute Director and economist Jeffrey Sachs, the evening took the form of a conversation about the work that Farmer’s international charity organization, Partners In Health, is undertaking in Rwanda.

Sachs opened the Distinguished Lecture Series event by introducing Farmer as “someone who’s set the world on fire with an idea”—that of providing quality health care, particularly in treating multidrug-resistant tuberculosis and HIV infections, to poor people the world over.

In its 20-year history, PIH has established quality health care facilities, research outfits, and advocacy programs for destitute populations in developing countries. Starting out in Haiti, and since expanding its reach to nine other countries including Peru, Siberia, and most recently, Rwanda, Lesotho, and Malawi, PIH has accomplished what many public health experts deemed impossible just a decade ago.

“Never, never take no for an answer when you have a good idea like Paul’s idea,” Sachs said.

Farmer described the attitude of public health experts and development economists of the ’90s as defeatist and doubtful of the possibility of any real change in the face of such formidable poverty and disease as that faced in rural Haiti, for instance.

“There really was no example of how to do this in a place like Haiti,” he said.

But since its inception, PIH has yielded a “complete proof of concept if you ever needed it,” in Sachs’ words.

Just within Haiti, what began as a modest one-building clinic called Zanmi Lasante in 1987 is now a sophisticated and elaborate complex of services with a 104-bed hospital, facilities for surgery, women’s health, and pediatric care, and even a primary school, an infirmary, and a training center for community health workers.

As a direct result of the success of the PIH community-based health care model, in 2002, Haiti was among the first 10 countries to be granted funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

After visiting Zanmi Lasante in 2000, Farmer said Sachs was so taken with PIH’s achievements that he recommended they scale them up. “’You should be using the “B” word [billions], not the “M” word [millions],’” Farmer remembers him saying. Farmer briefly presented PIH’s efforts to combat HIV in Rwanda, underway since 2005, noting the particularly crucial features of developing the private sector and training community health workers to deliver health care.

No comprehensive health care system has ever been set up to completely alleviate the infectious disease burden in a poor country on a national scale, he said, but he sees in Rwanda a unique opportunity to make this happen.

“I haven’t seen it, but I think we can do it,” Farmer said.

He pointed to its non-corrupt governance and the very real capacity to build such a system as distinguishing Rwanda as an ideal candidate for achieving this goal. Working alongside the Rwandan Ministry of Health, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Clinton HIV/AIDS Initiative, PIH is currently exporting Haitians to Rwanda to catalyze this transformation using the Haitian model.

“There’s something very compelling about having a Haitian say to a Rwandan, ‘If you can do it in Haiti, you can do it anywhere,’” Farmer said, highlighting the structural similarities in the two nations, including great poverty and a history of violence.

After a brief conversation between Farmer and Sachs, about half of the 90-minute panel was devoted to questions from the audience. These ranged from the practical to the ideological, touching on topics such as family planning as a core feature of women’s health programs and the pressing need for more salaried community health workers.

Sachs closed the event by inviting Farmer back to present a status update on the national-scale Rwanda plan in two years. “Mark the date,” he told the audience. “You’re all invited.”

This widely anticipated event garnered 600 formal registrants, with registration opening over a month ago, and almost as many on its wait-list, which closed on Oct. 25. Over 500 participants were finally squeezed into the event, including all wait-listed individuals who showed up.

“I found it really inspirational,” said attendee Samantha John, SEAS ’09, who had been waiting to hear Farmer speak since last year, when he was scheduled for an appearance here that was subsequently cancelled. “This made everything in my life seem so small.”
Kathleen Apltauei, GS ’06, now a student at NYU’s Wagner Graduate School of Public Service, was daunted by the work still to be done. “I found their optimism impressive, if perhaps a tad unwarranted,” she said. “I’m just comparing their progress to the enormity of what’s left.”

Ramya Pratiwadi, SEAS ’09, commented that the conversational format of the event was particularly well-suited to this audience, most of whom were well-informed about public and global health. “The conversational aspect really made the event ... the way he [Farmer] was joking around and put everything in layman’s terms, I thought it was great,” she said.

Devika Bhushan can be reached at devika.bhushan@columbiaspectator.com.