When Farmer first visited Haiti, a year after graduating with a bachelor’s degree in medical anthropology from Duke in 1982, he says he “had no clear idea of what I wanted to make of my life.”

But his indecision would not last long.

“I worked as a volunteer in a crappy clinic,” he says. “Haiti is the reason I went into infectious disease, because I saw so many people die unnecessarily of these diseases when I was a student.”

Once he had become closely acquainted with the woeful lack of medical treatment for Haiti’s poor—and gotten his medical degree from HMS—Farmer didn’t hesitate to attack these problems head-on.

“Rather than focus on something very simple that would be in-and-out, he asked people there what they really needed,” says Joia Mukherjee, the medical director of Partners in Health (PIH), the non-profit medical organization which Farmer and close colleague Jim Y. Kim founded in 1987. “And they said, ‘We need a hospital, because we’re very ill.’ So he built the hospital.”

The hospital was the Clinique Bon Saveur, which Farmer established in Cange in 1985. It is still going strong—and its services are still necessary for the ever-growing health problems of Haiti’s poorest.

Along with a number of associated outpatient clinics, the 40-bed Clinique treated more than 50,000 impoverished patients in 2000, dealing mostly with victims of AIDS and drug-resistant tuberculosis—and all for free.

Farmer’s colleagues say his efforts have not always met with approval from western nations.

For several years, he locked horns with the United Nations’ World Health Organization (WHO) over its program of treatment for extremely poor patients with drug-resistant tuberculosis—a program which Mukherjee says amounted to letting such patients die on the grounds that treating them would not be “cost-effective.”

“The field of international public health is a mess because of no funding,” Farmer says. “So of course people in this arena have set their sights low. Our own view was that we need to raise more money rather than lamenting the lack of it and setting standards lower for poor people.”

In essence, Farmer was fighting to convince the WHO to reinterpret what they saw as a hard bottom line and trying to impose his personal, hands-on approach on an entire system.

But Farmer did not give up, raising money through PIH and proving that financial considerations could be overcome when the far more important concern of human life was at stake—even when those lives belonged to the profoundly poor people that medical organizations had often neglected in the past.

Today, the incoming Director-General of the WHO is Jong-Wook Lee, who Farmer says “is a great man” who strongly values the health of the poor.

And Mukherjee says PIH representatives—including Kim, Farmer’s closest associate—will have a strong advisory role in the WHO’s immediate future.

Coming Back to the Ivory Tower