Paul Farmer, Trinity ’82, was a global health scholar who worked to re-envision the way the world approached healthcare in low-resource settings. Farmer passed away on Feb. 21, 2022, at the age of 62. Farmer’s work, particularly in Haiti, set a precedent for capacity building and community-based healthcare models that held dignity, human rights and sustainability at the forefront. As an anthropologist and clinician, Farmer devoted his life to addressing grave disparities in health. As a Duke alumnus, Farmer’s enduring legacy remains deeply relevant to students today, especially those working at the intersection of global health and social justice.
One of Farmer’s distinguishing traits was his commitment to embedding himself within the social fabric of the communities that he served. Unlike many foreign aid efforts that approach their work from an arms length, Farmer took residence among the people of Cange, Haiti — listening, learning and responding to their needs in real time. Additionally, his work was not one broad stroke; he saw his patients as individual people and felt a great sense of responsibility towards them. He was known for hiking into the high points of the mountains to do welfare checks on patients when they missed a dose of their antiretroviral medication.
The essentiality of Farmer’s work is evident in its global reach. Farmer began treating drug-resistant tuberculosis in Carabayllo, Peru, and his efforts to thwart multidrug resistant tuberculosis would continue on to Cuba and Russia. With additional support, Farmer was able to lower the prevalence of tuberculosis in his target countries so much so that they became comparable to their high-resourced counterparts. He leveraged these accomplishments to endorse the idea that “some lives matter less is the root of all that is wrong with the world,” emphasizing that improving healthcare in resource-constrained settings was both critical and achievable.
Farmers worked from the understanding that one is ill-equipped to address health disparities when they work within a vacuum. In order to enact meaningful change, you must develop a profound understanding of the economic, political, historical and cultural forces shaping a community's lived experience. As he noted in Tracy Kidder’s “Mountains Beyond Mountains,” “In mastering a language, one had to learn not just the literal meanings of words but also their connotations, and to grasp those one had to know the politics and economic systems and histories of a place.”
For Farmer, learning Haitian Creole entailed more than improved communication; it was about respect, deep cross-cultural engagement and the dismantling of power imbalances between doctors and patients. His work to understand the language was emblematic of his larger philosophical approach: to be of service to a community is to truly understand it from within.
As someone who seeks to cross the chasm that is often imposed by cultural and linguistic differences, I find this commitment to be particularly moving. For me, studying Haitian Creole under Jacques Pierre, lecturing fellow in French, Haitian Creole and culture, has revealed how interwoven language and culture are. To study a language without consideration of the context from which it is derived — and without knowledge of the people who speak it — is to only partially engage with the language. By studying the history of Haiti and all that the country has endured, I have developed a refined perspective and a greater appreciation for the language.
Farmer shared a similar reflection in that his awareness of history's consequences was not theoretical — it was born from lived experience. His time in Cange enlightened him to how damaging small decisions made in distant centers of power can be. As he recollected, “I would read stuff from scholarly texts and know they were wrong. Living in Haiti, I realized that a minor error in one setting of power and privilege could have an enormous impact on the poor in another.”
Farmer’s work and legacy are still alive today. His foundational work persists through Partners In Health, an international organization that stands as a beacon of community-driven global health. His philosophy — that healthcare is a fundamental right that all humans are entitled to, not a privilege — has influenced the perspectives of generations of medical practitioners, activists and students.
In light of current events in global health — most notably Trump administration’s withdrawal of “$58 billion in international foreign aid,” a figure that represents funding for “maternal and child health, nutrition, neglected tropical diseases, and global health security” in Haiti and many of the regions where Farmer dedicated his life’s work — we feel the weight of his legacy now more than ever. These reductions have real consequences that will be felt. As underscored by Wesler Lambert, the current interim executive director of Zanmi Lasante, “The potential rollback of PEPFAR support is not just a bureaucratic decision; it is a direct threat to the lives of thousands of Haitians. It risks undoing two decades of progress, jeopardizing the ability of patients to access treatment, and setting back global efforts to control HIV.”
Understanding that access to healthcare should not be determined by geography, affluence or political will —but rather respected as a fundamental human right — remains one of the most imperative challenges in this moment. Haiti, a country that has endured centuries of structural violence, continues to resist, rebuild and push forward — much like the many countries worldwide that, despite spliced funding and fractured support, remain steadfast in their efforts for universal health.
Given this, Farmer’s legacy imparts one clear message. Solidarity entails more than distant concern — it demands a keen eye, cultural understanding and the willingness to engage on the ground, in the language of the people. For those of us, including myself, who seek to follow in his footsteps, we must understand that global health is more than medicine: It is about history, policy decisions and the lived experiences of those who are most vulnerable. It is about holding a community's voice at the center and elevating it. I believe that the first step towards meeting this end starts with language, as it is the bridge that allows us to truly see, hear and stand alongside those we aspire to serve.
As the landscape of global health continues to shift, I hope we can be reminded of Farmer’s far-reaching contributions and his vigorous aim to work with global communities on even footing.
Mya Harris is a Trinity senior.
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