Although Paul Farmer spends the vast majority of his time consulting with individual patients, he arguably accomplishes even more good by convincing others to donate their money and time to help him fight disease in the Third World. Farmer is a politician as well as a doctor: he makes speeches around the world, influencing powerful people to send their money to Haiti and Peru. Farmer’s nonprofit ventures require him to work with large government organizations, obey strict rules, and at times navigate through the complex world of bureaucracy. In order to understand Farmer’s success as a doctor, we need to understand how he goes about organizing, planning, and—at times—humbly begging.
Usually Farmer’s fundraising strategy is simple: communicate his passion and his personal convictions to the wealthiest people in the world, most of them American. One of his most important allies is Tom White, a Boston development millionaire who gives enormous sums of money to Farmer’s hospitals in Cange and Lima. As Kidder explains, White is sympathetic to Farmer’s political and ideological convictions: he respects liberation doctrine and, like Farmer, has deep misgivings about American foreign policy. It’s largely because of individuals like White that Farmer’s most important charity, Partners in Health, survives for so many years.
But at times, Farmer faces a more difficult task: soliciting money and resources from institutions that he doesn’t entirely respect. In these cases, he’s forced to “soften” some of his political and moral stances, at least rhetorically. When PIH is trying to fund TB treatments in South America, for instance, Farmer makes a series of speeches in which he implies that denying South America this treatment would be disastrous, for the reason that TB bacilli would eventually spread to the United States, causing massive death. While he privately believes that saving South American lives is a worthwhile end in itself, Farmer presents his plan to American investors in a more palatable way: measuring the “value” of the treatment program in American lives—the only currency his audience understands.
As with any politician, Farmer has to soften or compromise on some of his beliefs in order to accomplish tangible goals. But because of his strong overriding commitment to protecting individual lives, the outcomes of his dealings with donors and other nonprofits never feel like compromises. For all his political engagement, Farmer claims that he’s not dogmatic in his thinking—the only thing he’s really dogmatic about is healing the sick. In this sense, any money he raises from a wealthy donor is a victory for PIH, and any partnership he arranges with another nonprofit is a step forward for his patients.
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Nonprofits, Politics, and Compromise Quotes in Mountains Beyond Mountains
He made about $125,000 a year from Harvard and the Brigham, but he never saw his paychecks or the honoraria or royalties, both fairly small sums, that he received for his lectures and writings. The bookkeeper at PIH headquarters cashed the checks, paid his bills—and his mother’s mortgage—and put whatever was left in the treasury. One day in 1999, Farmer tried to use his credit card and was told he’d reached his limit.
One time when they were together in Boston, White said, “You know, Paul, sometimes I’d like to chuck it all and work as a missionary with you in Haiti.” Farmer thought for a while, then said, “In your particular case, that would be a sin.”
Some people said that medicine addresses only the symptoms of poverty. This, they agreed, was true, and they’d make “common cause” with anyone sincerely trying to change the “political economies” of countries like Haiti. But it didn’t follow, as some self-styled radicals said, that good works without revolution only prolonged the status quo, that the only thing projects like Cange really accomplish is the creation of “dependency.”
He’d write about how the Centers for Disease Control, a federal U.S. agency, had gone so far as to identify Haitians as a “risk group,” along with several other groups whose names began with h—homosexuals, hemophiliacs, and heroin users—and about the incalculable harm all this had done to Haiti’s fragile economy and to Haitians wherever they lived. In his thesis, he’d marshal a host of epidemiological data to show that AIDS had almost certainly come from North America to Haiti.
In early 1994, just before The Uses of Haiti came out, Farmer wrote an editorial for The Miami Herald. The gist of it was: “Should the U.S. military intervene in Haiti? We already have. Now we should do so in a new way, to restore democracy.”
Farmer and Kim began collecting a number of official WHO statements. Some put the case more plainly: “In developing countries, people with multidrug-resistant tuberculosis usually die, because effective treatment is often impossible in poor countries.” For Farmer […] there was a larger principle involved. A TB epidemic, laced with MDR, had visited New York City in the late 1980s; it had been centered in prisons, homeless shelters, and public hospitals. When all the costs were totaled, various American agencies had spent about a billion dollars stanching the outbreak. Meanwhile, here in Peru, where the government made debt payments of more than a billion dollars every year to American banks and international lending institutions, experts in international TB control had deemed MDR too expensive to treat.
Then Goldfarb spoke up again, his voice calm and acidic. “I want to share with you a simple reality. I have six million dollars. With three million dollars I can eemplement DOTS for five thousand Russian prison inmates. And assuming that ten percent have MDR-TB, forty-five hundred will be cured and five hundred will go down with MDR-TB and die. And there’s nothing much you can do. So. I have a choice. And my choice is to use another three million dollars to treat the five hundred with MDR-TB, or go to another region and treat another five thousand. I’m working with leemited resources. So my choice is not involved in the human rights of five hundred people, but five hundred people versus five thousand people.
As sometimes happened, Paul seemed to know what Jim was thinking. “What do you want to do now?” he asked. There was warmth in the question, Jim felt, a real invitation for him to come clean. “Political work is interesting to me, and it has to be done,” he said. “I prefer it to taking care of patients. It’s O for the P on an international scale.”
Farmer was forty now, and he had the credentials to operate in the way Hiatt envisioned, on a purely executive level. In academic circles his reputation had grown. He was about to become a tenured Harvard professor. He was near the head of the line for the big prizes in medical anthropology; some of his peers were now saying that he’d “redefined” the field.
