Beyond mountains there are mountains

As I emerge from an incredible few weeks in Zambia, I wanted to reflect on a recent loss in the international world – Dr. Paul Farmer, co-founder of Partners in Health. Farmer was a doctor, a humanitarian, and a writer, who helped shape the global health landscape in ways that every international development organization can learn from. After graduating from Duke University, he volunteered in Haiti at a hospital, and was taken aback by the fact that people had to pay in advance before they could receive treatment. He returned to Haiti during his time at Harvard Medical School, striving to create a different kind of hospital. Instead of one centralized place, he created a vast network of community health facilities through his work with Partners in Health.

In reading about Paul Farmer over the years, I’m always struck by three things. First, Farmer’s work to engage communities is almost unparalleled in the space. The model of various clinics focused around community health workers who were trained to do a number of tasks and help reach the last mile of patients. Over 99% of the employees are from the countries that they work in – rather than parachuting in doctors or residents from Western countries, Farmer preferred to engage doctors and nurses. He was especially proud that the clinics he helped to establish employed locally hired teams that he helped to train.

Second, Farmer often felt that structures like the WHO and World Bank prioritized cost-effectiveness rather than just effectiveness. While treatments like oral rehydration were a cheap solution to treat dehydration, Partners in Health was founded on the idea that larger investments had the potential to save more lives. That’s why they invested in modern teaching hospitals that could leverage local talent to reach a wider number of people.

And last, his biography Mountains Beyond Mountains, is titled after a Haitian proverb, that Farmer lived by – “Beyond mountains there are mountains.” Opportunities and obstacles are infinite alike. Farmer saw this in his own work with Partners in Health – as the organization made progress with diseases like malaria, tuberculosis, HIV/AIDS, they saw a reduction in mortality. Oftentimes that meant they would see other illnesses down the line, like cancer, and had to modify their approach to be able to treat those illnesses as well.

In so many ways, Farmer’s life’s work has influenced almost every sphere of international development – including my own work with Impact Network. May he rest in peace, knowing the lives that were saved and bettered with his own.

-Reshma