#PaulsPromise (and my promise to Paul Farmer)
Rest In Peace, Dr. Paul Farmer
Gardens for Health International (GHI) is one of those things that would not exist but for Dr. Paul Farmer. One of the countless things – lives, friendships, careers, organizations, belief systems, senses of purpose and meaning, treatment regimens, books, movies, academic disciplines, and more – that we have been trying to collectively tally since his achingly all-too-soon death, in Rwanda, on February 21, 2022.
There is literal causality: it was because of Partners in Health’s work in Rwanda that I – along with Emily Morell – pursued an internship there and found an incredible community of those dedicated to health equity. It was because of Paul’s warmth and exuberance that I felt welcome in that community. And it was because of Paul’s endorsement – initially, a minute-long video that I remember anxiously recording on my digital camera – that GHI gained invaluable legitimacy.
But it is GHI’s spiritual center for which we owe Paul the greatest debt. And here the causality gets a bit murkier. Please forgive the gardening metaphor, but it really feels apt – Paul (a gardening fanatic himself) didn’t plant seeds so much as magically change the soil such that entirely new ecosystems could grow and thrive. Those of us whose lives were transformed by his often cannot pinpoint the moment of transformation. It wasn’t reading AIDS and Accusation or seeing a community health worker in action. Rather, it is the gradual, continuously unfolding realization that maybe his vision for global health equity isn’t just possible, but imperative. A moral imperative. This belief starts to change the way you see the world. It opens your heart up to an entirely new type of love. It reveals glaring inequities – and the violence of those inequities – and unmasks those who, whether by action or omission, perpetuate those inequities.
Most importantly, you see that this belief does not belong to Paul Farmer. It lies dormant in all of us – and, for many, Paul has roused us from our slumber – and we must make it our own in order to act upon it. You start to see that you are part of a Movement for global health equity, premised upon beloved words from Gwendolyn Brooks, read each year at GHI’s harvest celebration:
we are each other’s
harvest:
we are each other’s
business:
we are each other’s
magnitude and bond.
To know GHI’s work is to know our abiding commitment to the Kinyarwanda phrase turi kumwe, meaning “we are all in this together” or “we are one.” It is not a phrase that appears in our mission statement or on our homepage, but it is the reason that I and many others feel connected to the organization, year in and year out.
While it is a collective sense, turi kumwe probably means something different to each person who utters it. For me, turi kumwe means that no one gets left behind, as with the eponymous fund – funded largely through voluntary staff contributions and governed by a rotating staff council – that provides direct assistance of money and other resources (such as a new roof or water storage system) to families whose needs extend beyond what GHI typically provides. Turi kumwe means solidarity with the families we serve and with each other. It is what we say when we show up for each other in ways big (weddings, funerals, births, etc.) and small (lending a hand to fix the printer or offering a mid-afternoon snack). It is why we take lunch together – often alongside neighborhood children – each day. Turi kumwe also means that we see this work as the biggest of tents and there is something sacred that binds everyone who joins in, however they are able.
To know Partners in Health’s work is to know its abiding to commitment to the tenants of accompaniment and partnership. The lines of our spiritual lineage could not be more direct, but we have also made these ideas our own in order to act upon them.
To know Partners in Health’s work is also to know that its U.S. image as a Boston-based, Harvard-bred, white-led humanitarian organization is thankfully – and increasingly – not the image of the organization in the countries in which it works. Partners in Health’s commitment to working alongside the public sector and centering local leadership is absolute, and complex. GHI has long endeavored to also make good on this commitment, but we have found startlingly few examples beyond Partners in Health. GHI only survived in its early days because of Rwandan engagement, partnership, and leadership and it thrives today because of Rwandan engagement, partnership, and leadership. It is fitting that Solomon Makuza, GHI’s first Rwandan Executive Director, joined us from Partners in Health. I immediately felt the same kinship with Solomon that I have felt with others throughout the Partners in Health family. While I know that Solomon shares my sense of pervasive injustice, he has also been the standard-bearer for a Paul-like optimism, holding space for possibility and progress and finding joy by connecting, deeply, with individuals.
Looking back, it is easy to see how GHI came out of a very particular cultural and political moment (as are all moments, fifteen-plus years later). While we were inspired by Paul’s clarion call for global health equity and the right to health, we were also buttressed by another popular movement at the time: social entrepreneurship. It is now funny to think that these two movements were often talked about in the same breath – the former is rooted in the idea that capital should not dictate the value of a human life and, with that, the necessity of a robust public sector that can confer economic and social rights, while the latter draws its inspiration from the private sector. In the most cynical sense, the latter asked that we find “sustainable” – and, better yet, revenue-generating – solutions to poverty without challenging the very systems that created poverty in the first place. For a long time, we tried to be all things to all people and pretend as though these two ideologies were not in tension. (Though Paul was never one to mince his words on this topic.)
Personally, I was aware that I was part of an idealistic youth movement and thought that, like generations before me, I would age into a pragmatic understanding of why there must be poverty and why we must treat the poor as though their lives matter less. But something went wrong along the way. Fifteen-plus years later, I’m more insistent than I have ever been that we should spend all the money in the world and print more money if we have to – whatever it takes – in order to guarantee the right to health. I’m more devout in my belief that, as the fulfillment of this right lies with the public sector, we need to do the incredibly hard work of engaging with governments, starting with our own, to make them more representative and more responsive to those who are most marginalized.
GHI has evolved well beyond its early days and the organization’s approach is uniquely its own. But I feel the same clarity when I visit GHI that I felt in 2006 when I worked out of the Partners in Health hospital in Rwinkwavu – the same clarity that I felt years later when I worked for public defenders and housing attorneys. These organizations and individuals openly acknowledge that we live in a world that tells us to treat people without means as though they mean less and, every day, they forcefully work against that idea by ensuring the highest standards, by listening to people and acting in ways that respect their autonomy and affirm their dignity. When they meet someone in crisis, they do not hide behind the narrow dictates of their professional role but instead seek to provide holistic support that addresses social, economic, and political realities. Indeed, in my own career as a policy attorney working on the social determinants of health, I have genuinely struggled to understand the line separating clinical health from public health as the two were so completely interwoven in my early experiences and education – how can we treat someone if the environment in which they live is making them sick? How we can prescribe someone a treatment that they cannot afford?
While I seem to have endless words about Paul’s influence on GHI’s work and my own, I will limit myself to one final observation: keep going. When your mission is rooted in social justice (the why, not the how), there is *likely* no point of completion (but how sublime if there were?). There is no singular cost-effective model to bear out and replicate. You have to keep moving towards justice, and calling out injustice. You have to challenge authoritative individuals, institutions, and stances that function to preserve an unjust status quo. You will make mistakes, big mistakes. People will lose interest. Morale will flag. Political and cultural capital will ebb and flow. Philanthropic dollars will follow the latest fad. But stay curious and open. Demonstrate solidarity with longstanding and emerging movements – combatting racism, decolonizing international aid, protecting women’s rights, advancing LGBTQ+ rights, supporting workers, saving our planet, fighting corporate greed, and so much more. Pull in new people – young people! – and lift them up. Give them a platform. Make them feel like they are part of something and that it matters because it does.
Paul talked about the legions of young people whom he inspired as his “retirement plan.” I don’t think any of us imagined that it would look like this (I pictured Paul attending various 25th-anniversary celebrations, held by governments around the world, for the perfect, enduring fulfillment of the Right to Health…and Food, and Housing, and Education). This is too soon. But I do promise to keep going. And I will do so alongside the ever-expanding Partners in Health community and with boundless gratitude for Paul and his legacy.
– Emma Clippinger