Celebrating Paul Farmer:His life inspires our medical education work

Join the Journal of Cancer Educationin honoring Paul Famer.

We celebrate Paul Farmer.

Paul Farmer challenged us: “If access to health care is considered a human right, who is considered human enough to have that right?”

Let us acknowledge writers who inspire us to celebrate Paul Farmer. Tracy Kidder won a Pulitzer Prize for his book “Mountains beyond Mountains,” in which Kidder described and photographed Farmer, as he traveled with Paul over time and national borders; Lisa Rosenbaum captured the attention of the NEJM constituency, sharing the moral clarity with which Paul Farmer illuminated global health.

Tracy Kidder titled his Pulitzer Prize-award winning book “Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World.” As Kidder explains, he respectfully references a Haiti idiom anticipating “mountains beyond mountains,” i.e., challenges that may emerge following well-won initial successes. Kidder lets us join him as he follows Farmer, infectious disease physician and anthropologist, as Kidder moves with Farmer from Harvard lecterns to patients’ bedsides in Haiti. We listen, through Kidder’s narrative, as “Dokté Paul” spends time cultivating relationships with patients and their community.

Kidder tells us how Paul Farmer led health care outcomes research. Farmer created medical care oases, building relationships that nurtured-communities. Farmer shared evidence of outcomes with the NIH review community; the NIH, in turn, came to appreciate that medical care might anticipate warranted trust - as did the experience of patients for whom “Dokté Paul” cared.

Beginning with Farmer’s work in Haiti, Kidder lets us hear how Paul Farmer created the nonprofit “Partners in Health,” as an enduring tool for health equity. Farmer’s work expanded our understanding of what a physician could do; Kidder let us see what physician-advocate Farmer did accomplish. Paul Farmer’s outcome research evaluated medical care for HIV patients with tuberculosis; patients received medical care, including antiretroviral medicine - and food.

How encouraging to hear, in Tracy Kidder’s narrative, that Paul Farmer respected his life partner, Didi Bertrand, an anthropologist from Haiti, and their children. Paul’s family continued to inspire him, across time and borders. In Rwanda, in February of 2022, Paul Farmer died.

In “Mountains beyond Mountains,” Tracy Kidder shares his narrative and photos, as he travels with Paul Farmer, from classrooms in Harvard’s medical school, to the bedside of patients in Haiti. Tracy Kidder continued to visit with Paul Farmer, as he moved through Peru, and on to Moscow, ending in Rwanda. Paul Farmer championed medicine’s infrastructure, including medical education.

Kidder continues to write compelling true-life stories. In House, he tells a story of a family house being built in Amherst, Massachusetts. As artisans “raise high the roofbeams,” Kidder also let us read about relationships they construct. Kidder also worked with our Journal of Cancer Education editor, Joseph O’Donnell. Kidder tells how medical student Deo left his war- ravaged Burundian medical school and then Rwanda, emigrating to Joe O’Donnell’s academic home in Dartmouth. Kidder tells Deo’s story in Strength in What Remains.

Joe O’Donnell knew Paul Farmer. Joe shared his hope that Farmer would tell his story, including Paul’s ability to negotiate with the pharmaceutical industry for costs of HIV medication, with our journal.

When Paul Farmer died at the age of 62, I had read about, but not met Paul. Tracy Kidder’s “Mountains beyond Mountains” lets us hear Farmer’s story. My colleague, Joe O’Donnell, as well as my colleague Senait Fisseha, knew Paul as a friend and colleague. I was honored to journey to Africa with Art Michalek and Joe O’Donnell. Later, I worked with Senait Fisseha, M.D., J.D, planning together with Dr. Tedros (Ted) Ghebreyesus, as they extended medical school education in Ethiopia. As with Joe and Art, members of our AACE commmunity, Senait and Ted worked to build the infrastructure of medical education.

For Mountains beyond Mountains, Kidder won a Nobel Prize. Generations can continue to let Paul Farmer’s life inspire theirs. In the Journal of Cancer Education’s 2019 review of our journal, we can read about our growth, across political boundaries and health care communities. This issue of the Journal enables us to acknowledge leaders from Africa.

Continuing our Journal’s respect for diversity, may we acknowledge Senait Fisseha, for her leadership in medical education. Professor Senait Fisseha was born in Ethiopia. Her medical specialty is reproductive endocrinology. For the WorldHealth Organization (WHO), Professor Fisseha serves as Chief Advisor to Dr. Ted Ghebreyseus, who is the WHO Director- General. At the University of Michigan, Senait chaired as Chief of the Division of Reproductive Endocrinology and Infertility Dr. Fisseha also served as founding Executive Director of the Center for International Reproductive Health Training. Senait’s colleagues include Dr. Tedros (Ted) Ghebreyesus, who now leads the World Health Organization as Director-General. His early career in medicine researched malaria. Ted led work confronting Ebola; he continues to negotiate access to medication for Covid. Of note to oncology, as leader of WHO, Ted’s award, in the year of Paul Farmer’s 2022 death, lets us honor the memory of Henrietta Lacks. Ted’s posthumous award honors her, “whose cells – taken without consent are a world changing legacy.”

I, Patricia Mullan, savored my academic training, which focused on cultural anthropology and psychology. My graduate training focused on designing medical school curricula, assessing medical trainees and practitioners, and program evaluation. My grant-supported research has continued to focus on cancer, from curriculum development, assessment of medical practitioners in practice, to program evaluation.

I was honored to join Senait, continuing to work with her and her colleagues in curriculum development, assessment, and program evaluation, in Ethiopia. We met with Senait and Ted at UM, planning our work in Ethiopia. In Ethiopia, we met other colleagues collaborating with Senait from the University of Michigan’s Medical School. This included Dr. Dalton, health services researcher and teacher. Our work in Ethiopia included collaborating with a transplant surgeon. The surgeon worked with Senait, preparing a medical school in Ethiopia’s capital city of Addis Ababa, as a training site for transplant surgery. He explained to his students from Ann Arbor, Michigan, that the climate of Addis Ababa would likely provide them with a temperature ranging from (parochially-rendered) 48 to 75 degrees Fahrenheit.

As we work to further medical education, contemporary colleagues upon whom we can draw include Michael Patton. Patton continues to lead program evaluation. He explains actionable impact evaluation, focusing on Africa; Patton identifies our world as experiencing pandemics and climate change. Harvard’s historian Caroline Elkins received a Pulitzer-award. Her Pulitzer-award winning “Legacy of Violence” painstakingly explains post-colonial governance in west Africa. In addition to writing this book, Ellkins’s testimony won an international judgment for the surviving people of Kenya. We might read as the post-colonial British government continues to move populations across its vision of the world as its chess board. Elkins illuminates the social context framing our efforts to lead medical care and education.

Serving as a bookmark to Paul Farmer’s leadership, Kamal, working with his colleagues, exemplifies what collaborating health care palliative care provider-advocates can accomplish. In 2019, Kamal and his colleagues published, in Health Policy, their explanation of their reform they achieved in Medicare’s reimbursement for palliative care. The reform aligned provider reimbursement to health care providers as they care for patients, whose needs change over time.

I aspire to continue working as a senechai - storyteller. The poet Ocean Vuong provides an inspiring example: elicit and scribe the stories our emigrants may share with us, mindful that “on earth, we are briefly gorgeous.”

We thank the Journal of Cancer Education. We particularly thank Art Michalek and Joe O’Donnell, for nurturing for leadership in preventing and treating people with cancer, with compassion and competence. We also thank Maria Bishop, who continues to lead our journal in this tradition.

Slàinte Mhath (good health)

We join the Journal of Cancer Education in acknowledging work upon which we can build. This includes:

Dalton V. Xiao Xu, Mullan PB, et al. International Family Planning Fellowship Program: Advanced Training in Family Planning to Reduce Unsafe Abortion. International Perspectives on Sexual and Reproductive Health. 2013 39:42–46.

Kamal AF, Wolf SP, Troy J, et al. Policy changes key to promoting sustainability and growth of the specialty palliative care workforce. Health Policy. 2019: 910–918.

Kidder T. Mountains beyond Mountains. The quest of Dr. Paul Farmer, a man who would cure the world. New York, Random House. 2003.

Kidder T. Strength in what remains. New York, Penguin House. 2009.

Mullan PB. Patient care handoffs: action plans for entrustable patient care. University of Michigan School of Medicine. 2014.

Patton MQ. Evaluation criteria for evaluating transformation. AJE 2020; 142: 53–89.

Rosenbaum L. Unclouded judgment: Global Health and the Moral Clarity of Paul Famer. NEJM. 2022.

Schuitevoerdrer D, O’Donnell J. Michalek A, Vetto J. Thirty years of the Journal of Cancer Education:a review. Journal of Cancer Education. 2019. 34:388–391.

Spencer KL, Grace J. Social determinants of Health. Ann Rev Sociol. 2016. 42:101–120.

VO. Time is a mother. New York, Penguin House. 2022.