Dr Paul Farmer’s last book Fever, Feuds and Diamonds: Ebola and the Ravages of History published in 2020 takes readers back into history before the Covid-19 pandemic to understand how the neo-colonial approaches to development ravaged some of the poorest countries in Africa.
In the book, Farmer explores the violent history preceding the Ebola epidemic – the longest and largest in recorded history – which began in south-eastern Guinea in 2013 and later spread to Liberia and Sierra Leone. Part memoir, part academic exposition, the Fever, Feuds and Diamonds describes his rich experiences of working in West Africa during the epidemic and thereafter, mostly focusing on Sierra Leone.
Farmer is critical of the approach adopted by the European and American healthcare professionals who were assigned to contain the outbreak, instead of undertaking the messy and dangerous work of caring for, rather than quarantining or isolating, the already afflicted.
When Farmer died on February 21, aged only 62, tributes poured in from around the world. Among those who expressed his condolences was Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organisation, who recalled Farmer’s efforts for health equity.
Paul Farmer, born in Florida, was the author of several books and leader of research and practice in epidemics, having worked during the HIV epidemic, Ebola and recently the Covid-19 pandemic.
He was the Chair of the Department of Global Health and Social Medicine at Harvard Medical School, and co-founder of Partners In Health, an international non-profit, featured in the film Bending The Arc (on Netflix).
As a student of medical anthropology, Paul Farmer began to understand the systemic inequities in primary health care provision in low- and middle-income countries and made tireless efforts to “irrigate” the health and clinical deserts of West Africa, Haiti, and economically poorer sections in the United States.
As a teacher, orator and practitioner, Farmer advocated for the explaining the “control-over-care approach” and its historical, colonial origins in the field of public health. He reframed the field of health in terms of equity and challenged the colonial-era policies that are still prevalent in a command-and-control approach as witnessed even in the isolation, quarantine and handwashing approaches put in place during the Covid-19 pandemic.
His extensive work and writing about Haiti was filled with assurance, having lived and worked there throughout his adult life and a familiarity that he had nourished within its rural reaches as an anthropologist and as a doctor who cares for the destitute sick.
In his foreword to Farmer’s seminal work, Pathologies of Power: Health, Human Rights, and the New War on the Poor, Amartya Sen, the senior economist lauds Farmer’s knowledge of maladies such as AIDS and drug-resistant tuberculosis, which in combination with his expertise on culture and society, acquired not just by learning from a distance but also from actually living and working in different parts of the deprived world.
Paul Farmer and his colleagues have laid the ground of valuing critical insight on legal and historical ramifications of ignoring the care aspect of health care systems, especially in underdeveloped and resource-afflicted countries because of years of violence, disease outbreaks and imposition of Western ideals of medicine and health.
However, the global challenges faced today are manifold – racism, transnational and transregional health disparities based on class, caste, gender, sexual preferences, and several other factors.
It is Farmer’s dogged determination that enabled the global health community to see beyond the immediate ramifications of living and responding to a global pandemic but also question, reflect, and look deeper into the systemic injustices and deprivations that cause death and suffering without any support.
Paul Farmer may have shown that despite the outcome, the fight must continue. As more like-minded individuals come together, the diverse views we can gather could help spark the change we want to see.
Dr Sneha Krishnan is Associate Professor at Jindal School of Environment and Sustainability, OP Jindal Global University and Founder, ETCH Consultancy Services.