Dr. Paul Farmer, a physician who devoted his professional life to advancing health as a human right, was an advocate, friend, and mentor to many at Harvard School of Dental Medicine (HSDM). He understood the importance of oral health as a human right and was a key partner with HSDM faculty in building oral healthcare capacity in the far corners of the world. Dr. Farmer died February 21, 2022 in Rwanda at the age of 62. HSDM faculty who knew him well, reflect on his legacy.
In every situation, Paul Farmer saw the humanity of each person. Our eyes and face tell the world when something is wrong. When he saw needs and knew how to address them, he did. If the usual policies and procedures impeded delivering necessary care, he found a new and different way to do so. The patient was the center of his focus, and everything emanated from that laser-like focus. Bring what the patient needs to the patient. Let the doctors, nurses and health professionals work as a team and deliver care near home. Bring world class care to low resource areas: cancer care, surgical care, dental care. Adding dental care to Human Resources for Health (HRH) was groundbreaking. Although the United Nations and World Health Organization have declared oral health an essential human right, no other NGO has welcomed and integrated dental care and oral health providers like HRH and Partners In Health (PiH) under Paul. With collaborators in Haiti, Rwanda, and elsewhere, we initiated a paradigm shift around addressing and including dental care in standards of primary and preventive care for low resource populations. We are contributing to better overall health and wellness, the core of Paul’s mission, through better oral health. Look at the faces. A healthy smile lights up a face and expresses happiness, love, confidence, and hope; the essence of what Paul brought to each life he touched.
– Jane Barrow, Director of Global and Community Health, Executive Director HSDM Initiative to Integrate Oral Medicine, Lecturer on Oral Health Policy and Epidemiology
“It’s all about equity.” Paul Farmer’s words rang true the day I heard them and stayed with me ever since. Why should social determinants and skewed distribution of resources blind us from recognizing and advancing health as a human right, lulling us into an ignorant slumber where we tacitly approve that the way things are is the way they must be? We are socialized to believe that resources required to diminish poverty and provide equitable health will forever be lacking, therefore accepting a lower standard of care for poorer communities and countries, often of color, is the inherent unbreakable norm. That is the “socialization of scarcity for others” theory that Dr. Farmer taught about and fought against. He wrote about it in “Reimagining Global Health.” Poverty and inequality drive poor health. If we subscribe to the belief that it is impossible for the world’s poor to have health care equal to its rich, then it will be so. Dr. Farmer didn’t accept that norm. And because of his inspiring work and legacy, neither do I.
Resources avail whatever is prioritized. In 2011, Rwanda’s leadership prioritized a health workforce able to deliver health promotive and disease preventive services, equitably, throughout the country. An array of stakeholders, funders, visionaries, and implementers joined forces within the framework of the Human Resources for Health Rwanda program, envisioned and championed by Dr. Farmer. Oral health often remains sidelined when health systems strengthening projects take the global health ‘field’. This time, in Rwanda, oral health made the cut, and we were players. My blessing was to lead our team through eight years of implementation to establish the first and only school of dentistry in the country, a success recognized publicly by Dr. Farmer. Rwanda refused the status quo, rooted in racist colonialism, and dared to break the scarcity norm, insisting that resources be channeled to its self-identified priorities. Today Rwanda has what it dreamed – a homegrown oral health workforce training program producing oral health professionals who serve Rwandese throughout the country. Local. Qualified. Equitable. Sustainable.
–Donna Hackley, Instructor in Oral Health Policy and Epidemiology, Interim Director, Pediatrics
Many years ago, as a solo private practice dentist in Colorado, I began a journey to discover how I might make an impact beyond my dental chair and find greater fulfillment in my work and thus my life. A supportive friend sent me the book Mountains Beyond Mountains. Dr. Farmer’s courage, faith, and hope inspired me to leverage my own courage, faith, and hope. I took a leap from a private practice in downtown Denver, reading about Haiti from the pages of that book alone, to a full-time position in global health at the Harvard School of Dental Medicine, working in a hospital in Haiti with Partners in Health. This is the influence and impact Paul had on the human spirit. He gave us the courage to challenge our own expectations of ourselves, to shock our family and friends with new life goals and world views, to leap from the pages of a book into real communities across the world.
Our team has come together through our own unique journeys to pioneer HSDM’s work in global oral health, largely shaped by Dr. Farmer’s influence. I learned how to name what I had witnessed in my community when I read the term “structural violence” in Pathologies of Power; we are thus committed to purposeful community partnerships in everything we do. In the broader dental community, our approach has been informally nicknamed “the Harvard Model,” with a focus on capacity-building and local empowerment, where Rwandan providers are treating Rwandans, Haitian providers are treating Haitians. We work to decrease dependency on outsider health care providers, including ourselves, with a continued goal of dissolving harmful power dynamics and addressing structural violence at every level.
I recently came across a journal entry I wrote back in 2008 while searching for meaning in my career, after reading Mountains Beyond Mountains: I dreamed of partnering with local teams of health care providers such as nurses and community health workers to improve oral health in their own communities around the world, especially where dentists were scarce or nonexistent. This is exactly the work I do today. Thank you Paul, for sharing your light with the world so that we can find our own. As you so wisely said in To Repair the World, “All of your most important achievements on this planet will come from working with others—or, in a word, partnership.”
–Brittany Seymour, Associate Professor of Oral Health Policy and Epidemiology, Discipline Director, Global Health
To be touched by greatness is a privilege and a blessing. Paul Farmer is a friend. Not close, but true. He respects our collective work. That is valid. I learned to respect him, not just based on what has been written, but more-so based on the conversations with those he served and worked with. Paul's passing today deeply penetrates those who knew, loved, and respected him. His depth was such that he is still among us. For the many living in disenfranchised environments who know him best, their impact may be different, perhaps, because of great despair. For them it may mean losing a beacon of hope and light. For me, I am more determined to continue the good fight and service to humanity. We, who have been touched by this person, feel obligated to carry this work further and deeper. Paul gave all he had daily. On occasions, when I would see him, I wondered from where does his passion derive, and how does he keep going? How does he find balance?
Thank you, Paul, and your family, for allowing yourself to make the sacrifice for so many of us. I feel the weight of you. You have come, and in the blink of an eye, you have gone. I do not know whether you suffered in your last moments, or how much you suffered due to your daily grind, finding restitution for the atrocities that humans commit upon each other; but I do know that you fought the "good fight!” You lived an honorable life and left it all on the field! I believe that I speak for many who will make sure that your legacy lives on. We shall always call your name because it gives hope and joy!!
– Brian Swann, Interim Assistant Dean for Diversity, Inclusion, and Belonging,
Assistant Professor of Oral Health Policy and Epidemiology
