Paul Farmer inspired the global health community to improve cancer care in low- and middle-income countries

Last week the world lost a true visionary and a wonderful human being. Paul Farmer was committed to equity in health and beyond. His life’s work has helped make this world a fairer and better place. He was a humanitarian, a champion of human rights.

He was kind and generous with his time, and fun to be around. Paul just loved people, all people, and they loved him. He was not only comfortable in settings and situations that would be outside of most of our comfort zones, but he regularly sought out such situations.

Photo courtesy of Stephanie Mitchell/Harvard University
Copyright: President and Fellows of Harvard College

I first met Paul during a residency in Boston. He and Jim Kim were behind me in training, and I was responsible for planning internal medicine clinical rotations for the year. Paul and Jim were what we called “hemi-docs” – the two shared an internship slot so they could spend time outside of Boston, essentially creating Partners in Health (PIH). When they came to me with leave requests, I asked them where they were going and what they were doing. Haiti? What the hell were they doing there? Really? I was intrigued and inspired and wanted to know more.

I have followed Paul’s career and our paths have crossed at various times. After completing my postgraduate training in oncology, I developed my own interests in global oncology, partly inspired by Paul. During a trip to Rwanda in 2009, I was invited to visit the PIH Rwinkwavu clinic. On the walls of the clinic, I saw the phrase “Inshuti Mu Buzima” – Friends in Life – which was how Partners in Health was known in Rwanda. During my visit, a meal was served, not only to the patients, but to their families, to the staff, to the visiting medical students, to everyone. Paul believed that optimal health and healing for a patient could not occur without addressing food, clean water, shelter, transportation, and family and community support and health. Paul was teaching and addressing “social determinants of health” before the phrase became the buzzword it is today.

Although trained in anthropology and infectious disease, Paul also cared deeply about the inequities he saw in cancer care and survivorship in low-resource settings. In 2010, Paul was the lead author of a call to action published by the Global Task Force on Cancer Care and Control in Developing Countries, a group led by Felicia Knaul and the Harvard Health Equity Initiative. . The paper challenged the global health community‘s assumption that cancers could not be adequately treated in poor countries, noting the analogy to similar baseless arguments against HIV treatment when skeptics opposed the use of antiretroviral drugs in low-resource settings in the early 1990s. The call to action explored how the response to HIV/AIDS could provide a model for addressing the global burden of cancer and concluded that much could be done to prevent and treat cancer, even in the most resource-limited settings.

In 2013, at the invitation of Sandy Swain, then president of the American Society of Clinical Oncology, Paul spoke at the opening ceremony of the ASCO annual meeting. He addressed a standing crowd on the theme, “Building Bridges to Improve Cancer Care in the Context of Poverty: Lessons from Haiti, Rwanda and Malawi.” I saw that speech again this week after Paul’s death, reflecting on his enthusiasm and support for improving global cancer outcomes conveyed in his speech, and the wisdom of his words of encouragement.

Paul challenged us to engage in serious efforts to address the huge gap in cancer outcomes in low- and middle-resource countries, calling for urgent action, while acknowledging the challenges. He called on academic medicine to establish health equity pathways to bring oncology trainees to underserved communities, wherever they are. Paul took aim at what he called the failure to imagine that we can’t treat cancer patients in a low-resource setting, urging us to “Bring in the staff and everything and bring in the fight against the cancer in Africa”.

He concluded by saying that it wouldn’t be easy, but we could do it and we had to set ourselves high goals. “Providing adequate health care in contexts of poverty is by definition difficult, but the past two decades have taught us that setting our high standards can help bring in new resources to solve old problems. Paul’s words continue to influence and shape our priorities and direction today – our ASCO mission statement strives to “promote equitable patient care of the highest quality”, and one of our four main strategic objectives is “to have a global impact”. We heard you Paul!

In 2017, I visited PIH Butaro District Hospital in Rwanda, an incredible facility, providing state-of-the-art cancer care in a setting that could only have been achieved by dreaming big, setting the standards the highest and by not listening to the skeptics. The visit focused on a project involving patient navigation, peer support and community engagement, driven by the understanding that to cure the patient, we must address the whole community and cultural context of the patient.

If we were to lose Paul so soon, it is comforting to know that he passed away in Butaro after a week of teaching and touring cancer with medical students, in a facility, community and country that he loved, doing what he loved.

Paul Farmer has inspired and influenced the entire global health community. His passion and contributions will continue to inspire generations to come. On behalf of myself, ASCO, and the global oncology community, I pledge to honor Paul’s legacy by working to achieve equitable access to prevention, diagnosis, treatment, and high-quality supportive cancer care for everyone, wherever they live. My thoughts are with Paul’s wife and children, his Partners in Health family, and all who knew and loved him around the world.