Life

I Argued With Paul Farmer Until the Day He Died. We’re Worse Off Without Him.

I still can’t believe my friend is gone.

A white man in black glasses smiles while standing in front of a mosaic wall.
Paul Farmer in New York in 2017. Desiree Navarro/Getty Images

Some days after the announcement of his death in Rwanda at age 62, it seems that everybody loved Paul Edward Farmer Jr., M.D., Ph.D., physician-anthropologist, and writer. I know that I did. And he loved me back. There is nothing special about either of those things, because he actively sought love and gave it as freely. I often felt like he projected his own condition onto others, a way of manifesting their more desirable personal qualities. He’d often tell me, a self-avowed misanthrope, that I was especially kind and big-hearted. Cardiomegaly, he called it, after the actual cardiac condition. Typical PaulSpeak.

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I first met Paul when I was an undergraduate at Brown in the late ’90s, and he guest-lectured in a small seminar run by two of his anthropologist friends. (We were assigned two of his books for that week’s class and I had read neither; he called me out on it—subtly.) We corresponded by email for years about human rights, liberation theology, and public health, occasionally meeting at conferences or on Harvard’s campus, as I completed my Ph.D. in the department of anthropology. After I moved on to become a professor, he invited me to spend my junior sabbatical in the department of global health and social medicine at Harvard Medical School.

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A woman who worked as a research assistant in the anthropology department reached out this week to express her condolences for my loss. She had seen us talking together in the office, or at department lectures, and noticed how close we seemed. “I didn’t know him,” she wrote, “but he always acknowledged me, even from afar.” I think she did know Paul, because that was the kind of person he was. He recognized others’ humanity. It’s what made him a good doctor, and it’s what made him a better anthropologist than he claimed to be. (His recent messages to me were filled with doubt about where he stood as an anthropologist.) An astute critic of social, political, and economic inequalities, and their impact on health and well-being, he understood a person’s place in a hierarchy; he lingered a bit longer with the driver, the janitor, the waitstaff, the cleaner. He loved his patients too. My WhatsApp conversations with him from before the pandemic were frequently filled with pictures of him with former patients in Peru, Rwanda, and Sierra Leone. He boasted about hosting a large dinner party for Freetown-based Ebola survivors at one of the most expensive hotels in the city, at a time when survivors were stigmatized, held at arms’ length. The day before he died, he sent me what he called a “sweet” video that medical students at the University of Global Health Equity in Rwanda had made for him: a photomontage, with Nina Simone’s “To Be Young, Gifted and Black” as the soundtrack.

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When I first started working in HIV/AIDS prevention in the mid-1990s, which also happens to be when I first met Paul, highly effective AIDS therapies had just become available—but only in the Global North, and to those who could afford them. Concerns about cost effectiveness and the cultural norms of “the poor” were offered as an explanation for not distributing such medications to them. My first book focused on HIV care and support in Sierra Leone, and writing it required extended engagement with Paul’s pioneering research and his and Jim Yong Kim’s tireless advocacy to expand access to HIV treatments worldwide. I think it is easy to underestimate the intentionality with which Paul, a keen observer of the white liberal (WLs, in PaulSpeak), mobilized shame to enlist the support of powerful policymakers, organizational leaders, and others in efforts to ensure access to lifesaving therapies. He showed that programs and policies that failed to offer a “preferential option for the poor” were inequitable, and actually produced the problems they’d been trying to resolve: the spread of HIV/AIDS and AIDS deaths. Very few among the do-gooders wanted to be revealed to have undervalued the lives of others.

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Occasionally, when another academic discovered that I studied medical anthropology at Harvard, they would ask if I knew Paul Farmer. That’s how I learned that Paul had his fair share of haters too, among whom there were at least three camps: those who had never met him but were suspicious of his celebrity (Paul and I had a running joke called the Bono Plan, which was essentially that one day “his friend” Bono would call me on my birthday); those who had met him and were suspicious of his charisma; and academic readers who were skeptical of his claims and the cogent, confident prose with which he set about pursuing them. A call-to-arms essay like his scathing, vivid 2015 London Review of Books piece “Who Lives and Who Dies?” isn’t something every academic can produce. Neither do other academics motivate undergrad readers like Paul did.

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Intellectual criticism of his work might come from his leftist, progressive interlocutors who questioned whether he had come untethered from his socialist roots. Scholars committed to the disciplinary silos of academia found his history too divorced from the archives, his anthropological analyses insufficiently attentive to “culture,” his public health analyses too ethnographic. In reviewing his earlier writing about Haiti, his main critics highlighted an ideological tic that is reflected in his later work as well: He tended to center his political-economic critiques on neocolonial or imperial formations, looking at relations between nations, rather than within them. For many scholars of Haiti, his 1994 book, The Uses of Haiti, while a thoroughly researched work on U.S.-Haiti relations, suffered from a serious omission: It had not sufficiently focused on the role of race, color, and class among Haitians, and the role of national elites in the immiseration of ordinary Haitians. The more I read of his work, the more I appreciate his commitment to being an undisciplined thinker, and the way he brought his political, moral, and intellectual commitments together in compelling (albeit not particularly concise!) prose.

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He was deeply influenced by liberation theologians like Gustavo Gutiérrez and Black radical thinkers like Frantz Fanon. His most recent book, Fevers, Feuds, and Diamonds: Ebola and the Ravages of History, about the West African Ebola outbreak, was modeled on the work of Guyanese historian Walter Rodney and offers a deep history of the region, calling attention to the role of enslavement, regional wars, and responses to other epidemics in shaping Ebola’s emergence, and to the racialized character of the response.

No one could accuse him of not having done the reading. He was always asking me for reading suggestions if I brought up a new concept or mentioned an idea I was writing about. He read widely and voraciously, sending me links to things he’d read from the New Yorker or mentioning books he’d just read: from Agatha Christie to the Mexican gothic novels his daughter had given him for Christmas, to Saidiya Hartman’s first book. When our schedules finally lined up and we met up in Freetown, Sierra Leone, I discovered that he had dragged a suitcase full of books about Sierra Leone, Liberia, and Guinea to read in the relatively little time he had to himself in his hotel room.

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This walk-the-talk impression that so many of us had of Paul is why his signing a letter, early this month, supporting the Harvard anthropologist John Comaroff, an alleged serial abuser, disappointed so many people. We have become accustomed to learning that some of our intellectual heroes not only have failed to practice what they preach but that they also engaged in predatory behavior that was at odds with their published scholarship. A keen observer of human nature, and of the organizations humans inhabit, Paul understood that patron-client relations were crucial within elite academia. But it typically seemed important to him that he not use the power and goodwill that he had accrued through workplace promotions, prestigious awards, and celebrity status to harm others. The same week that he signed the letter, he’d penned a co-written op-ed in the Boston Globe, decrying the racist treatment of his colleagues at the Brigham and Women’s Hospital by white supremacist protesters. It made no sense. His signing the “Comaroff letter,” as small an act as he originally perceived it to be, would have a significant impact on whether students felt they could trust him—or even trust the integrity of his life’s work. How could he not have known?

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When I saw his name on the letter, I was shocked. Paul tended to stay out of the affairs of the anthropology department, and if he did intervene, I’d assumed he’d be doing so on the behalf of students. I immediately contacted him to find out why he’d signed. At the time, he seemed to think he was actually safeguarding LGBTQ students from abuse in the field (as Comaroff claimed to have been doing when speaking to one student in a way she found quite disturbing about the danger of her being raped during fieldwork), as well as supporting colleagues who had specifically asked for his help with the administration. I told him what I knew about the situation—mostly detailed accounts I’d heard from others about decades of harassment by Comaroff and his wife, star academics in the department—and argued that signing such a letter did not align with the values I knew he held dear. He immediately apologized to me. I told him that I was not the person he needed to apologize to. We repeated this back-and-forth over the next couple of days. He was working 14-hour days, balancing clinical and teaching responsibilities in Rwanda with administrative responsibilities back in Boston. The weight of having been on the wrong side of such an important issue was eating away at him: “I just don’t feel like I have the thick skin required for an environment like that. Nor do I want thick skin.”

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On the evening before the retraction from the majority of the signatories was published, he sent me a message saying he’d planned to retract his signature and apologize. He insisted on an apology and not simply a retraction. He didn’t like the idea of backpedaling. But this was not the consensus view, it would seem, among the other signatories in the group; the letter was published as a retraction only. As we continued to talk over the course of these interceding weeks, I sensed he was weary of the politics of the Faculty of Arts and Sciences, where the departments of anthropology and African and African American studies reside. He relished his clinical work, his clinical teaching, and felt a sense of purpose in his role as chair of the department of global health and social medicine. He had expressed some ambivalence in our conversations about where his priorities should be over the next few years.

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In the last week of his life, Jan Brunson, a colleague at the University of Hawaii, who’d attended a webinar in which he was presenting, publicly questioned him on the letter. She’d asked him how he reconciled his social justice work with having signed the letter: “First of all,” he said, “I want to say that I don’t think that I can reconcile that. I think it was an error. And so I agree with Dr. Brunson and I think saying that … feels insufficient. I said that as well. I wouldn’t want to sound like I was defending myself by saying that the topic at hand was about graduate-student advising, and a request for transparency in the process. … I agree with the critique. I don’t feel that those two things can reconcile. I think it’s better just to say that I made a mistake and I’m very sorry about it.”

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A mutual friend who was in Rwanda with Paul at the time sent me the video, after I had reached out to him about the inadequacy of having simply retracted. I told Paul that I saw his response. He wrote, “I’ve only said one thing and that is I’m sorry and was wrong. … But I feel I’ve dishonored myself by signing a letter before knowing shit about any legal case. In fact, it was about protecting LGBTQ grad students, I thought. What an idiot.” He continued, “You already told me I was an idiot, and did I contest that? Or defend myself? I did not.” (For the record, I never called him an idiot.)

I inquired about his health, because he looked a bit tired in the video.

“So you’ll rest?” I pressed.

He assured me he would find some relief once he’d arrived in Sierra Leone. I was skeptical, because he would always qualify his promises to me about getting more rest. “But don’t forget how much I love the clinical part so that’s kept me going Xoxox.” Paul could be so infuriatingly committed to his work. Asking him to rest was asking far too much.

He lived enough for three extraordinary lifetimes. He died doing what he loved.

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