Mary Wilson
Well-known member
Madhukar Pai MD, PhD
I am a Canada Research Chair of Epidemiology & Global Health at McGill University, Montreal, where I serve as Associate Director of the McGill International Tuberculosis Centre. I did my medical training in India and public health training in Berkeley. My research is mainly focused on improving the diagnosis and treatment of tuberculosis in low and middle income countries. I like to write about global health, technologies of relevance to global health, healthcare delivery challenges in low income countries, and inequities in healthcare. I serve as an adviser to non-profits such as WHO, Stop TB Partnership, FIND, and TB Alliance.
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Oct 21, 2022,06:24pm EDT
Madhukar Pai
I Write About Global Health, Infectious Diseases, And Equity
Paul Farmer, physician, activist, academic, humanitarian, and teacher died in Rwanda on February 21, 2022. Few people in the field of global health have had a bigger impact than him. After his death, people all over the world took to social media and blogs, and wrote about how his life inspired them. My favorite was this tweet from Arcade Fire, the Canadian rock band: “Paul Farmer changed our lives forever. He showed us how to work harder for others than for yourself. He was the punkest mother fucker WE ever met.”
I’ve had the privilege of interviewing him twice, once on stage in 2018 when he visited my university (McGill University), and, more recently, for Forbes, about his 2020 book on Ebola in West Africa. Both times, I was blown away by how much time Paul gave me, and the words of encouragement he had for my work on tuberculosis.
Recently, for a global health course that I teach at McGill, I tried to summarize my big learnings from Paul, and posted that as a tweet. Inspired by the responses to my tweet, I interviewed 20 people from around the world, asking them for their biggest learnings. By sharing them in this post, we hope to keep his legacy and teachings alive.
Lesson 1: Every person matters
Paul strongly believed that all people, no matter who they are or where they are, deserved healthcare and support. In Haitian Creole “tout moun se moun” roughly translates to ‘every person is a person.’
He saw health as a fundamental, non-negotiable human right. “If access to health care is considered a human right, who is considered human enough to have that right?” is a particularly famous Paul Farmer quote. ...
Lesson 2: Practise accompaniment
Lesson 3: Approach everyone with a hermeneutic of generosity
Lesson 4: Make equity the core of global health practice
... “Do we want global health, as is practiced from universities across the globe, to be radically different from colonial health or tropical medicine? If so, then let’s stop referring to it as “global public health” or “global health security” and start calling it “global health equity,”
Lesson 5: Resist socialization for scarcity on behalf of others
Paul believed that global health is ‘socialized for scarcity on behalf of others.’ Countries under-invest in health, and, because of the under-investment, choices are often made between prevention and treatment; between disease A versus B; and between disease control versus clinical care. ...
An excellent current example of setting a lower standard for others is our acceptance that rich nations deserve unconstrained access to Covid-19 vaccines, bivalent boosters and anti-viral treatments, while people in low-income nations should settle for much less or nothing. Everything is possible for the rich and privileged, but very few interventions are ‘cost-effective’ in low-income populations. This apartheid logic has killed millions already.
Lesson 6: Tackle structural and social determinants of diseases
In many of his books (e.g. Infections and Inequalities, and Pathologies of Power), Paul emphasized that epidemics are driven and shaped by social, economic, political & neocolonial forces. ...
Lesson 7: Engage communities
“Community engagement cannot go wrong and has to be practiced in all corners of the world,” ...
Lesson 8: Irrigate clinical deserts
... “most of West Africa is a public health desert, which is why Ebola spreads there, and it is a clinical desert, which is why it kills there.” His book provides compelling data on how an overwhelming majority of the mostly White American and European healthcare workers who contracted Ebola survived (because they got modern care in US or European hospitals), while the infection killed two-thirds of their West African peers. Many died because even simple intravenous rehydration treatment was not made available to them in the clinically barren settings they were in.
Lesson 9: Be in it for the long haul
Gene Bukhman, a cardiologist and medical anthropologist at the Brigham and Women’s Hospital, was Paul’s student. “I think the biggest thing I learned from Paul goes back to a very early conversation I had with him. I was sure that all forms of tuberculosis would be virtually wiped out very soon given how focused he was on this issue. It was ridiculous that such a treatable disease should persist in the 21st century! ...
Lesson 10: Counter failures of imagination
We are living in the midst of multiple global threats - Covid-19, climate crisis, and conflicts. None of these global threats can be solved without equity, global solidarity, transnational cooperation, and global citizenship. ...
https://www.forbes.com/sites/madhuk...s-we-learnt-from-paul-farmer/?sh=347bebbd6619