A Million Dollar Prize For A Doc Who Believes In 'Accompaniment'
When Dr. Paul Farmer learned that he would receive a million-dollar award for his work, he was a bit ... baffled. He is a Harvard Medical School professor, medical anthropologist and co-founder of Partners In Health, an organization whose mission is to bring modern medical care to those in need around the world. But the words "medicine" or "health" do not appear in the award, announced Dec. 16. It is the Berggruen Prize for Philosophy and Culture. "I was a little shocked to get a prize with the word 'philosophy,'" he says.
And yet it's apt, says Nicolas Berggruen, real estate investor and founder of the private equity firm Berggruen Holdings. He founded the Berggruen Institute that awarded the prize to Farmer. "We have a simple idea. It is to reward somebody who is developing new thinking to help society evolve," he says.
Farmer, 61, who is the author of the new book Fevers, Feuds, And Diamonds: Ebola And The Ravages Of History, spoke with NPR from his home in Miami, Florida, about his philosophy and his life's work.
In a 2011 address to Harvard students, you talked about a key element of your philosophy of care that you call "accompaniment." You said, "There's an element of mystery and openness in accompaniment: I'll keep you company and share your fate for a while. And not just a little while." The promise to stick with patients through thick and thin seems basic but highly neglected in most medical settings. What does "accompaniment" mean to you in a health-care setting?
I'm an infectious disease specialist. I work in hospitals, in ICUs. But that's just a tiny fraction of what's needed. When people are unable to make choices — if they're in prison, or refugee camps or are impoverished — they're less able to adhere to a treatment. They need help outside the hospital or clinic. In Haiti, community health workers are called accompagnateurs, which means people who accompany. The community health workers do what your mother does for you when you're sick and stay at home. She stays with you, she accompanies you. Accompaniment means: I'll go with you and support you on your journey wherever it leads. I'll keep you company.
You've worked in impoverished areas of Haiti, Peru, West Africa, and Guatemala. What have you learned about how to provide care to the world's poorest people?
I've learned that social disparities like racism get into the body. How does something outside of us get into us? If you look at apartheid in South Africa, you see that people get sick with tuberculosis, malaria and other diseases because of poor work conditions, lack of jobs, shantytowns. You have to look at what's happening to the patient in front of you, and think about ways to address social disparities. If there's food insecurity, then you provide food when you provide care. Or if patients drop out of treatment, you provide transportation to the clinic, or you send community health workers to the patient.
I had an epiphany in Haiti during the early AIDS years. We were working with women's groups about HIV prevention, and one woman said that prevention is about "food, wood and water." If you want to protect women from HIV, make sure they have jobs so that, in their struggle to survive, they have no need to become commercial sex workers.
How would you compare the health care provided in the world's poorest countries to the care provided to America's poorest people?
They're pretty similar and pretty deplorable. But I've seen many examples of superior care in poor countries. Rwanda, for example, was a small country coming out of genocide against Tutsi people in 1994 when the question for health authorities became how can we roll out a caregiving response to HIV. I imagine distrust in authorities must have been at an all-time high. Authorities dealt with the distrust by focusing its HIV response on the rural poor, genocide survivors and other poor people. They provided care first to those who needed it the most. Within just a few years they were providing universal access to new AIDS diagnostics and treatments. If you compare that nationwide response to Americans marginalized by poverty and lack of insurance, the experience in Rwanda in providing AIDS treatment was better than in some parts of the U.S.
How do those lessons translate to the current pandemic?
With COVID-19, you still must look at social conditions. How do you expect someone to isolate for ten days or two weeks if they don't have enough food or can't pay the rent or live in crowded conditions?
I was in Rwanda during COVID-19. To go from an American city to Rwanda was to be humbled by the fact in Rwanda, they had few cases, very few deaths and high rates of mask wearing and contact tracing.
Why is the U.S. doing so poorly in this pandemic compared to other countries?
Lots of things: Racial injustice and health inequities in addressing COVID-19 are reasons. There's a paranoid approach to politics and a lack of leadership. There's been a long history of underfunding public health measures, so that across the country, people say there aren't enough resources to do things like contact tracing. And nothing is more tragic than the politicization of wearing a mask. I mean, how did that happen?
People insist that the virus doesn't discriminate; we're all in the same boat. Do you think that's true?
If we're in the same boat, it's a luxury liner with various classes of service. There are some people down in the bilge. Some people are in places on that boat where they're sure to do poorly.
Take a meat packing plant or a prison or a crowded slum somewhere or a reservation. It's absurd to claim the risk is the same as in a leafy suburb where people have big homes and can keep themselves isolated safely.
As the vaccine rollout begins in wealthy countries, what will happen if enough vaccine doesn't get to poor countries?
We really have to think globally. Failing to have a rapid rollout around the world will ensure that this pathogen lives on.
On a happier note: What will you do with a million dollars?
It's kind of wonderful to, one day, go suddenly into the donor class! We're in the middle of three crises bound up together: racial injustice, social disparities and a health-care crisis. So I'll steer some of that money to institutions like Partners in Health and the Equal Justice Initiative in Montgomery, Alabama. My wife has worked with issues of rights for women and girls, and that work is on my mind, too.
For myself — I plan to buy some bromeliads, a tropical beauty, for my garden.
Susan Brink is a freelance writer who covers health and medicine. She is the author of The Fourth Trimester and co-author of A Change of Heart.