I read the tragic news of his death at the young age of 62 in Rwanda. Farmer was one of the truly inspiring people. A highly trained doctor who came from humble beginnings, his mission in life was to bring high quality health care to some of the poorest nations in the world, starting with Haiti. A strong believer in the need for global justice and equity, along with Ophelia Dahl (who happens to be the daughter of children’s author Roald Dahl and Academy Award winning actress Patricia Neal), he co-founded the organization Partners in Health which I have supported for many years. They sent me an email announcing the sad news and saying that his death was due to an ‘acute cardiac event’, which I understand to be a heart attack. The Miami Herald has a report.

Dr. Paul Farmer, the renowned infectious disease specialist who devoted his life to fighting deadly epidemics and spent the last several years working on four continents delivering health care to millions, has died in Rwanda, his organization Partners in Health confirmed. He was 62.

A Florida native who lived in Miami with his wife and children when he wasn’t traveling or teaching at Harvard University, Farmer was co-founder of Partners In Health, a nonprofit health care organization based in Boston with a sister organization, Zanmi Lasante, in Haiti.

The recipient of many awards, one of his most recent being the 2020 Berggruen Prize for Philosophy and Culture, and its $1 million cash award, Farmer told the Miami Herald that his personal mission was to change the way humans think of infectious disease and address social inequalities in health care delivery.

The cause of Farmer’s death was not immediately known but PIH said in a tweet that Farmer passed away unexpectedly Monday in his sleep. As news traveled about his shocking death, tributes poured in with the headline “devastating news.”
…

Farmer was personable and preferred to be more behind the scenes than in front of it. When it was announced that he had won the Berggruen Prize, he said he was deeply honored but still felt anxiety over being single-out. Without hesitation be began crediting his army of researchers and healthcare providers, and said “a gift this large, allows me to join the donor class.” “I’m going to steer my prize money to two big but far from insurmountable problems: Getting us out of this pandemic and amping up our reckoning with racial injustice,” he said. “Primary beneficiaries will include two organizations with which I’ve been involved for decades, Partners In Health and the Equal Justice Initiative. These are organizations that do not turn away from the problems associated with exclusion, and the mistrust that invariably follows exclusion.”

Before COVID-19, Farmer devoted his life to fighting every major epidemic that had hit the countries where he devoted his time: HIV/AIDS, tuberculosis, cholera, Ebola, Zika and chikungunya and now COVID-19. Among his many cherished accomplishments was the construction of the post-quake, state-of-the-art 200,000-square-foot University Hospital of Mirebalais that Partners In Health and Zanmi Lasante, built in Haiti.

At Case Western Reserve University, I served on a committee that each year selected a book for all incoming students to read and in 2005, we chose the book Mountains Beyond Mountains by Tracy Kidder that was a biography of Farmer. It was my role to give a talk at the assembly for the new students that took place at the beginning of the school year in Severance Hall, the magnificent home of the Cleveland Orchestra, about my impressions of the chosen book. Below is the text of my talk that year.

I was reading Mountains Beyond Mountains and enjoying it when I received a shock. It occurred when I read that Paul Farmer was younger than me. I was immediately reminded of satirist Tom Lehrer who said in the introduction to one of his songs: “It’s people like that who make you realize how little you’ve accomplished.” Lehrer was just 37 years old at the time, and he added: “It is a sobering thought, for example, that when Mozart was my age, he had been dead for two years.”
 
I had pretty much that same feeling when reading this book.
 
Of course, you are much younger than I or Paul Farmer and so have many years to achieve as much or more than him, if you desire to do so.
 
But there are still some aspects of reading inspiring biographies of people like Paul Farmer or Martin Luther King or Mahatma Gandhi or Nelson Mandela or Rosa Parks that can be discouraging and it is that question that I want to address. Such people are often portrayed as having confronted some great challenge in their lives that they rose to meet, and so achieved greatness.
 
Unfortunately this portrayal of such people as unusual heroes and saints confronting extraordinary challenges breeds the feeling that these were somehow rare and special people with special qualities, and that the rest of us either do not have these special qualities or that we may not be fortunate enough to be confronted with a great challenge that will enable us to show our mettle.
 
I remember the high school I went to in Sri Lanka. It was a Christian school and at the beginning and end of each year we would sing a hymn that had the words (not quite in this order):

Once to every man and nation
Comes the moment to decide
In the strife of truth with falsehood
For the good or evil side
Some great cause, some great decision,
Offering each the bloom or blight,
Then it is the brave man chooses
While the coward stands aside.

It was a very inspiring hymn, so much so that I still remember nearly all the words decades later. When we sang it we hoped that one day we would be confronted with that once-in-a-lifetime moment, with a stark choice between good and evil, right and wrong, because then we would bravely choose the side of right and, like Gandhi and King and our other heroes, we would show the world what we were made of.
 
So we wait for this major choice to occur. And we wait. And we wait. And we wait. And then, one day we find that life has almost passed us by and we have that Tom Lehrer moment of realization.
 
I now feel that the sentiment expressed in that hymn is profoundly wrong. In fact, if you look more closely at the lives of the people I mentioned, they did not wait for the great moment of choice, that big decision that changed their lives. What really happened is that these people, throughout their lives, kept making small but important decisions.
 
To get a visual sense of what I am saying imagine that you are going along some road and waiting for some major fork to appear so that you can choose between two very divergent directions. What the lives of these great people really teach us is that often the road we travel actually has a large number of little forks that each diverge slightly. Each choice does not change our direction by that much. But when we consistently choose to go in a particular direction, we end up going in a much different direction than if we chose randomly.
 
What people like Farmer and King did was to make deliberate choices in the small things in life. Then when some major decision did come along, they almost did not have to think about what to do. Their instincts, developed by years of small choices, kicked in and they knew what they must do.
 
What I have learned is that it is the little decisions and challenges that we are confronted with every day that matter. Those are the decisions that shape our instincts, that make us who we are.
 
I remember Noam Chomsky, a professor of linguistics at MIT who has also been a prolific and sharp analyst of US foreign and domestic policies, talking about an incident in his life when he was in elementary or middle school. He said that a fat classmate of his was having his life made miserable by class bullies. Chomsky said that he felt sorry for that poor boy but did nothing to help him. He said that his inaction haunted him afterwards and made him feel guilty and he vowed that henceforth he would always take the side of the underdog. And I believe that that is what made him what he is today. I think all great people, when you look closely at their lives, made small but critical choices all along the way.
 
So the lesson of Paul Farmer’s story is not only to think of grand goals of changing the world, although we should have such goals. It is also to look around us right now, to see who are the people who are the underdogs, who are the people left out, who are the people discriminated against, victimized and picked on, and consistently take their side.
 
On page 244 of the book Kidder describes Farmer “stewing over an email from a student who had written that he believed in Farmer’s cause but didn’t think he could do what Paul did. Farmer said aloud to his computer screen, “I didn’t say you should do what I do. I just said these things should be done!””
 
That’s the take home message for me from this book. We should look around and see what should be done, however small, and set about doing it. Paul Rogat Loeb in his excellent book Soul of a Citizen says, “[T]here is no perfect time to get involved in social causes, no ideal circumstances for voicing our convictions. What each of us faces instead is a lifelong series of imperfect moments in which we must decide what we stand for.”
 
I remember the news report of a British soldier who performed an act of incredible heroism, risking his life. The Queen of England, when giving him an honor, asked him how he made his decision so quickly to risk his life to save others. The soldier played down his heroism saying, “It was nothing. It’s just the training.”
 
Training builds instincts. When you consistently take the honorable side, the side of the weak against the strong, the side of those who have not against those who have, you find that, without even realizing it, you have already made the major decisions of your life. That is the true lesson of biographies like these.

I remember one story in the book that illustrated his passionate commitment that everyone everywhere should get the best possible medical care. A poor patient of Farmer’s in Haiti was seriously ill but there was a small chance that they could survive if they could be airlifted to a major hospital in the US for some expensive treatment. The question for Farmer’s medical team in Haiti was whether so much resources should be used on one person, who was not likely to survive despite it, when those same resources could be used to treat many, many people. Farmer took the decision to airlift the patient. The patient did not survive. But the story illustrated that Farmer just could not bring himself to accept the utilitarian calculus. There was a patient right in front of him who needed help and might benefit from state-of-the-art care. He could not bring himself to trade away that patient’s needs in exchange for supposed benefits for others in the future.

Although I never met Farmer personally, he had connections with my university and I attended an inspiring lecture he gave a couple of decades ago. Just this year the university announced that he was to be the 2022 recipient of its annual Inamori Ethics Prize, a decision I wholeheartedly approved of. He and his organizations would have been well-deserving of the Nobel Peace Prize.
 
I am truly saddened by the death of Farmer. There are few public figures whose death at any age comes with a deep sense of personal loss, even if one had never met them. To have someone like Farmer die so young is immensely tragic.