As I mentioned last week, I had been planning to share some thoughts on the sudden passing of Dr. Paul Farmer until the Russians invaded Ukraine. Since there’s little to do right now besides panic over tweets, I’m going to go ahead and do so.

Farmer was an icon of humanitarianism—a man who changed the philosophy and practice of public health in poor countries all over the world, and thus helped to save untold millions of lives. From humble beginnings as the son of a high school teacher and a supermarket cashier in Western Massachusetts, Farmer rose to a status of peerless fame and influence. He was routinely referred to in popular media as a “saint.”

This was a typical photo:

By the time I first met Paul, in Haiti, his star had been burnished to a shine. It was 2009. He had long since moved from his longtime base in the Haitian village of Cange—the impoverished rural hamlet where he co-founded the medical NGO Zanmi Lasante, known to the rest of the world as Partners in Health. I had just finished writing a feature on the stunning success of AIDS treatments and prevention in Haiti, a story in which PIH and Farmer played a major role. (Of particular import was PIH’s “accompagnateur” program—in which Haitian HIV patients are trained to help others keep up with their medicine. This program helped disprove the racist, classist skepticism of many in the United States and Europe that cutting-edge HIV drugs would be wasted on the nonwhite poor.)

The story was thus flattering to PIH, and thus Dr. Farmer—a fact which an irate Farmer-hating public health expert (there are indeed some, who make up for their small numbers with a commitment to being as irritating as possible) had hammered me about day and night for weeks. When Paul next arrived in Haiti, he sought me out to thank me for the piece.

This was easy to do because Farmer knew exactly where I’d be: He was coming with Bill Clinton, who was making one his first visits as U.N. Special Envoy for Haiti. On our way up to the flood-damaged city of Gonaïves, Farmer told me, excitedly, that he had made sure the former president had read the article. He also made sure I got some face time with the ex-president, so Bill Clinton could also tell me, personally, that he had read my article (about how great PIH and Paul Farmer were). The introduction in turn was of course also a favor to me — one that would pay dividends, especially as the former president took on an even more outsized role after the catastrophic earthquake that struck half a year later.

This is to say that right off the bat I got a picture more complex than “Saint Paul”: Farmer’s loyalty, empathy, and generosity, as well as his constant striving to have and be next to power. I believe strongly that Paul saw this ultimately as being for the benefit of his patients and more generally the world’s poor. It was also undoubtedly to the benefit of Paul Farmer.

Farmer learned this dance, like so much else in life, in his beloved Haiti. In the 1990s, he had parlayed his relationship with the embattled President Jean-Bertrand Aristide (and especially the First Lady Mildred Aristide) into critical support for Zanmi Lasante. Aristide had started out as a liberation theologian who championed redistribution to Haiti’s poor—a position that won him the admiration of American leftists including Farmer but got him overthrown twice in coups with clear links to the U.S. government.

In 1994, while Aristide was in his first exile, Farmer wrote a book called The Uses of Haiti. In that book, he lambasted the United States and its then-president, Bill Clinton, for routinely breaking their promises to the Haitian people, pledging to undo the predations of the past, then leaving them worse off than before.

Aristide was restored later in 1994 by a U.S. invasion, ordered by Clinton in exchange for the Haitian president’s agreement to adopt neoliberal economic policies (which ended up all but destroying the country’s agricultural sector). Even as Aristide became increasingly corrupt — and presided over the murder of allies-turned-critics such as the Haitian radio journalist Jean Dominique — Farmer stood by him, remaining on the board of Aristide’s foundation. I suspect those continued ties to Aristide, who remains a bugaboo on the American right, are what doomed Farmer’s short-lived 2009 bid to run USAID.

Bill Clinton picked up the slack in the wake of Farmer’s abortive USAID nomination, no doubt eager to have some of Farmer’s humanitarian luster rub off on him, by naming him the United Nations deputy special envoy for Haiti. When Paul came back to Haiti with the ex-president, I went with them to visit some economic projects. Clinton was in the midst of his push to convert Haitians to his prosperity gospel of cheap garment assembly factories and better integration into “global” (meaning U.S.-dominated) supply chains. While the ex-president was off backslapping with some elite Haitians at a private port, I asked Dr. Farmer how a co-founder of Zanmi Lasante could align himself with a leader who seemed committed to funneling Haitians into sweatshops. He answered by talking about the ways that greater economic development would improve health outcomes overall.

“There’s a great book you should check out,” I said. “It’s called The Uses of Haiti by Dr. Paul Farmer.”

Paul burst out laughing. I think that conversation cemented our friendship.

In what turned out to be the last decade of his life, Farmer continued this pattern. He helped oversee the expansion of PIH and its model of ground-up “social medicine” — empowering local populations to take charge of their own health, and address the economic and social factors that make them sick—into a dozen countries. In 2010, he risked his new U.N. status by playing a crucial role in my reporting on the origins of the Haiti cholera outbreak. In 2014, he spent long stretches as a first responder in West Africa during the Ebola outbreak. In 2020, PIH began working for the first time in impoverished communities of the United States in response to the COVID pandemic. Farmer died at work in Rwanda, at a medical school he helped create.

Yet, it was notable that one of the first public reactions to Farmer’s death was from his friend and ally Rwandan President Paul Kagame—an Aristide-like figure who came to power in response to the genocide in that country, only to stand accused of “serious civil and political rights violations” in his decades of rule since. Farmer’s last days were sadly dominated by a conflict of loyalty, belief, and solicitousness to power: He had signed a defense of his powerful Harvard colleague John Comaroff, who had been credibly accused of serial sexual abuse. Confronted by shocked colleagues and friends, Farmer retracted his signature and told his friend, the anthropologist Adia Benton, that he planned to apologize.

Maybe that’s just what power does, even to the extremely righteous. Most of us don’t travel in circles of presidents and world leaders. But far fewer in that rarified air devote, much less constantly risk, their lives in the service of helping those less fortunate than themselves. Paul Farmer wasn’t a saint. I think he’d prefer for us to think of him as an imperfect man who showed us how to do good in a world that sorely needs more of it right now.

Edited by Sam Thielman