Paul Farmer, Partners in Health, & Healthcare Access

This article is an excerpt from the Shortform book guide to "Mountains Beyond Mountains" by Tracy Kidder. Shortform has the world's best summaries and analyses of books you should be reading.

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Who are Paul Farmer and Partners in Health? What was their mission?

Partners in Health is a non-profit organization co-founded by Paul Farmer to provide medical care to Haiti’s rural poor. Its founding was inspired by Farmer’s vision to deliver health care to everyone, regardless of their ability to pay.

Read more to learn about Paul Farmer and Partners in Health.

Paul Farmer & Partners in Health: Funding

Paul Farmer co-founded Partners in Health in 1987, initially funding it with his earnings from his job at the hospital in Boston—$125,000 per year—as well as from giving lectures and writing books. Whatever money he didn’t need to pay his bills went into funding Partners in Health. 

However, most of the funding for Partners in Health came from grants, including a $220,000 MacArthur Genius Grant, and one generous donor from the Boston area.

Paul Farmer & Partners in Health: Work in Haiti

The first initiative of Paul Farmer and Partners in Health was the foundation of Zanmi Lasante hospital in the city of Cange in Haiti. Though there were other hospitals and clinics in the area, many required patients to pay more than they could afford for treatment, including for the medical equipment used to treat them, like gloves. And many local hospitals and clinics lacked basic sanitation.

In contrast, though the staff at Zanmi Lasante sometimes made mistakes or botched lab testing, they were able to offer more affordable services. Farmer insisted that the hospital treat nearly everyone, regardless of their ability to pay. 

Some of Farmer’s accomplishments included:

  • Serving one million people in the local area, including with a staff of community health workers who treated people with tuberculosis in their homes for a fraction of the cost of treatment in the US
  • Reducing transmission of HIV from mothers to babies
  • Funding construction of sanitary water systems and schools

In 1999, Zanmi Lasante spent $1.5 million on treating patients in Haiti, both on-site and in their homes. In contrast, Farmer’s local hospital in the US treated roughly the same number of patients, but had an annual budget of $60 million and only treated patients on-site, not in their homes.

Paul Farmer & Partners in Health: Work in Peru

In 1997, Paul Farmer and Partners in Health’s work expanded beyond Haiti to Peru. Father Jack, a priest and member of PIH’s board of advisors, had decided to open a parish in a slum outside of Lima, Peru and suggested that Partners in Health open a clinic there.

A long-time colleague of Farmer’s at Partners in Health, Jim Yong Kim, worked to establish the clinic, modeling it after Zanmi Lasante hospital in Cange. Farmer advised Kim while working from Haiti.

Just as Farmer had in Haiti, Kim conducted a health census to find out what the community needed. Community members asked for a pharmacy where medicine could be dispensed. Shortly after the pharmacy’s completion, it was bombed by guerrilla leaders who were in a civil war with the government. The guerrillas thought that the pharmacy offered helpful medicines and services that would pacify locals to the point that they wouldn’t support the guerrilla’s cause to force change from Peru’s government.  Kim opted to rebuild the pharmacy in another location.

The Survival of Partners in Health

Despite the major changes to treatment and drug costs, the continued survival of Partners of Health as a nonprofit was in jeopardy. The organization had largely relied on the wealth of one major donor to finance much of its operations, and the donor had spent most of his wealth.

Now that they had helped advance TB treatment in Lima, Kim envisioned expanding treatment to the rest of the country, with help from larger benefactors like the Gates Foundation. In 2000, Partners in Health received a $45 million, 5-year grant from the Foundation to treat all MDR patients in Peru and reach an 80 percent cure rate, just as they’d done in Lima. Eventually, Kim hoped to expand the Partners in Health’s TB treatment program to other countries that needed it.

Paul Farmer, Partners in Health, & Healthcare Access

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Here's what you'll find in our full Mountains Beyond Mountains summary:

  • How Dr. Paul Farmer came to operate a hospital in Haiti
  • What the connection is between sorcery and tuberculosis
  • How Dr. Farmer's organization is a model for treating patients in poor countries

Darya Sinusoid

Darya’s love for reading started with fantasy novels (The LOTR trilogy is still her all-time-favorite). Growing up, however, she found herself transitioning to non-fiction, psychological, and self-help books. She has a degree in Psychology and a deep passion for the subject. She likes reading research-informed books that distill the workings of the human brain/mind/consciousness and thinking of ways to apply the insights to her own life. Some of her favorites include Thinking, Fast and Slow, How We Decide, and The Wisdom of the Enneagram.

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