Attacking the ties that bind poverty, illness

Jim Yong Kim remembers the drive home from the airport with his father, a dentist in the small Iowa city where Kim was raised. His dad asked Kim, who was on a break from Brown University, what he’d decided to study.

Kim, today a professor of medicine and of social medicine and the Francois Xavier Bagnoud Professor of Health and Human Rights, mentioned his ongoing interest in politics – he’d campaigned for George McGovern as a 12-year-old – and in philosophy, a subject studied by his mother, whom he still counts as an influence. His father said nothing at first, pulling the car to the side of the road before he spoke.

“My dad said, ‘When you’ve finished your residency, you can do whatever you want,’” Kim recalls. “‘You’re a Chinaman’ – my dad talked that way – ‘You need a skill. You can’t think that because you have some idea in your head you’re going to study philosophy and the world is going to take care of you. So get your skill first and then you can pursue other things.’ For me, he was right.”

Today Kim is accomplished by any measure, but he credits that accomplishment to his parents’ guidance, to the discipline instilled in him at Harvard Medical School, and to the friendships and professional trajectory that have their roots there. He won a MacArthur Foundation “genius” grant in 2003 and in 2006 was named one of Tim e magazine’s most influential people. He is known globally for his work on AIDS and tuberculosis and is hailed for bringing treatment of multi-drug-resistant TB to the poor through his work with the Boston-based nonprofit Partners In Health. He’s also known for his work at the World Health Organization to expand AIDS treatment to millions living in impoverished areas once thought impossible to reach with modern AIDS drugs.

In addition to his three professorships, Kim heads three different academic organizations at three different Harvard-affiliated institutions: he chairs Harvard Medical School’s Department of Global Health and Social Medicine, heads Harvard School of Public Health’s Francois-Xavier Bagnoud Center for Health and Human Rights, and serves as chief of Brigham and Women’s Hospital’s Division of Social Medicine and Health Inequalities.

Kim is also the point person in a push to create a new academic field to study the best ways to deliver health care in impoverished places – a position that has sometimes put him at odds with those who believe that care delivery falls outside the mission of an academic research institution.

But as with the many other challenges he’s faced, Kim acknowledges the obstacles ahead and immediately begins to plot a way to overcome them.

It doesn’t hurt, of course, that Kim is personable and funny. And, though he is vocal about his interest in the policy underpinnings of health care, he’s also willing to don rubber gloves at a moment’s notice to help an ailing child or try to revive a man who died on a plane flight, as Kim did during one February 2008 afternoon on a trip to visit rural clinics in the tiny African nation of Lesotho.

Kim is passionate about both the need to extend modern, quality health care to the world’s poor and his belief that it is possible. He has honed his arguments during long nights talking with fellow professor and Partners In Health co-founder Paul Farmer. Kim met Farmer in medical school and threw his lot in with him in 1987 when the two, together with a handful of colleagues, founded the nonprofit dedicated to providing high-quality health care to those in some of the world’s poorest nations.

Kim is also a believer in the special place that Harvard and similar institutions hold in the world. The health-related problems facing the world’s poor are so complex, tied in with poverty, lingering colonial inequities, bad government, and First World indifference, that he recognizes it will take the best of the best – smart, passionate people trained at the world’s best institutions – to effect change.

To naysayers who claim that change is impossible, Kim has a simple answer: It has already begun.

He cites the World Health Organization’s 3 by 5 Initiative, in which he had a hand, which set a goal to treat 3 million AIDS patients with antiretroviral drugs by 2005. It wasn’t so much the Initiative itself, since there have been many such programs to cure global diseases, as it was how governments and international health organizations changed the way they did business that crossed a threshold in global health, Kim said.

That’s because never before has the world made a commitment to treat the poor for a disease like AIDS, which has to be managed for a lifetime. By committing to treating AIDS among the world’s poor, Kim said, the international health community and the nations that support it are for the first time committing to providing long-term care of an ailment that will require robust primary health care systems. In effect, Kim said, in committing to treating AIDS, the world has committed to providing adequate primary health care to the world’s poor for the first time ever.

And that’s something Kim can get behind.

Guiding moments

Kim grew up in one of the very few Korean families in Muscatine, Iowa, a small city of 22,000 on the Mississippi River. Kim did well in school and credited friends from a summer science camp for urging him to apply to Brown University, where he received his bachelor’s degree.

He arrived at Harvard Medical School in 1982, and as he was casting about for a specific career path, Kim met Arthur Kleinman, who was just beginning an M.D./Ph.D. program in medical anthropology. Kleinman, who has appointments as a professor of anthropology in the Faculty of Arts and Sciences, and as a professor of psychiatry and of medical anthropology at Harvard Medical School, introduced him to Paul Farmer, who had already begun the work among the Haitian poor that would lay the foundation for Partners In Health.

Kim describes his college and medical school years as ones of searching, for both a cultural identity and the right professional path. That personal process led Kim, who did know he wanted to work for social justice, to do his doctoral work on health care in South Korea. He came home wiser, having learned to speak Korean, but also convinced that the South Koreans didn’t need a whole lot of further help from him.

“I came to the conclusion that there’s not much for me to do there; these guys are going to own the world soon,” Kim said.

Kim had continued his friendship with Farmer through the mid-1980s, and on his return from South Korea, Kim made his first trip to rural Haiti where Farmer worked. There, Kim witnessed a nation that provided a contrast to South Korea. He saw grinding poverty and the rampant health problems that accompany it: disease, malnutrition, and never-ending complications that can result from simple ailments gone untreated for too long.

Of that first trip to Haiti, Kim recalls long hours in the small clinic at Cange, physical exhaustion, but also inspiration.

” Haiti made a big difference to me. I thought, ‘Oh my god, I had no idea that things were quite this bad,’” Kim said. “This is what I have to do.”

So Kim dedicated himself to the nonprofit organization. He visited Haiti but spent much of his time during the late 1980s and early 1990s heading the small staff at Partners In Health’s headquarters in Boston. In 1994, he headed Partners In Health’s expansion into Peru to treat drug-resistant tuberculosis, an ailment that international health officials thought too complex to treat in a poor setting.

For the next six years, his work focused on Peru and tuberculosis, leading a program that not only proved wrong the prevailing wisdom about treating multi-drug-resistant tuberculosis in a poor setting, but also establishing a model program that became a standard for similar efforts elsewhere.

Through his work on tuberculosis, Kim met Jong-wook Lee at the World Health Organization (WHO). After Lee became WHO’s director-general, Kim joined his staff. With the director-general’s ear, Kim pushed the controversial 3 by 5 Initiative as a way to set ambitious goals that would force people to stop talking and start working to get antiretrovirals in the places where they were needed. Lee listened, took the heat from detractors, and got behind the program.

“I was, and still am in many ways, an activist,” Kim said. “So what does an activist do if he has his hands at least partly on the reins of an organization like WHO? I said we have got to change the discourse; we have got to change the paradigm.”

Kim worked at WHO for two and a half years, eventually overseeing 3 by 5 himself, as the head of WHO’s HIV/AIDS unit. Though the program ultimately fell short of its goal, it forced the international health community to drastically ramp up its antiretroviral drug distribution programs. Kim said he’d heard recently that by the end of 2007, they’d finally gotten 3 million people on antiretroviral drugs, a notable accomplishment even if it occurred two years late. Now, with the attention of global health practitioners turning toward building the primary care systems that can sustain HIV treatment and many other important health interventions, Kim feels the difficulties in getting 3 by 5 off the ground were well worth it.

“I’ll never forget the day the Lesotho minister of health told me, ‘When you first announced 3 by 5 we were very upset: How the heck were we supposed to do it? But then we got it. When you said 3 by 5, you were telling us to get about our business – get about our business and just save lives – and for my part I felt that for the first time people in Geneva understood what we were going through down here,’” Kim recounted.