Farmer was a “larger-than-life figure in the world of global health,” said Indrani Guzmán Das ’16, a student in the class who’s currently earning her master’s at the Harvard T.H. Chan School of Public Health (she is dual enrolled at Weill Cornell Medical College, where she’ll earn her M.D. next year). But Farmer played a more accessible role at Harvard, where he earned both an M.D. and Ph.D. in medical anthropology in 1990 before becoming a popular professor and department chair.
Das remembered taking a version of the undergraduate class now known as Gen Ed 1093 “Who Lives, Who Dies, Who Cares? Reimagining Global Health,” then co-taught by Kleinman, Farmer, Salmaan Keshavjee, professor of global health and social medicine at HMS, and Anne Becker, the Maude and Lillian Presley Professor of Global Health and Social Medicine and dean for clinical and academic affairs at HMS. “I remember this very charismatic professor who, whenever he spoke, emphasized the need for caring for all people,” Das said.
Eighteen undergraduates and graduate students pursuing a variety of fields enrolled in Kleinman’s course this semester. “One of the coolest parts is hearing so many different perspectives,” said Katie Sierra ’23, an integrative biology concentrator with a secondary in social anthropology who plans to attend veterinary school in the fall.
All were keen to study with Kleinman, whom Farmer credited for his training as a medical anthropologist. “My motivation was to study Paul Farmer just as much as to study with Arthur Kleinman,” said Matta Zheng, a first-year Divinity School student in Buddhism. Zheng called Kleinman “a personal intellectual hero” who helped inspire his path, with long-term plans to attend medical school and eventually meld the spiritual with biomedical healing.
The class syllabus includes “Pathologies of Power,” published when Farmer was in his early 40s and incandescent with fury on behalf of patients in Haiti, Russia, and Chiapas, Mexico. As Farmer wrote in the introduction: “This book is a physician-anthropologist’s effort to reveal the ways in which the most basic right — the right to survive — is trampled in an era of great affluence, and it argues that the matter should be considered the most pressing one of our times.”
As they discussed the book, students picked up Farmer’s observations about worsening inequality under neoliberalism, his scorn for elites who equate illness with moral failing, and his call for medical outcomes to outweigh cost-benefit analyses. One student saw a subtextual disapproval of aid organizations that profess neutrality. “It seems Paul is saying that is not at all how you should approach things,” she said.
At one point the professor opened the conversation to critique, offering his own take on the book’s fiery prose. “If Paul were in the room with us — wouldn’t that be wonderful, if he were alive and in the room? — he would be a little taken aback by how strong this is,” offered Kleinman, adding that Farmer learned to be more diplomatic over the years, “in part to mobilize resources.”
From there, students wrestled with closer-to-home issues including caregiver shortages, medical racism, and the depersonalizing effects of electronic medical records. Oh, and what if U.S. hospitals stopped fixating on finances and patient throughput? What if they instead developed metrics to gauge things Farmer cared about, like effectiveness of communication or quality of diagnoses?
“One of you might be the one to flip the switch and get hospitals to start measuring care,” Kleinman told them. “This is what reading Paul Farmer is all about. He changed things in this world. What can you do to change things?”