San Francisco Chronicle - May 14, 2005
Sabin Russell, srussell@sfchronicle.com.

"It's a 'Lazarus effect.' That's what the people call it," said Farmer, the renowned physician and medical anthropologist whose tireless work in Haiti, Peru, the jails of Russia and the slums of Boston has set a standard for the care of AIDS and tuberculosis among the poor and dispossessed.

Last month, in partnership with the private foundation of former President Bill Clinton, he launched a new program to bring rural health care and AIDS treatment to remote eastern Rwanda -- a nation rising from a ghastly genocide a decade ago.

"We've been wanting to go there for a very long time," said Farmer, relaxing Friday at the Berkeley home of a friend before delivering this morning's commencement address at the UC Berkeley School of Public Health.

The 45-year-old Farmer, described as "a man who would cure the world" in a profile of his work by Pulitzer Prize-winning author Tracy Kidder, was also in the Bay Area to receive an award Wednesday from Global Exchange, the San Francisco human rights advocacy group.

"He's an uncompromising critic of war, poverty, violence and oppression, because all of those things affect his patients' lives," said Global Exchange spokeswoman Andrea Buffa.

Like Haiti, Rwanda is rugged and rural, impoverished, with a history of political instability. An estimated 500,000 Rwandans are infected with HIV, many of them women who were gang-raped during the genocide.

Despite a desire to bring his work to Africa, Farmer has previously avoided a major commitment. He feared making a promise he could not keep. "To work in a very poor country, like Haiti, or Rwanda, you need lots of resources, " he said.

But publicity from Kidder's 2003 book, "Mountains Beyond Mountains," drew additional attention to the work of Partners in Health, the Boston charity that finances Farmer's work. That acclaim, commitments from wealthy American donors, and a blossoming relationship with the William J. Clinton Foundation based in New York conspired to bring Partners in Health to Rwanda.

Farmer's team is already setting up shop in a location picked for him by the Rwandan Ministry of Health.

"It's an abandoned hospital, with bullet holes," said Farmer.

Situated near Akagera National Park, a reserve in the eastern lowlands about four hours from the Rwandan capital Kigali, the site is afflicted with poverty, disease and neglect, fertile ground for Farmer's brand of medicine -- a system that assumes health care is a human right and relies on community health workers to deliver it.

In Rwanda, Farmer is banking on years of experience building Zanmi Lasante, his clinic in central Haiti and on the expertise of community of caregivers who made it work.

"The Haitians are in Rwanda, training the Rwandans," he said.

Despite his extraordinary success in Haiti, Farmer believes that he made a fundamental blunder in developing his program as a private entity, divorced from the public health system.

"It was the wrong model," he said. "It took us 15 years to realize our own shortcomings. In the last four years, we've been working with the public health sector in Haiti to make amends for our sins."

He called it "the opposite of privatization."

Consequently, he is working closely with Rwandan authorities in transplanting his model to Africa, hoping to heal a broken health care system, so that the system can heal its own.

Farmer -- whom former President Clinton recently suggested was worthy of sainthood, or at least a Nobel Prize -- concedes there is something for him in all this work.

"I get the satisfaction of seeing someone who would otherwise die, do well," he said. "That is very satisfying."

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