I first met Paul at Duke in 1979. We were both undergrads of a somewhat nerdy cast, and therefore odd ducks in a school where sports and fraternities set the tone. I was fresh from a high school year abroad in France and had been reading all the structuralist anthropology and linguistics I could get my hands on—Lévi-Strauss, Benveniste, Jakobson, Barthes, Kristeva, and also Foucault, Althusser, Deleuze, and Derrida. Paul knew this stuff too, but he wasn’t as impressed by the elegant ballet of signifiers as I was.
Our teacher Weston LaBarre was an eclectic structuralist, adept at handling networks of meaning and also warmly curious about the lives of the people he studied. Through Weston, Paul got to know the ethno-psychiatrist Georges Devereux, a builder of theories with an astonishing range of on-the-ground experience, having lived and worked as a therapist among Native Americans and mountain peoples of Southeast Asia, as well as practicing and teaching in US hospitals. Devereux’s work made a deep impression on us because of its respect for the dynamic of transference and counter-transference—in other words, the ways that the person being observed influences the observer, and the observer influences the observed.
At that moment in his life I think Paul was expecting to train as a psychiatrist and work with indigenous populations somewhere in the world. But Devereux was too ill and frail to take Paul on as a student. That turned out to be a providential dead end. For another part of Paul’s omnivorous reading in French anthropology had led him to Haiti. In ethnopsychiatry there was the great book on Haitian vaudou by Alfred Métraux. Métraux had been close to Parisian surrealists I was reading: André Breton, Michel Leiris, Léopold Sédar Senghor. And from that group it was a short step for me, under Paul’s tutelage, to begin reading Haitian authors like Jean Price-Mars, Jacques Roumain, Jacques-Stéphen Alexis, René Depestre, Jean Métellus, René Bélance, just to cite those who wrote in French. He met Depestre, Bélance, and Métellus and interviewed them for a book we were going to write together, Three Haitian Poets, Selected Translations and an Introduction. That book never happened as such, for reasons having to do with the timidity of American publishers and our being total unknowns, but parts of it eventually leaked into print.
Paul went to Haiti after graduating from college. The year was 1982-1983, coincidentally the year that a mysterious and fatal auto-immune syndrome began to be reported among gay men, blood transfusion recipients, and Haitians (a collection of categories that was random but somehow not random, if you thought less about causality than about stigma). There he came straight up against the limits of what was known (charitably) as charitable healthcare in a profoundly impoverished country: patients were turned away from the hospital’s door for no reason but lack of funds, and other patients were given useless diagnoses—prescribed treatments they could never access. Tracy Kidder has written memorably about one night of desperate frustration in a hospital that was poorly set up to do its job. So Haiti announced to Paul, in the starkest possible terms, what the problem was. It was what he would later call “medical nihilism.”
And Haiti also brought Paul the vision of a solution. When I went to visit Paul in the spring of 1983, he had just moved from a room in Port-au-Prince to the town of Mirebalais, where he was living with the Lafontant family. Father Fritz Lafontant incarnated the “preferential option for the poor.” Père Fritz and his wife, Yolande, whom we called Mamito, chose to live among the squatters in the mountain village of Cange, people who were badly-off even by Haitian standards. He leveraged ecclesiastical connections with the Episcopal Diocese of South Carolina to bring doctors and dentists in for short clinical visits. Built like a football tackle, a theologian of great insight, Father Fritz saw no reason central Haiti should not have its own well-equipped, well-staffed, and free hospital, ringed round with outreach services and social benefits. Nobody in Cange or Mirebalais disagreed or called him unrealistic, at least not in my hearing. His utter conviction inspired and guided Zanmi Lasante, the original core of Partners In Health. HIV, hurricanes, earthquakes, coups, murders, kidnappings, and other heartbreaks—nothing could divert the ékip solid of Zanmi Lasante from their path.
The successive challenges and, let’s put aside modesty, victories of PIH, which I trust will go on until there is no more need for them, all grew out of that encounter. Paul’s passion for Haiti was infectious and his engagement was total. I don’t know what would have happened if Paul had gone somewhere else after college. By now it is impossible to imagine Paul without Haiti or, I think, Haiti without Paul.
(Read at the 2023 Paul Farmer Symposium on Global Health, Harvard Medical School.)