Gateses inspiring others, counters 'defeatist mentality,' doctor says

By TOM PAULSON
SEATTLE POST-INTELLIGENCER REPORTER

Dr. Paul Farmer, the Harvard physician renowned for demonstrating that complex AIDS care can be done even in poverty-stricken Haiti, said the Bill & Melinda Gates Foundation's efforts in global health have reinvigorated those used to working with scraps and advancing by inches.

"There has been a hang-dog, defeatist mentality in global health for a long time," said Farmer, who spoke yesterday at the University of Washington Medical School. A new group called Puget Sound Partners for Global Health sponsored his talk.

		Gilbert W. Arias / P-I
	Dr. Paul Farmer shares Bill Gates' view that fighting disease effectively reduces poverty.

Having spent more than two decades living among the poor in a squatter's settlement in rural Haiti, Farmer has encountered many critics who tell him his is a noble gesture but a waste of time and resources trying to provide health care to those living in extreme poverty.

The real problem, they say, is intractable poverty. Treating the diseases of poverty is like treating the symptoms rather than the root cause.

Bill and Melinda Gates, in making global health their primary philanthropic cause, have encountered similar pessimism as they have devoted billions to fighting Third World diseases.

"But they've rejected this defeatist view," Farmer said yesterday in an interview. He shares with the Gateses the view that poverty and disease are closely linked -- and that fighting disease is an effective method for fighting poverty as well.

That has been his experience in Haiti, he said, where in the past people were dying from treatable tuberculosis. TB is still the leading killer of adults in Haiti, followed closely by AIDS, but in the communities where Farmer works there have been measurable gains in health and welfare.

"By reducing the burden of disease, you can set up a virtuous social cycle," he said.

Just a few weeks ago, Melinda Gates went to see for herself on a visit to Haiti with Gates Foundation co-President Patti Stonesifer. Farmer visited the Seattle philanthropy Monday to speak with staff members about his work on health and equity.

Farmer, the subject of Tracy Kidder's latest book, "Mountains Beyond Mountains," was motivated to move to Haiti as a medical student. He and a colleague, Dr. Jim Kim (now at the World Health Organization), wanted to prove that they could train the Haitians to care for themselves and effectively deliver daily anti-TB medications to thousands of people.

At the Clinique Bon Saveur in Cange, Farmer and his colleagues have over the years expanded the repertoire to include anti-AIDS drugs. They recently opened new clinics in the region and now see about 1,000 patients a day for all kinds of medical needs.

This expansion was funded by a $2.4 million yearly grant from the Global Fund for AIDS, TB and Malaria -- a global initiative modeled after the Gates Foundation's ground-breaking project for expanding basic vaccinations, the Global Alliance for Vaccines and Immunization. Gates has also donated $100 million to the Global Fund for AIDS.

"But we're not just focused on AIDS," Farmer noted. Bringing better AIDS care to this poor region in Haiti, he said, was "a wedge in the door" to train more health workers and improve clinics for all health care needs.

Farmer is no single-minded disease warrior, either; he has written and spoken extensively about global inequity, human rights and poverty. He and his Harvard colleagues have attacked many past economic policies that they believed contributed to global poverty.

"The people I live with in Haiti were displaced by a big poverty reduction project, a dam-building scheme," Farmer said. The development experts have been wrong about how to deal with poverty, he said, and need to stop viewing these developing world problems through Western eyeglasses.

Bill and Melinda Gates are listening to the experts but also to those in the trenches, Farmer said. They clearly view their philanthropy as a moral and social obligation, he said.

"It's a human rights issue that people are dying of these readily treatable illnesses." Even AIDS in the Third World, Farmer contended, needs to be viewed not as the planet's most unwieldy health disaster but rather as another treatable, infectious disease.

The Gateses have done a lot to begin to "reawaken" the world to these neglected diseases of poverty, he said, but much more needs to be done.

When talking at the Gates Foundation on Monday, Farmer jokingly referred to living in America as "living in 'The Matrix.' " Most of the Western world is oblivious to the gathering storm of resentment brewed by inequity, poverty and disease, he said.

"The poorest people in Haiti know what they don't have," Farmer said. The gap is increasingly large and untenable, he said, and we would do well to close it.