Staff, Stuff, Space, and Systems
Paul Farmer was born in 1959 in North Adams, Massachusetts. In 1982, he graduated cum laude from Duke University in Durham, North Carolina, and received his M.D. from Harvard Medical School and Ph.D. in anthropology from Harvard University in 1990.
In 1983, while working in Haiti, Dr. Farmer helped create a local community-based health program. Four years later, he co-founded Partners In Health with Ophelia Dahl, Thomas J. White, Todd McCormack, and Jim Yong Kim. Dr. Farmer noted that “what happened in those four years [was] beyond the usual idea that a lot of young Americans have—that we want to start our own thing: a non-governmental organization, some new device. I call it the quest for personal efficacy. How can we harness that quest into meaningful changes for other people, not just ourselves?”
Dr. Farmer is driven by the same need to help others that is so fundamental to Aurora’s concept of Gratitude in Action—a concept he fully supports: “Gratitude in Action is what we need. There is not one of us who hasn’t benefitted from the kindness of others. Often, it’s family, but strangers, too. Even as a child, I was acutely aware of kindness to strangers, including that of my parents.
When we established Partners In Health, I saw a number of things. One of them was the death of a young woman in childbirth. But that happened so many times in that first decade, and it taught me many lessons. These were ‘stupid deaths,’ the term used by the Haitians. I thought that might mean these were deaths easily averted, but in fact, they required a lot to prevent.”
In order to bring long-lasting change to “medical deserts” lacking access to healthcare, Dr. Farmer and his colleagues came up with solutions that were efficient, sustainable, and locally oriented, while finding ways to overcome such basic shortcomings as a lack of electricity or running water. “These are not things I had to worry about, even growing up rather poor in the United States. We might not have had electricity the entire time, but we weren’t running a hospital! But then you go to Haiti, and some 95 percent of facilities are unelectrified. And this is when I started using the mantra of ‘staff, stuff, space, and systems.’ This sounds so rudimentary, but it wasn’t rudimentary to me as a young medical student. And it changed me forever, in a good way,” says Dr. Farmer.
Dr. Farmer’s mantra of staff, stuff, space, and systems has helped reorient the field to the resources required to deliver quality care. The essentials of quality care include staff (like doctors, nurses, and community healthcare workers), stuff (medications, operating equipment, and even bandages), space (hospitals, operating rooms, and lecture halls), and systems (outreach programs, referral services, and medical records).
Putting all of these elements together is overwhelming, but Dr. Farmer knows a secret to handling the pressure. And it comes from a somewhat surprising source: “I have a friend who used to be a school principal, but she works with me now. She used to tell her students: ‘You’ve got a lot of homework? Divide it into little chunks.’ So, staff, stuff, space, and systems—they’re not bite-sized chunks, because, for example, how long does it take to train a skilled obstetrics nurse? But you can set the process in motion.”
“We adopted this approach very early on—learning from failures. In medicine, that is standard.”
As these components are introduced and brought together, the quality of care improves. Of course, the process is not always smooth, but that hasn’t deterred Dr. Farmer. “We adopted this approach very early on—learning from failures. In medicine, that is standard. When I was learning how to be a doctor, I was also a graduate student in anthropology. And you can’t convince me that anthropologists don’t spend most of their time looking at failures. They do. They’re a grumpy crowd; they’re not very cheerful. So I was trained twice, in a way, to respect the importance of failure. People die, but the mission has to live on and get better,” he explains. And so it does.
In 2020 alone, PIH provided 1.6 million outpatient visits in the clinics and hospitals it supports, facilitated 1 million women’s health checkups around the world, and conducted 800,000 home visits from community health workers. With 18,000 staff employed globally, the organization has helped millions of people, strengthening healthcare systems in close cooperation with local stakeholders in Haiti, Kazakhstan, Lesotho, Liberia, Malawi, Mexico, Peru, Russia, Rwanda, Sierra Leone, and within the Navajo Nation.
As a leader of a global organization’s strategy development, it would be understandable if Dr. Farmer moved away from practicing medicine. But it’s still one of his priorities, and he always finds the time to treat patients: “That’s my way of keeping close to the mission. It’s just the way I like to get rejuvenated. I regularly take time just to do clinical work, and that’s been helpful for me.”
Dr. Farmer’s goals have always been ambitious, and he doesn’t feel like his work is done or will be done any time soon. On how the world could help his organization maximize its impact, he says: “When I retire to heaven or to the nitrogen cycle, wherever it is we go, I’m going to be happy anyway, because I’ve really enjoyed this work. My real wish, if I had one, is to see Partners In Health endure for as long as it is needed. Getting a major gift to protect the work – that’d be good.”
