The Uses of Paul Farmer: The Doctor and the Haitian Machine

Published by CounterPunch:

Photo credit: Reuters
Photo credit: Reuters

In the end, we will remember not the words of our enemies, but the silence of our friends.
– Martin Luther King Jr.

PORT-AU-PRINCE – Dr. Paul Farmer stood alone in a corner of Hotel Karibe conference room, watching the spectacle.

Reporters buzzed around Bill Clinton, jostling with one another and yelling out questions. The former president was the newly-minted United Nations Special Envoy to Haiti.

It was September 2009, just a few months before the earthquake.

Farmer had been appointed as the Deputy Envoy. But it seemed perverse that the reporters would ignore him.

“Dokte Paul,” as his patients here call him, has been a true friend to Haiti.

A Harvard-educated doctor and public health expert, Farmer co-founded Partners In Health. As a tiny clinic in rural Haiti has grown into a medical complex and now a hospital, he’s innovated and delivered top-class healthcare to the poorest Haitians for three decades.

His accomplishments are profiled in Tracy Kidder’s book Mountains Beyond Mountains, which is taught in classrooms across the country. I was reading it at the time.

As a recent college graduate and a newcomer to Haiti, I wasn’t going to miss this chance to interview a personal hero of mine. So I ran over.

We talked about Haiti’s challenges. He folded his arms and leaned in, peering through round wire-rimmed glasses. His answers were thoughtful. Farmer had always been a sharp critic of the international community’s treatment of Haiti.

Eventually I asked him a blunt question: “Do you think the administration here was under pressure from international forces to fight the increase in the minimum wage?”

I’d seen graffiti calling for bump in wages in Port-au-Prince earlier that day. In the preceding months, as the government stalled on enacting the wage hike from $3 to a mere $5 per day, protests had engulfed the downtown area.

Farmer stammered a little bit, said he didn’t know, and subtly changed the subject.

One reader left an ominous comment on the interview. “No disrespect to Dr. Farmer, as I believe he is sincere,” he wrote, “but he is now a part of the ‘machine’ that essentially drives Haiti.”


Two years later, WikiLeaks provided me and two colleagues with a window into that machine: 1,918 secret diplomatic cables from the US Embassy in Haiti.

The cables proved beyond any doubt what had seemed obvious. Behind the scenes, American officials had mounted a full-scale assault on the minimum wage increase, financing studies against it and pressuring the president to oppose it.

If Farmer had “engaged in the hard process of discernment” – an idea he promotes in his book Haiti After the Earthquake – the answer to my question would have been “Yes, of course.”

It was strange. In the past, Farmer wrote disapprovingly of plans to give Haitians low-paying jobs in textile factories – what many consider to be sweatshops. Either he had changed his mind or was holding his tongue.

In 2004, Farmer hadn’t shrunk from castigating the United States and the Haitian elite for the coup d’etat they carried out against Haiti’s then-president, Jean-Bertrand Aristide.

To this day, he remains a board member of the Institute for Justice and Democracy in Haiti (IJDH), which is a strong defender of Aristide and his political party, Fanmi Lavalas.

But when Fanmi Lavalas was banned from entering candidates in the first post-earthquake election, Farmer’s response was tepid.

I ran into Farmer at a meeting of the now-defunct reconstruction commission (co-chaired by Clinton) just before the runoff round, in March of 2011.

I asked if he was worried about the Lavalas party’s exclusion from the ballot. “Of course I’m worried,” he said, “because if you have scant participation or exclude anyone from engagement. . .that’s a formula for instability.”

At the time, IJDH and most progressive advocates took the position that the election was unfair, fraudulent, and should be annulled. I followed up by email asking if he agreed with IJDH. Farmer wrote back:

“Good to see you. Sorry to have missed your deadline. But am on the board of ijdh so you are really asking questions for other reasons?”

I responded seeking to clarify what that meant, but received no reply.


The next time I saw Farmer, he warmly greeted me in the hall of a huge mansion.

I managed to evade the minimum $250 donation for a fundraiser being held in Austin, Texas, where I was visiting family. I wore some of my best clothes but still looked underdressed. The opulence on display seemed shameless.

Turns out the mansion belonged to Roy Spence, chief executive of a big marketing agency. He was Hillary Clinton’s “messaging guru” during her 2008 campaign.

Farmer humored the crowd with an engaging speech calling for accompaniment with, rather than mere charity to, the poor.

Cheryl Mills, Clinton’s chief of staff at the State Department, stood next to him, beaming. Mills had just taken a shellacking in a Rolling Stone investigation of Haiti’s faltering reconstruction effort.

But this wasn’t a fundraiser for Partners In Health, Farmer’s highly-respected health organization. It was for an obscure group called Students of the World, which is run by Roy Spence’s daughter, Courtney.

A documentary filmmaker friend of mine went to the second fundraiser in East Austin – the one for the non-rich – the following night. Unprompted by me, he complained a few days later about how bad it was.  He said it seems like they “parachute in” and produce “bad promo videos” about charities in Haiti and other poor countries.

And yet that night, there was Farmer wrapping up his speech. He urged the assembled guests – influential Texas politicians and businessmen among them – to donate to Students of the World.

Before I left, Farmer autographed a copy of his book for me. He said he’d flown all the way from Rwanda for the event.

In the book, Farmer argues that humanitarian funding should be directed to Haiti’s public sector – the government – instead of to foreign charities. Groups like Students for the World are lambasted as haphazard and unaccountable to Haitians.


“Oh, he adores Clinton,” a senior member of Partner in Health, told me as our plane approached the Haitian coastline. “I don’t get it.”

It was March 2012. By chance, our seats on the flight to Port-au-Prince happened to be next to each other. We’d struck up a conversation.

She said Paul had changed over the years and that now she represents the “left-wing of PIH.” But the organization had taken a decidedly non-political turn.

I told her how disappointing it was when PIH had refused to sign on to a petition to protect Haiti’s displaced from forced evictions not long after the quake. She wasn’t surprised.

The petition was addressed to Bill Clinton, the UN Envoy to Haiti, among other authorities. And Clinton is “close to Paul,” the petitioners were told by Donna Barry, PIH’s Advocacy and Policy Director.

A week later, I found myself facing Clinton at a press conference at PIH’s new hospital in Mirebalais. I asked a pointed question about the UN’s responsibility for Haiti’s cholera outbreak.

His frank response, in which he stated that cholera had arrived in Haiti via the fecal waste of a UN peacekeeping soldier, was a welcome surprise.

Farmer got up after him and delivered a boilerplate call for improved water and sanitation in Haiti. Clinton put his arm around Farmer’s back when he sat back down.

“I think he knows what he’s doing, and I trust his judgment and his integrity,” political analyst Noam Chomsky told an interviewer who asked about Farmer’s involvement with Clinton and the UN.

“Paul Farmer, that is. I’m not talking about Clinton,” he added, with a derisive laugh.

As Chomsky explained, by any objective measure, Clinton has severely damaged Haiti.

After the quake, he admitted to destroying the livelihoods of Haitian farmers during his presidency when he pressured Aristide to lower tariffs on imported rice. It was a “devil’s bargain,” he said, that was beneficial for “some of my farmers in Arkansas.”

In October, both Clintons inaugurated a sprawling, scandal-ridden industrial park in Haiti’s north, where thousands of Haitians will sew garments for Wal-Mart and other US retail giants for meager wages.

Farmer, meanwhile, has been awfully quiet when it comes to public advocacy on Haiti’s behalf. His name last popped up in the news when the UN, in a slick PR move, appointed him a special advisor for a brand new $2.2 billion cholera initiative.

In fact, the initiative is anything but new. It’s been around for years, unfunded, and the UN itself has only contributed 1% of the overall funding goal.

The epidemic continues apace. Cholera killed 27 Haitians in the first week of January.

Farmer is still on the board of IJDH, which is suing the UN to accept responsibility for the outbreak and pay reparations to the victims. He’s made no public comment about the lawsuit. Neither has the UN, except to say it’s studying the claims.

“He’s been bought off by people who acknowledge that his critiques had merit and gave him a position, meaning Clinton and the UN,” one longtime Haiti aid worker told me.

A Washington insider who works on Haiti policy called him “their useful idiot,” he said. “We see the same problems. Haiti needs a voice of reason to stand up to these powerful players. He could be that voice.”

“It’s sad, really.”


Sadder still are the dusty, bleak encampments where thousands of Haitians displaced by the quake eke out an existence each day.

At a huge camp called Carradeux, withered tents flap listlessly in the wind on a crowded hillside. Aid agencies have long since left most camps, leaving clogged and overflowing latrines in their wake.

“Haiti’s reconstruction? It began in [Clinton’s] mouth, but it never materialized on the terrain. I don’t see it,” Bemès Bellevue, a 31-year-old taxi driver whose worn features make him look much older, told me on Thursday.

It was the 1090th day Bellevue has lived under a tent with his wife and two girls, aged 5 and 7. Human beings are not supposed to live like this, let alone for three years.

I’ve never met a camp resident who knows about Farmer. They haven’t heard his talk of “building back better.”

I asked Samuel Maxime, editor of Defend Haiti, an online news magazine popular with the Haitian diaspora, what he thinks of Farmer today.

He said it’s hard to criticize anyone working on health in Haiti because lives are at stake.

Indeed, this makes it difficult to subject Farmer or any humanitarian to critique. But meaningful accountability is precisely what’s been missing from the aid sector. Farmer himself made the point in our first interview.

“Nonetheless, I think Farmer is a large part of the machine that enables corruption in Haiti,” Maxime continued. “In the grand scheme of things I believe someone like Farmer, who knows right from wrong, integrity from corruption, and looks the other way as he does – he enables it, in fact, like MLK Jr. would say – they are complicit in it.”

Maxime said he’s especially disappointed Farmer hasn’t stepped up and stated clearly that all the evidence shows the UN brought cholera to Haiti.

“I don’t think that’s becoming of a Harvard man.”


After several unanswered emails, Dr. Farmer responded just before this went to publication. He called me on the way to the airport, where he was to catch a flight to China for a meeting on tuberculosis.

We spoke cordially for two hours. Farmer said he hoped his words would give me pause. But they haven’t.

I found him to be defensive, wishy-washy and self-contradictory.

“I chuckled at that because I think it’s good to be useful,” he said, taking particular umbrage at the phrase “useful idiot.”

He asked repeatedly whether I agreed with that. I said he was being silenced and used.

Farmer eventually disclaimed any leadership role, saying, “I’m really not a UN official. I don’t have any obligations.”

“On the second year anniversary [of the quake] I wrote what I had to say and I don’t really have any more to say.”

When I said he had lost the razor-sharp critical voice from Uses of Haiti, he said, “I hope you’re wrong about that.”

I asked several times whether the UN brought cholera to Haiti. He talked around the question, never answering it directly. Isn’t it important to identify the source of the outbreak?

“I don’t think that’s true. I don’t think it was true with the [past] HIV or cholera outbreaks…If I were to rank the top 5 interventions, to slow cholera…I would not put legal action before building a water system or treating Haitians.”

Do you believe in IJDH’s advocacy work? “Yeah, I do! I would never disassociate myself from IJDH.”

But later, “I’ve never worked in any social justice organization where there aren’t serious disagreements inside.”

On the failed reconstruction commission, he said,  “I didn’t have a dog in that fight other than wishing it well…I hope there will be many other iterations of trying to coordinate aid. I didn’t assert that it would work.”

He agreed that Rwanda, which he has often held up as a model, would not have accepted the commission.

I asked if he has been successful in encouraging aid to flow directly to the Haitian government. Farmer admitted, “The answer is no, not much success.”

“I definitely care most about Haiti of all the places I’ve worked, but I don’t claim omniscience,” he said.

Additional thoughts for the blog: I was pleasantly surprised by the universally positive (late-night, who knows what the morning will bring) reaction to this piece on social media. The venerable infectious disease blogger Crawford Killian took the big picture view: “The silence of Paul Farmer is itself an instructive memo: If you want to do any good at all in Haiti, don’t criticize the bosses.”

That said, I respect Dr. Farmer as well as those who still believe in him. And I want to offer my take on one point that’s been made a few times. Matt Vecere wrote on Facebook:

Another great article… As for Farmer, I asked him at a talk in LA about the UN and their role in cholera. He said his position at the UN does not allow him to say everything he wants to say and followed by pulling up a photo of a UN truck dumping sewage into a river, as well as photos of the Nepalese base with broken sewage pipes. I think it’s pretty clear what Farmer is doing: compromising his ability to spout off the way he’d like to so that he can hopefully influence the big players and affect large scale change. It may work, it may not. But I still believe in him.

Twitter user Janiebt echoed that view, asking, “Bravo, but how does one not compromise integrity while making major political allies and receiving support from major funders?”

A portrait of Dr. Farmer from the series “Americans Who Tell the Truth.”

I addressed this exact question in a much earlier draft of this piece, using Farmer’s own words from his book Haiti After the Earthquake. Here’s what I wrote:

Farmer says he rejects the notion of “currying favor with power qua power” in a long footnote in the book.  He quotes Dr. Martin Luther King’s response to someone urging him not to criticize the Vietnam war: “What you’re saying may get you a foundation grant, but it won’t get you into the kingdom of truth.”

I submit that a book on Haiti that scarcely mentions the $850 million military peacekeeping force occupying the country will not get its author into the kingdom of truth.  I submit it is disingenuous to praise Haiti’s popular movement, as Farmer does in the book, without discussing how it has been suppressed in recent years.

Some speculate that Farmer took the UN position as a quid pro quo wherein he lent his good name out but gained the influence to direct resources to worthwhile projects in Haiti.  But Farmer concludes the footnote, “It wasn’t as if we didn’t need foundation grants to respond effectively…But we didn’t need to sell our souls to get them.”

Indeed, Farmer reveals in the book that funding was already in place for his largest and most promising project in Haiti when the quake struck.  Next time one of my Haitian friends in Port-au-Prince is looking in vain for decent medical treatment, I’ll be able to tell her to go to a brand new $15 million hospital under construction in Mirebalais instead of out to PIH in remote Cange.  It’s his leadership of projects like this that earned him a reputation as one of the most effective do-gooders in the world.

16 thoughts on “The Uses of Paul Farmer: The Doctor and the Haitian Machine”

  1. YES!! You clearly state many of the frustrations I feel. Heck, I am still in this perpetual state of “pissed off” after reading A Travesty in Haiti IN NOVEMBER!!!! Currently reading The Big Truck That Went By… I think Machine is a fair assessment… In the words of Roger Waters…. “Welcome to the machine….” And maybe Farmer is a pawn, who thought, let me get “in” and I can change things…. certainly that’s what one would think he was hoping for based on his previous books on Haiti… I think the same thing.. IF I could be part of the planning, we could really change things in Haiti. I WANT to do that… I WANT to think that… but as much as I try to Pa janm pedi espwa… I am feeling overwhelmed, frustrated and useless. Revolution anyone?? =) Keep writing the truth…. because there are people out here who still believe… Thanks. Lori

  2. Ansel! Great piece brother. It shows that Paul is not “beyond critique” as many people once said. It is because he has made such a positive impact on the country, and continues to wield so much influence, that we need to hold him to a higher standard. Even if he doesn’t claim omniscience, many have claimed it for him. I am sensing parallels to the way I feel about Obama, or even Aristide, with regard to their relationship with power and how it in turn effects their role in progressive change. This is a larger discussion… Great work!!

  3. Very interesting and informative piece, thank you very much! Your reference in your final note makes me think of French philosopher Jacques Ellul, who used to speak of “the machine”, in reference to reliance on technology and the emergence of modern technocracy, and how such means of considering information and our necessary actions and reactions to it endangered us and poisoned our civilisation.
    People like Bill Clinton are mere puppets of this “machine” and have gotten to where they are thanks to their subservience to it; it seems a frightful shame to see that Dr. Farmer may have fallen prey to this “birdcatcher”; yet maybe there’s time and opportunity for him to direct his actions in a better way…?

  4. Thanks for the bad message, you good messenger. I wonder if Jim Kim might be riding with another machine at the World Bank. I wonder, also how you would assess Haiti’s chances to ever get back on track toward a real constitutional democracy. If so, I guess they’d be one up on us in the good ol’ us of a.

  5. It’s sad to see all these people, hi-ranking, come here in the middle of the poorest nation in america, spending all that money… With no fundamental will of change. Some idealistic viewpoint like Mr. Health is just a bug among the well-thought plan….

  6. In reading your recent article about Paul Farmer I understand you to be well intentioned toward Haiti. I am no more familiar with your work and worldview than you are with mine. I am offering this critique of your work with humility and objectivity. I do feel, however, that if you truly reflect on the immense (unprecedented) work of Dr. Farmer, and internalize all that he has witnessed and worked against- you might have chosen your words differently.

    Try to imagine being there in person with Dr. Farmer over the years as he has worked not only in Haiti, but in Chiapas, Russia, Rwanda . . . try to internalize the time away from family, the heartache of consoling parents of dead children again and again. Try to feel the frustration of knowing that governments are against Haiti. Wake up and work every day knowing the world similarly cares little about Chiapas. Understand that the world does not even realize the Holocaust of the Americas (see David Stannard) occurred and sadly continues in Chiapas, in Guatemala, is ongoing in Mato Grosso (, and lives on in Haiti. Then realize Paul Farmer has worked against this reality every day for years.

    Paul Farmer is one person, with no more ability to bring about change than you or I. Paul Farmer did not hop off a plane in Haiti and become “influential” overnight. It is only through his work and non-silence (that any one of his critics is free to replicate if they so choose) that he has any influence at all. There is really nothing stopping you, me, or any other single reader of your article from achieving the same level of influence. Consider that.

    Farmer has spent more time working, writing, speaking, and building hospitals where the silence is than you or I ever will. The Paul Farmer you see at fundraisers, events, press conferences, and returning emails in the middle of the night is overtime from what he is first and foremost; a physician who takes care of people, one-on-one, one person at a time.

    Examining your view called to mind a discussion I had with someone attacking Obama on gun rights. This person could effortlessly espouse his view but his assertiveness was not matched with real reflection on the issue. I wondered though, how would his view change if he had the life experience of feeling, and even smelling, the pure stress of trying to save a child on the operating table blown to bits over nothing. Its real.

    You are a talented writer. I would suggest you go to Dallas, Houston, or Chicago. If you can find some way to work around the HIPPA laws, spend a few Friday nights embedded with the Trauma Surgeons. Go into the OR with them. Take in the sounds and smells. Watch nurses and scrub techs working so hard for people they will never know. Tell the stories of the kids getting blown away every f***kng weekend. Watch how the newly minted surgical interns struggle to keep up with GSW after GSW. Watch how the chief resident talks with the parents of dead children. Write about what the young man with the bullet holes was doing 24 hours prior. Its dramatic and powerful and unseen by most Americans. There is silence on this issue. People have NO idea. You could do the story justice. Roland Martin on CNN would be speechless. Ansel I’m telling you we are in need of some raw reporting.

    I digress. . .

    Just like in a Chicago trauma bay, a physician in Haiti experiences Haiti – witnesses Haiti in a way that few people can. Many readers, having not truly witnessed what Dr. Farmer has been witness to. . . having no idea what a 120 hour physician workweek feels like- having never consoled siblings of a dead brother, or sister, or mother, will read your work and applaud your sharp words as they fall on that high ranking “cog” in the Haitian Machine, who, as you seem to suggest, is Dr. Paul Farmer.

    Your readers’ strange, uninformed acceptance, and even vociferous support of the view you put forth compelled me to offer a response. When you look at the volume of Farmer’s work, he is far from silent.

    Consider what Farmer, the “idiot”, has accomplished compared to others in that stagnant place the world loves to forget. What change do you think would come from his words had he spoken out against wages in Haiti? Against party-elections in Haiti? Against other issues/people you suggest he should? Words are words, actions are actions.

    I would argue that Dr. Farmer is still the person you held in esteem as one of your heroes. Lambasting one of your heroes should not be an easy thing to do.

    1. Thank you Dr. Ekubek for your defense of Dr. Paul Farmer! How true your words are – It is “easy” to criticize when one hasn’t had the experience of a person, like Dr. Farmer!

    2. (Here’s a response had I sent to Dr. Ekubek by email:) I appreciate the feedback. Paul is still a hero to me. Whatever errors he might be making now don’t erase all the brave work he’s done, whether its treating patients or building clinics and hospitals. The piece didn’t diminish any of that. He was part of what inspired me to come here in the first place.

      But to those who’ve said Farmer isn’t terribly influential or involved in politics outside of healthcare – at the very least, you probably don’t know that. I’ve come to believe it’s not true.

      We’re all looking for ways to correct mistakes that are being made (sooner rather than later) so that Haiti can really recover and rebuild. I think raising the question of accountability or lack thereof with respect to Farmer or any prominent actor, in the context of Haiti, is rarely if ever a bad thing.

  7. It is important to point out that when most of the NGO community and media were completely silent on the U.S. Chamber of Commerce backed ‘aid starvation’ of Haiti (circa 2000-2004), Farmer was one of only a few people to well document what was going on and attempt to disseminate that information internationally. See here for Farmer’s discussion on how the cut off in aid was leading to deteriorating health conditions (including a decrease in access to potable water):
    CEPR estimated that the cut off in aid cost Haiti’s elected government 32.38% of its budget over that time period. It is astonishing how such information has been almost completely ignored, even by those writing with the benefit of hindsight (See for example: Alex Dupuy’s ‘The Prophet and Power’, Girard’s ‘The Tumultuous History’, and Katz’s ‘The Big Truck..’).
    Farmer’s current UN position is contradictory and this blog post brings up valid criticism. I would just add that an appraisal of Farmer’s work must also include a recognition of his ongoing backing of the UniFA medical school:
    With UniFA and PIH’s goal in part to build a sustainable medical system geared towards Haiti’s poor majority, the legacy of Farmer and others will also be for future generations to consider.

  8. Maybe Mr. Farmer found that in order to do some good, you have to get your hands a little dirty. Its hard in this world to live up to our ideals. Mr. Farmer has done far more than most. What kind of funding would he get from power structures that exist if he completely denigrated them? Anyone with ideals will find that they will not be able to live up to them eventually. No one is beyond criticism, but this article makes it sound like Farmer is some sort of “sell-out” and not a guy whose trying to do some work in the world.

  9. Herz treading of the self granted license to discover the apexes of truths is cleverly using a pre-configured opinion thereby against and distant from catching an unpassionate or neutral or ethically speaking, an objective reading of the facts bringing to the surface the most intimate details of actually being Paul Farmer, the mission, the health care, the solution and the commitment to providing free access to medicine in the Haitian context. In comparison Herz has only few empty and insignificant intellectual postures with a personal agenda that are built upon his tactic of misusing an idea he is misappropriating ” the silence of our friends” as if this would be the parameter of the final judgement Herz is imparting. You might want from Farmer to wear costumes and fight battles that are on your script, and you might puzzle up your informed conjectures to stitch your idea of universal responsibilities that Farmer has but what really transpire is that you are failing to explain the actual facts you lined up in your show, the truths as underpinned gears of the dynamics you almost touched with the “money for silence” idea, which you only use to reinforce your affirmation and do not use to fully follow the money and see the deployment of his work. Can you remove Farmer from Haiti? Can we remove you from Haiti? Are you sure that your feces did not contaminated the ground and the water? do you know what was below the holes you made your droppings? “If I were to rank the top 5 interventions, to slow cholera…I would not put legal action before building a water system or treating Haitians.” Did you get your sewer story right? Are you sure he needs to talk for you? Are you sure he is the catalyst for minimum wages changes? Didn’t you read the cables and the legislative colonial frame concocted by lobbies once called “masters” buying the US congress? Why is Haiti a country where slavery is rampant? Would you be able to build and balance the extensive unparalleled health care access he has provided to Haiti with the truth you want him to fight for in your specific terms? I think you are too sure with a talent. Do you think that could get you killed in Haiti? if you were actually influential? politically speaking? intermingling with the course of “authority” and “power”? “On the second year anniversary [of the quake] I wrote what I had to say and I don’t really have any more to say.” Are you a child looking for attention from the big daddy?

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