The sower.

We need more farmers. Not industrial farmers, family farmers, or even subsistence, organic farmers (although we could do with more of the latter). We need more versions of Paul Farmer, the forty-six-year-old Harvard physician/anthropologist profiled by Tracy Kidder in his book Mountains beyond Mountains (see Commonweal, "The Good Doctor," February 11).

Farmer was recently named a "champion of the poor" by Time magazine (November 7) for his work with the indigent, chronically ill, and dying, not only in the United States, but in Haiti, Russia, and Africa.

Farmer grew up poor himself, in the southern United States. As an undergraduate at Duke University he discovered liberation theology and a broader understanding of his own Catholicism. Partly as a result, in 1987 he established Partners in Health (PIH), a nonprofit, Boston-based charity that attempts to meet the public-health needs of those who live in blighted or dysfunctional settings, including Russia's prisons. Farmer seems to have a three-pronged agenda: to alleviate the suffering of the poor and really change their lives, you've got to deal with people, programs, and public policy simultaneously.

Farmer touched on each during a recent panel discussion on the eradication of malaria and tuberculosis. The panel was part of Time's Global Health Summit, held in New York from November 1 to 3. Hundreds of experts--representatives from government, finance, business, science, journalism, and health care--converged to consider what organizers described as the ten most challenging health-care issues facing the world today (see time.com/globalhealth).

People When the panel needed a description of malaria's symptoms, it tapped Farmer, the clinician. He was succinct, professional, personal, and graphic. As Time noted when it described Farmer as a champion of the poor, his PIH clinic in rural Rwanda not only treats patients with AIDS, TB, malaria, typhoid, cholera, and malnutrition, but does so with the same degree of attention given patients in the best hospitals in the world. According to Time science editor Philip Elmer-DeWitt, Farmer "calls this approach the 'preferential option for the poor.'"

Programs Farmer is particularly concerned with the health of communities, and with how public-health practices impact them. For example, he and the panel drew attention to the alarming incidence of drug-resistant malaria and TB, not only in developing countries but in the developed ones too. It victimizes scores and is growing, in large part because too many infected patients never complete their full treatment regimen. Instead of blaming the patients, though, Farmer and his coworkers try to discern their concerns and devise programs to help them complete the therapy. In Haiti, PIH has had a phenomenal 100-percent success rate in treating TB at its clinics after talking with patients and their families and figuring out how to retain their cooperation. If someone is tempted to break off treatment in order to return home to assist a starving family, for example, the family is provided the necessary food so that the breadwinner doesn't interrupt treatment.

Policy Farmer's further insight into resolving the global health crisis is his attention to the third prong: how to affect broader public awareness and policy. He has been willing to ruffle feathers on this score, and not only those of multinationals, governments, and international organizations, but even of his natural allies. Malaria-bearing mosquitoes continue to wildly applaud the fact that we outlawed DDT, he told the panel. While not advocating the wholesale reintroduction of DDT in agriculture, Farmer proposed its use for certain purposes. For example, he said, its application should be reinstated in some African countries to douse the walls and roofs of thatched huts where mosquitoes breed. But were Kenya to do that, Charity Kaluki Ngilu, its minister of health told the panel, the European Union and the United States would immediately exclude the importation of Kenyan agriculture products. Well-meaning policies like the total ban on DDT demonstrate, Farmer noted, why the first world has to consider the many far-reaching ramifications that its social and economic policy directives have on whole peoples and continents.

By the time the Time Global Health Summit's TB/malaria panel completed its sixty-minute roundtable, Farmer, true to his name, had planted a variety of seeds. Besides raising the issues of greater awareness and resolve, he had demonstrated them personally.

Patrick Jordan is the managing editor of Commonweal.