Virchow published more than two thousand papers and dozens of books. At Duke, Farmer read some of his work in translation and several articles about him. Virchow’s was a career to stir a brainy youth’s imagination, an adventure that combined deeds and intellect, launched at an early age. When he was only twenty-six, the German government sent Virchow to Upper Silesia to report on an epidemic of what was then termed famine fever, now called relapsing fever. Virchow found a region impoverished by absentee landlordism, where the people, mainly Polish, lived principally on potatoes and vodka and suffered from endemic malaria and dysentery. In his report to the German government, he wrote that abysmal social conditions, which the government had fostered and done nothing to relieve, had caused the epidemic. This was forty years before medical science identified all the biological sources of relapsing fever—its vector is the louse—but subsequent discoveries would show that Virchow was right. Epidemics of the illness usually occur after social upheavals, in the ensuing overcrowding, poor hygiene, and malnutrition. In his report, Virchow expressed a fundamental law of epidemiology: “If disease is an expression of individual life under unfavorable conditions, then epidemics must be indicative of mass disturbances of mass life.” His prescription for curing Upper Silesia was “full and unlimited democracy.” This meant, among other things, establishing Polish as the official language, taxing the rich instead of the poor, getting the church out of the business of government, building roads, reopening orphanages, investing in agriculture. The government fired him. Virchow would write, “My politics were those of prophylaxis, my opponents preferred those of palliation.”
He had a knack for aphorism. “Medicine is a social science, and politics is nothing but medicine on a large scale.” “It is the curse of humanity that it learns to tolerate even the most horrible situations by habituation.” “Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community.” “The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.” This last was Farmer’s favorite.
Virchow put the world together in a way that made sense to Farmer. “Virchow had a comprehensive vision,” he said. “Pathology, social medicine, politics, anthropology. My model.”
Farmer had acquired, partly through Virchow, a moral understanding of public health. While at Duke, he also found a subject.
He was reading very widely, in anthropology and history and sociology and political science. He was interested in current events, especially in the violent troubles in Latin America. In 1980, when Archbishop Oscar Romero was murdered by a right-wing death squad in El Salvador, faculty and students held a protest vigil at the Duke Chapel, and Farmer attended. He also did some reading about the branch of Catholicism called liberation theology, which Romero had been murdered for preaching. Latin American theologians had developed the doctrine, and in the late 1960s Latin America’s Catholic bishops had endorsed some of its tenets. The bishop who had confirmed P.J. back in Brooksville had delivered a homily mainly about the perils of premarital sex. In the church documents Farmer read now, the Latin American bishops spoke about the oppression of the poor, calling it “institutionalized sin.” They declared that the church had a duty to provide “a preferential option for the poor.” Farmer remembered thinking, “Wow! This ain’t the Catholicism I remember.”
But he wasn’t mainly impelled by politics or religion, he’d say. He felt more curious about the world than outraged. He had the sense that the truth about events in places like El Salvador lay hidden from most Americans. And it was in the same spirit mainly that he got interested in the migrant labor camps not far from Duke. “Here I am in the middle of a very affluent university, with a lot of comfortable ideas, and I met this nun. She was Belgian, Julianna DeWolf, working with the Friends of the United Farm Workers. And she was a fearless article. I just remember thinking she was much more radical and committed than anyone I’d met, arrogant and humble at the same time. The Haitian farmworkers thought the world of her.” He met others like her—“church ladies,” he called them—and he was impressed, not by their piety but by what they were willing to do on behalf of the migrant workers. “They were just so much more militant, if that’s the word, than the WL’s and academics. They were the ones standing up to the growers in their sensible nun shoes. They were the ones schlepping the workers to the clinics or court, translating for them, getting them groceries or driver’s licenses.”
In Sister Julianna’s company, on tours of North Carolina tobacco plantations, he met a number of Haitians. The wretched conditions they lived in made the circumstances of his own childhood seem idyllic. He began reading everything he could find about Haiti. By the time he graduated, he knew enough to write an article of six thousand words about the Haitian farmworkers laboring in the fields near Duke. He called it “Haitians Without a Home.” At home and abroad, he’d come to think, Haitians were the underdogs of underdogs, “the shafted of the shafted.”
Farmer left Duke—he graduated summa cum laude—interested in all things Haitian. He visited Krome Detention Center in Florida and joined protests against what seemed to him the rank injustice of an American immigration policy that let in virtually every refugee from Cuba and sent nearly every fleeing Haitian back to hunger and disease and what had to be the Caribbean’s cruelest, most self-serving dictatorship. By now he had certainly progressed, as he would put it, from curiosity to indignation. But curiosity remained.
The history of the country seemed worthy of a Homer or a Tolstoy or, especially to Farmer, a Tolkien. The landing of Columbus on the island that he named Hispaniola and the extermination of the Arawak Indians that followed. The division of the island between France and Spain, which left the French in possession of the island’s western third, where they created an immensely lucrative and gruesome slave colony—a third of every new shipment of West African slaves died within three years. The slaves’ long and bloody revolt, which began in 1791 and which not even Napoleon and forty thousand troops could put down. And at last, in 1804, the creation of Haiti, Latin America’s first independent nation and the world’s first black republic. But independence had been followed by nearly two hundred years of misrule, aided and abetted by foreign powers, especially France and the United States. (From 1915 to 1934, the U.S. Marines had occupied and run the country.)
To Farmer, Haiti’s history seemed, indeed, like The Lord of the Rings, an ongoing story of a great and terrible struggle between the rich and the poor, between good and evil. What he read about the country’s culture fascinated him. Haiti had its own music and literature. Paintings by Haitian artists hung in European and American museums. The people of Haiti had created their own complex religion, Voodoo—with a rather distant supreme deity and a host of other gods, a pantheon including Catholic saints. It was a system of belief that seemed all the more worth studying because it was so widely misunderstood and ridiculed. And the Haitian tongue, Creole, was not, as was sometimes said, “a coarse patois” but in essence a Romance language, derived from French and, in some of its phonetic habits and grammatical structures, also clearly African. It was unique to Haiti, lovely and expressive and born of grim necessity—the French masters had deliberately separated slaves who spoke the same languages, and the slaves had fashioned their own tongue. Farmer began to study Creole before he went to Haiti in the spring of 1983. He planned to spend about a year there.
He’d won a prize of one thousand dollars at Duke for an essay about Haitian artists, and he figured this should last him, since he’d read that the average Haitian lived on far less. He had worked as a volunteer in the emergency room at Duke’s university hospital and had begun applying to the two schools, Harvard and Case Western Reserve, where one could get a joint degree as a doctor-anthropologist. He figured he’d find out if that was what he really wanted to become by trying out both disciplines in Haiti.
In 1983, when Farmer landed in Port-au-Prince, the airport was
still named François Duvalier, in honor of the infamous Papa Doc, who had ruled the country, with liberal use of terror, from 1957 until his death in 1971. His reign was being continued now in the person of his son, Baby Doc—a little less crafty than his father but with the same proclivity for murdering political enemies and for stealing and misappropriating foreign aid. He would soon proclaim himself “president for life.” In fact, the Duvaliers’ three decades in power were nearly up, but no one knew that then. The Haiti that Farmer first encountered ranked as an exotic destination for tourists, including sex tourists—Haitians are a comely people, the majority desperately poor; one international guide for gay tourists reported in 1983, “Your partners will expect to be paid for their services but the charges are nominal.” Port-au-Prince was a city full of slums, but it also had a few fancy neighborhoods and some good restaurants and hotels, and it was very safe for a tourist—patrolled by, among others, the Duvaliers’ Praetorian guard, the men in dark glasses, the tontons macoutes, named for a mythical bogeyman, Uncle Sack, who stuffed bad children into his bag. They didn’t harass tourists, not unless they looked in a suitcase and found a copy of Graham Greene’s mordant, anti-Duvalierist novel of Haiti, The Comedians. Even then, they’d merely administer a harangue.
Farmer didn’t bring his copy of the novel, and he didn’t hang around in the city at first. During a brief postgraduate fellowship at the University of Pittsburgh, he had met a member of the Mellon family. They had used part of their fortune to build a hospital in Haiti, the Hôpital Albert Schweitzer, situated in the town of Deschapelles, in the lower Artibonite Valley. Farmer journeyed out there from Port-au-Prince almost as soon as he arrived. He had high expectations, and it was a good-looking hospital, he thought. But it was staffed mainly by white, expatriate doctors. He’d imagined something different—a hospital at least partly devoted to training Haitians to treat Haitians. Besides, the Schweitzer didn’t have a job for him just then, in spite of his Mellon contact. He went back to the city, feeling, he’d say, “deflated.”
He began looking around for other situations. He came across a small charity called Eye Care Haiti, with headquarters in Port-au-Prince. It conducted mobile “outreach clinics” in the countryside and kept a small house as a base for those operations out in the central plateau, in the town of Mirebalais. Farmer headed there.
CHAPTER 7
Years later Paul Farmer received this letter from a woman he wanted to marry:
Lovely Pel,
My inability to promise a life with you, as your wife, does not stem from a lack of love or deep, deep commitment to you. Indeed, as you probably know, I have not felt a serious ounce for anyone but you since 1983. My decision was based, instead, on trying to envision our life together and I saw us not matching (the only way we didn’t fit). For a long time I thought I could live and work in Haiti, carving out a life with you, but now I understand that I can’t. And that’s simply not compatible with your life—the life you once told me you would like to lead even ten years ago. You pointed out to me once, during an emotional argument, that the qualities I love in you—that drew me to you—also cause me to resent you: namely your unswerving commitment to the poor, your limitless schedule and your massive compassion for others. You were right, and, as your wife, I would place my own emotional needs in the way of your important vision; a vision whose impact upon the poor (and the rest of us) can’t be exaggerated …
I was lucky to meet you when I was young, young enough to feel as though I have always known you and lucky to have been hugely influenced and loved by you. In the end, I hope you know that as part of my histology you can never be replaced.
Her name was Ophelia Dahl. She came from Buckinghamshire in England. She had traveled to Haiti in January 1983, in order to please her father and with the intention, rather vague, of doing good works. She was eighteen—“a slightly mature eighteen,” she would say—and was working as a volunteer for Eye Care Haiti. She was staying for a week at the Eye Care house in Mirebalais.
Back then Mirebalais was the country home of Madame Max Adolphe, formerly the warden of Fort Dimanche, where the Duvaliers sent their enemies, a prison likened by one historian to Buchenwald. Madame Max was now the national chief of the tontons macoutes. So Mirebalais was a place of some significance, different from most of the little towns scattered through the mountains and valleys farther north, in that it had intermittent electricity and radios playing at most hours, a small section of paved road at its center, ramshackle kiosklike stores beside the road, and a few places where you could buy a beer or a glass of the potent white rum called clairin. It also had a Teleco, a building near the center of town, where you could, with difficulty, get connected by phone to Port-au-Prince, or Brooklyn, or even Buckinghamshire.
Ophelia had wanted urgently to call home. A letter from her father had mentioned new troubles there, and she felt, irrationally and keenly, responsible for heading them off. She had gone into the Teleco, trying to think of the right things to say to her father. Her call didn’t go through.
It was raining when she stepped outside, feeling glum. The rain had driven everyone else indoors. In fair weather, children would crowd around Ophelia, and people would call out “Blan! Blan!” as she passed—not intending rudeness, she had learned, but merely announcing the presence of an unusual sight. Here in the Haitian provinces, it was of course her white skin that made her stand out. But certainly she was a lovely young woman. In the midday heat of Haiti, her face would grow red blotches, but at normal temperature her skin had a lovely clarity.
Trudging moodily back to the Eye Care house in the warm rain, Ophelia looked up and, to her great surprise, saw a young white man standing on the building’s balcony. “A pale and rangy fellow,” she would remember. She’d been living among Haitians for months, eating their kind of food and beginning to speak their language, and she took some pride in the fact that she wasn’t merely a tourist. She felt annoyed. Who was this blan on the balcony? What was he doing here on her turf? So she did what any well-bred English girl would do. She went inside and introduced herself to him.
The house had a common room with a cement floor, some wooden chairs, and a table. She and Paul sat down on either side of it and began to talk. Within minutes, she’d remember, she sensed that for the first time in months she didn’t have to hold herself back, not even the part of herself that she thought of as “slightly outrageous,” the part that liked bawdy humor and cussing. Before long she was telling this stranger about her aborted phone call and the hand-wringing feeling it left her with—trouble at home and she far away. She told him, “I want to write a nice letter to my father.”
Paul smiled at her. “You should start with ‘Dearest and indeed only Dad.’ ”
She laughed. At some point, Paul said, “Tell me about your family.” Many years later a friend of hers would offer this recipe for seduction: “Go out to dinner and say, ‘Tell me about your life.’ ” Ophelia would think of Paul and how, when he said those words, he made so many people feel he cared about only them at that moment. Of course, one knew that sometimes his interest was mixed with other motives, but he had this power because somehow one also knew that his interest was sincere. She told him about her movie star mother, Patricia Neal, and all the family tragedies—her mother’s well-publicized cerebral hemorrhage and long convalescence, and currently well-publicized and angry breakup with Ophelia’s father, the writer Roald Dahl. He was the one who had sent her to Haiti, in effect, by grousing that she should do something adventurous and useful. He worried that she lacked ambition. During her last two years of secondary school, she had studied geography, but before she’d boarded the plane to Port-au-Prince, she’d had to consult an atlas to find out where Haiti was.
She’d had a lot of pent-up thoughts and no one to tell them to, and now she did. Maybe any English-speaking stranger would have served the purpose, but this young man seemed close to ideal. She poured out her family’s story, her sadness, her present worries, an
d Paul listened intently, never saying she shouldn’t feel as she did, but only now and then suggesting ways she might accommodate her feelings. She was amazed. Here was this twenty-three-year-old American, who looked as though he was still molting adolescence, handsome enough but too pale and gangly and boyish-looking to be called dishy, and she thought, “How does he know what to say to me that would be comforting?”
She liked the way Paul responded to her near-celebrity. She didn’t sense he was thinking, “I’m talking to a movie star’s daughter!” He just seemed amused by the circumstance. He told her a little about his own family, and a few of the stories of his childhood, and these made her laugh. She gathered that he had come out to Mirebalais to see if he wanted to join up with Eye Care. So she described the various personalities on the team. She wouldn’t have liked him half so much if he hadn’t said, “Thank you for telling me that,” with such evident feeling, with his eyes opened wide.
They talked until about three in the morning. For the next few days he went out with the team in its Land Rover. He had told her that he was in Haiti mainly to do anthropology. She wasn’t quite sure what that meant. He had a tape recorder and a camera and a notebook, and, seated beside him, she watched him do his own watching from the truck. As they bumped along the dusty roads, past the miserable peasant huts, she asked him questions. Why were so many people sick? Why weren’t the roads better? He would answer her, but warily at first, as if he was waiting to be sure just who she was. He was embarrassingly enthusiastic, though. When people by the roadside called out, “Blan! Blan!” he would call back, “Hi!” and grin and make floppy-wristed waves. Once you were no longer a tourist, you didn’t wave, she thought. “Waving at your brown brothers?” she said.