On February 21, 2022, we lost a hero- a dedicated and selfless champion of health equity. Someone blessed with an infectious love for humanity, a man filled with the highest sense of humour, a cathedral thinker, a prolific researcher and writer, a doctor who was still on a mission to cure the world, Dr Paul Farmer- Muganga Mwiza, Doktè Polo, as he was commonly known in Rwanda and Haiti respectively. In 2009, I left my job as an assistant lecturer at the University of Rwanda to join Partners In Health (PIH), a social justice organisation founded by Dr Farmer, and his close friends Ophelia Dahl, Dr Jim Kim, Todd McCormack, and Boston philanthropist Tom White. At PIH, I took on a role of human resource manager at the new rural Kirehe Hospital living in a house that neither had electricity nor running water. Internet connectivity was a dream. My new office was a small partition made from a nursing station in the crowded internal medicine ward, with an entrance across the paediatric ward. If this was a major change from the life I had at the University, I could only imagine how it was for Dr Farmer. After a few months there, I met Paul for the first time. He had come to Rwinkwavu, in eastern Rwanda, to join an all-staff meeting for PIH teams. Rwinkwavu was the first among the most rural areas of Rwanda where PIH started its work. At the end of the meeting, Paul hugged each staff member—there were hundreds of us— and soon my turn for a hug and introduction came. At first, I expected a simple handshake, but Paul insisted on a hug – so I grabbed the opportunity for an embrace, and then went on to introduce myself. Before I could finish the introduction, Dr Paul interrupted me. “Of course, I know you, Kamanzi, and I know about your HR office amid patient wards at the hospital. It’s a nice place to be, yeah?” I was struck to hear him say my name and talk about my office next to the nursing station. I didn’t expect him to know me at all; but true to what I was told, Paul always knew all PIH staff by their names. I had finally met the man I had only read about in a famous book “Mountains Beyond Mountains,” written about him by Pulitzer Prize winning Author, Tracy Kidder. My journey to serve a dream, that would soon become my own, had started. It’s still on and counting… Paul worked and easily connected with every person he met irrespective of his/her status and background, from country presidents to cleaners, gardeners, and security guards. He knew how to guide and develop one’s potential. Partners In Health’s mission is “to provide a preferential option for the poor,” which simply means, “a call to look at the world from the perspective of the poor and marginalised, and work in solidarity for justice.” It’s the realisation of the plight of those in suffering, and the dedication to put their needs ahead of your own interests. For the last 13 years, I have served Paul’s vision which not only align with my personal life and career aspirations, but also my country’s vision. Among other things, I was honoured to work on anchor projects that stood deep in Paul’s vision—the development of Butaro District Hospital (BDH) and the University of Global Health Equity (UGHE). Indeed, those projects were meant to serve not only my country but also the region and beyond. At the grand opening of both projects, Dr Farmer was joined by his close friend and my President, His Excellency President Paul Kagame. I had the chance to meet two icons, who shared much in common in their dedication to serving those in need, and fighting for equity. In October 2016, I went to visit Dr Farmer at his office at Harvard Medical School. The school is surrounded by some of the world’s leading medical institutions – the Dana Farber Cancer Institute, Brigham and Women’s Hospital, Boston Children’s Hospital – in a Boston neighbourhood collectively known as the Longwood medical area. To get to Paul’s office, I took a train and then walked from Brookline Avenue to Shattuck Street and Huntington Avenue. I was engulfed the entire way, not only by the sound of sirens, but also by chatter among medical students and highly, richly educated doctors. I had been working at PIH’s Boston office for almost four years, as the Rwanda program officer, but nonetheless, for someone of my background – a childhood spent as a refugee, with parents who worked incredibly hard as subsistence farmers and were able to send me to good schools – Longwood still seemed an unfathomable, unattainable world. When I reached Paul’s office, he asked how I got there, and I described my trip. He asked what I thought about the area, and I said it seemed like a great place to be if you needed care – as long as you could pay for it. It was then that I realised the extraordinary scale of Paul’s dreams, and the vast scope of his expectations for me. As we talked about injustices in health care and the intersection of care delivery, training, and research, a path unfolded that would change my life. It became clear that he wanted to develop a Longwood medical area in Butaro, a rural region of northern Rwanda. Previously, before coming to Boston, I had helped PIH build the Butaro District Hospital and its Cancer Centre of Excellence – the first cancer centre of its kind in the region. Paul had asked me to meet that day because he wanted me to do the same for the UGHE, an envisioned medical school planned for a site, just minutes away from the Butaro hospital. The medical school’s mission would be to train the next generation of the world’s health leaders poised to make equitable changes in the way health care is delivered around the world. Paul wanted me to help build a unique and global University campus based in deep rural northern Rwanda. During my time with PIH, I had never shied away from a challenge as long as it was Paul’s vision– but this was a steep hill to climb. I had moved to the U.S. with my family and developed emotional bonds and close friendships with my PIH colleagues in Boston, enjoying after-work soccer games and camaraderie, and taking health care delivery courses at the prestigious Harvard University School of Public Health and Business School for the most part of summer. “Kamanzi is going to lead the development of our baby campus in Rwanda,” Paul had told the PIH Boston staff, who were emotionally bidding farewell to me. A few weeks later, in November 2016, my family and I were on a plane to Kigali. There was no time for re-acclimation. The day after we landed, I was on the road to Butaro, to work with general contractors and, examine site plans, and prepare for a whirlwind construction period and furniture orders. As I made phone calls to re-connect with colleagues, people kept asking why I could leave the U.S. and come back to Rwanda. It reminded me of some years back, when I left the University of Rwanda to work in Kirehe District. Both times, in Kirehe and at UGHE, my answer was the same: I was following Paul’s vision – period. This time, Paul had become not only a mentor, but a close friend and inspiration. Over the years, my time in Kirehe led me to become the district manager for PIH programs in Rwanda’s southern Kayonza District and northern Burera District, then the Rwanda program officer in Boston, and finally UGHE’s founding director of campus development. Paul was a mentor for everyone he worked with and followed him. At universities where he taught, after his lectures, he spent long standing hours speaking to the long lines of students who sought his advice. At hospitals where he cared for patients and taught medical students, he was always the last to leave speaking to patients and staff of all backgrounds. In the communities and on many home visits with community health workers, he deeply listened to not only understand the patient’s health condition, but also the lifestyle. His later actions would change the patient’s lives and build their hope for life. Some of Paul’s patients would later be on his staff or join him in the classrooms to offer their stories of recovery to students. Being successful in serving Paul’s vision requires you to embody the core values of empathy, humility, selflessness, accountability, trustworthiness, and love, among others. You learn to be a good listener, relentless, creative, and ultimately, devote your life to making a positive impact on other people’s lives. A hero Paul was a worldwide hero who selflessly dedicated his life to serving the destitute, with a strong sense of humour, bold vision, infectious laughter, and humbling love for all. He believed in a world where health care is free and accessible to all, everywhere. The books he wrote will continue to teach his guiding principles to generations to come, that it’s possible to change the world and cure injustice. As I was leading construction and development of Butaro hospital and UGHE’s nearby campus in Butaro, Dr Paul kept reminding me of the utmost honour it was to build the best university teaching hospital in rural Africa. He had deep conviction that even in the poorest places; places with dysfunctional politics, and violence, he would still make a huge difference. He was a strong believer that high quality medical care and medical education can and should be delivered in rural settings like butaro, just like how they are delivered in major wealthy cities like Boston. But his vision did not end there. In fact, he thought that what had been done was just the start. Any occasion he would get, he would make his vision and aspirations clear to people he knew would join him in achieving them. Paul made every time he had with people so special and fun. Every time I met Paul, I would leave highly challenged but also filled with much energy to keep serving and dream big. On one of the many campus tours and mentorship walks we shared this year, Paul looked at our campus tower, built of volcanic stone. It’s the highest structure on campus, and at that moment there were over 100 ring-necked African doves on top of the tower. Dr. Paul asked what I thought, and I told him it looked beautiful. He said, “You are right, but I am sure you know we are not done yet.” Every time he visited the campus and hospitals, he wouldn’t miss planting a tree before proceeding to other PIH sites on the continent. Paul loved and cared about nature and environment. He understood and taught about the intersection of human, animal, and environmental science. He was a dreamer who compassionately followed through on what he dreamed. He liked to give nicknames to his staff and friends, sometimes with just abbreviations; he called me his (TMI)-Trusted Master Implementer. I had my own names for him too. We both knew that once each party agreed on doing something, we would call it done. Paul believed and trusted that anything I was assigned to do, would be checked done on his end…this was also the case on my end. He trusted me to lead the development of a hospital that was urgently needed by patients, which would also help to eliminate what he called, ‘stupid death.’ He also trusted me to lead the development of a campus that he wanted to be the haven to train the next generation of health leaders poised to make equitable changes in the way health care is delivered around the world. He always reminisced about my choice to join PIH in rural Kirehe from the University of Rwanda and had seen my dedication to his lifesaving mission. He had witnessed my prior successes that met his standards. He never questioned my ability to work with others, to be accountable and deliver. UGHE students, who Paul had taught and those who will join in later years, are and will continue to be our dependable driving force in sustaining Paul’s vision to the world. Two years after I moved back to Rwanda, President Kagame joined Paul and others to officially open the campus. Our first medical school students had just started their orientation. We employed over 1500 local employees, some of whom later became full-time staff. Most of construction materials were local. Since its opening in 2005, UGHE has to date graduated up to 145 students. Its first cohort of medical students are in their 3rd out of 6.5 year of training. Once they graduate, they will help Rwanda and the rest of the world to curb down the existing acute shortage of healthcare workers. Over the course of the university’s construction, Paul visited several times to check on the progress, speak and interact with staff and contractors, and guide us on several issues—he was our master landscape architect, among other unofficial positions. He was involved in several reviews of our plant lists and gardening plans. Dr Paul brought and planted several Coastal redwoods trees around the thriving Butaro longwood medical area (BLMA). These are the tallest living tree species on earth. His vision was the BLMA be accessible to all and live for generations to come serving as the world’s medical hub dedicated to equity. Now, as I mourn and reflect on his passing, I look from the top of a beautiful hill opposite Butaro District Hospital, surrounded by Rugezi marshland foliage with backdrops of volcanoes in the Virunga Mountains. I am seated on a top terrace of Building A at the UGHE, outside a conference room named on behalf of H.E President Paul Kagame. Its break time, I see movements of UGHE medical students through the pathways of the main campus quad. This is a place that Dr Paul Farmer dreamed of, developed, stayed, and loved. During Paul’s last days, most of us, his Rwandan staff, were honoured to spend a healthy time with him. On the thriving UGHE campus, Paul and I walked up a hill where the campus is being expanded, we toured the site where Butaro District Hospital is being expanded, we planted countless trees and flowers together, and I shadowed Paul on patient visits at the Butaro hospital. Paul left us just as we were aggressively planning for the buildout of a tropical rainforest glade on the UGHE campus, inspired by “The Fellowship of Rings”, the Tolkien’s 1st volume of epic novel “The Lord of the Rings.” He and I were still on the same journey we had talked about, years earlier—to build a Longwood medical area in Butaro, accessible by all. The day Paul rested, we had texted each other in the morning, making plans to meet the following day. I was bringing several species of plants for his review and planting before he planned to leave for West Africa. The last text I received from him said: “I will be here waiting excitedly,” and ended with a heart emoji, as was common practice on several texts I had received from him. What stood out clearly, to all of us who had the chance to work with Paul, is that he wanted to see a world with justice. He wanted us to create conditions for marginalised voices to be heard, to defend the defenceless and to assess lifestyles, policies, and social institutions in terms of their impact on the poor. As Nelson Madiba Mandela said: “When a man has done what he considers to be his duty to his people and his country, he can rest in peace.” Dr Paul died in a place he dreamed of, worked to develop, and loved, surrounded by beautiful plants and flowers he cherished: roses, bromeliads, gardenias, and of course, coastal redwood sequoias. Paul lived a compassionate life that not only saved countless lives but also inspired our generation, and many more to come. That inspiration of future generations provides relief and solace, knowing that so many will work to sustain his legacy. And that is now our task: I am forever grateful and indebted to Paul’s beloved wife Dr Didi Farmer, and his children; Catherine, Sebastian, and Elizabeth for sharing Dr Paul’s legendary life with us. Paul will be dearly missed, but his vision will live on, with and through us, to build a just world, grounded in health equity for all. The Author is the founding Director of Campus Development for the University of Global Health Equity. Views expressed in this article are of the author.
