Next Generation is a Brigham Clinical & Research News column penned by students, residents, fellows and postdocs. If you are a Brigham trainee interested in contributing a column, email us. This month’s column is written by Brittany Powell, MD, MPP, a resident in the Department of Surgery and research fellow in the Center for Surgery and Public Health.

Brittany Powell

My Brigham education started ten years before I would walk the Pike as a general surgery resident, in an overcrowded undergraduate lecture theater. An administrator was telling the students present that we would have to enter a lottery for a place in the course when Dr. Paul Farmer took one long-legged step to the lectern and said, “We aren’t turning anyone away; we’ll just need to find a bigger classroom.”

This was the mentality Paul infused into my most important lessons in medicine and global health for the next decade, while I was his student, mentee, and research assistant at Partners In Health (PIH) and eventually, proudly, his junior colleague at the Brigham. The mentality is one of abundance, solutions-oriented and redistributive. The resources exist: we just need to get them to the places where they’re needed, to the people who need them. Or, if it doesn’t exist, we’ll build it. I saw Paul and his team build “it” — a curriculum, a network, a clinic, a hospital, a university — over and over in the decade of my time learning from him.

I was immediately drawn by the gravitational force of the urgency with which Paul saw the world’s problems, and his ambitions he had — and shared — for tackling them. Every time I went to him for advice, he encouraged me to think bigger and bolder. He was unrelenting in his ability to see the world for what it could be, and to invite others to share that vision and make it real. While I was in medical school at Stanford, Paul connected me to Dr. Robert Riviello, a trauma surgeon at the Brigham, whom I would have the great fortune of working with in Rwanda for the next eight years.

As a research associate in the Program in Global Surgery and Social Change (PGSSC), I got to explore a multitude of research methods and priorities, and, with Paul’s voice in my head, ultimately settled on national-level policy change and strategy-setting as my areas of scholarship and research. That choice has led me to some unexpected places — government ministries, international conferences, private sector meetings, and, to strengthen my contributions, back to school to pursue a Master of Public Policy and a Master of Business Administration at Oxford. The interdisciplinarity of my education mirrors the challenges that Paul elucidated in global health care, the challenges of translating lessons learned and best practices from one sector to another to strengthen the work that necessitates their collaboration. The public and private sectors and the academic medical system must work together to solve health care accessibility challenges. In my career, I want to be an orchestrator between these three essential stakeholders.

Paul’s mentorship was demanding, uncompromising, passionate and irresistible. And he shared it so generously with so many, lifting each of us up and urging each of us forward. It was one of his superpowers to help every one of us find our place in this shared work of global health equity.   Since his death last year, I have not stopped seeing the layered, interdisciplinary, international, disjointed and conjoined ways in which his students cover the planet. We are “TNTC”: too numerous to count, as Paul liked to quip. We work in medicine, surgery, public health, corporations, policymaking, biostatistics, architecture and development. There’s a mighty and diverse army carrying his legacy forward.

The Brigham — Paul’s clinical home, from his training forward — has played an important role, by valuing and supporting the work that Paul spearheaded all over the world. Just as our hospital’s support of boundary-pushing investigators on Francis Street working in precision medicine expands the possibilities of modern medicine, support of clinicians teaching—and learning—in Rwanda delivers on its promise: that no one should die of a treatable disease.

It is this support for global health equity that drew me to the Brigham as a trainee. BWH is a leader in global health because of tireless professors like Paul, who translate lessons from the bedsides and home visits and laboratories in Malawi, Mexico, and Haiti to the arbiters of institutional power in governments, multilaterals, and academic medical centers, shifting paradigms of patient care worldwide. Paul taught me that change starts at the bedside — when we care for patients, listen and bear witness to illness, suffering and injustice — and requires us to engage with systems of power, justice, and oppression. We can disrupt systems that harm our patients, and design new ones that serve all patients. That is what Paul spent his life doing.

I got to see one of these systems in action last summer at the University of Global Health Equity (UGHE) in Butaro, Rwanda. UGHE is a health sciences university in the north of Rwanda training a new generation of global health leaders, practitioners, and clinicians.

Spending time in this special place which fulfilled many of Paul’s big dreams for strengthening education and health care delivery was restorative, particularly in light of his sudden passing in February 2022. I got to share the campus with the students who were the last to listen to his jokes, be inspired by his quick wit and decisive explanations and to walk among the colleagues who planted trees and roses with him in his final days. I had the chance to write, think, read, and study on a campus where the foliage, lava stones, vistas and gathering points were all carefully considered by Paul, attentive to every detail.

UGHE is a place where I hope to continue to nurture the seeds that Paul planted. He gave us a common vocabulary and a shared purpose. He helped us access our universal humanity, and drove us to problem-solve. And he made it all truly joyful to work on hard things together. He bore witness to tremendous suffering, but never lost hope. The UGHE campus is infused with his joyful and hopeful spirit.

The global health community is aware that while we can never fill the void Paul leaves in our midst, we need to redouble our own efforts to keep up the pace he set for us. We all thought we’d have many more years working side-by-side with Paul. We honor him best with our work: by carrying out his vision, continuing our shared mission. The chance to teach future trainees Paul’s lessons, the ones that permeate the work I do from Boston to Butaro — what an incredible gift, and enormous responsibility.

The Legacy of Paul Farmer 

Farmer speaks with nurse Aminata Y. Koroma about pediatric patients at Port Loko Government Hospital in northern Sierra Leone. (Rebecca Rollins/Partners In Health)

On Friday, Feb. 24, at noon, the Brigham’s Department of Medicine will host “The Paul Farmer/Victor Dzau Lecture in Global Health Equity: Faith in Things Unseen: The Legacy of Paul Farmer in Global Health.” Mass General Brigham and BWH faculty and staff are invited to join Jim Yong Kim, MD, PhD, co-founder of Partners In Health (PIH), to learn more about the role Dr. Paul Farmer had in building PIH and the Brigham Division of Global Health Equity, as well as the role Brigham physicians have in influencing the current state of global health. Find details about the hybrid event on PikeNotes.

Readers inspired by Dr. Powell’s column can also learn more about Dr. Farmer’s work in Tracy Kidder’s Mountains Beyond Mountains, a book about the first half of his remarkable career; watch “Bending the Arc,” a documentary about the extraordinary efforts of Partners In Health to redefine dignified care for the poor; read a Q&A with Dr. Farmer in CRN; or read his own words in one of the many books he left us that record his teachings and vision.

 

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