Farmer, Magaziner: Get involved!

Physician and medical anthropologist Paul Farmer and Ira Magaziner, a one-time policy adviser in the Clinton White House, brought humor, counsel, and cautions to a public conversation on student engagement Sept. 20.

Greeting them was a packed-to-the-ceiling John F. Kennedy Jr. Forum, where the crowd was noisy, young, and ready to laugh — egged on by Farmer’s explosive wit. Magaziner, measured and lugubrious, happily played the young doctor’s straight man.

Not that the panel was a laughing matter. With audience questions included, it was a 90-minute look at global health challenges and related avenues for student activism.

For advice on public service, the audience had come to the right place. Farmer is co-founder and executive director of Partners in Health — a renowned model for delivering health care to the very poor. He is also the Maude and Lillian Presley Professor of Social Medicine at Harvard Medical School.

Magaziner is chairman of both the Clinton Foundation HIV/AIDS Initiative and the Clinton Foundation Policy Board. His passion for social justice began in the rural South more than four decades ago, when he was still in high school.

Early on, Farmer bolted forward in his chair to the sound of applause. “Do they know what they’re getting, these two guys — the squarest guys on the planet?” Slumped in his own chair, Magaziner just smiled.

The two met in 2002 at an AIDS conference in Barcelona, Spain, and by 2004 were working together in Rwanda. They described their collaboration as a blend: the doctor with skills in medicine and clinic architecture, and the analyst with skills in management, business, and politics.

AIDS led the conversation’s list of global health concerns. In the audience, a scattering of students wore T-shirts with the legend “HIV Positive,” part of a campaign by Step It Up, a collaboration of seven Harvard groups committed to fighting HIV/AIDS.

More than 6 million people in the world needed treatment in 2002, but only about 70,000 were getting it, said Magaziner.

HIV/AIDS treatment figures are better now, but still troubling. The key to fixing that is getting health care to “resource-poor countries,” said Magaziner — but lasting effort has got to come from within. About 80 percent of current financial aid comes from foreign sectors. “This is not sustainable,” he said.

Enter the Partners in Health model, which tries to “build up the civic sectors,” starting with existing public health infrastructure, said Farmer, who has opened clinics and hired staff in nine countries. “Our stuff is pretty much 99 percent local.”

It’s the kind of work that requires dispelling any neocolonial attitudes, said Magaziner, while embracing humility and respect. The hope is that soon “our job will be over as foreign visitors,” he said.

Farmer described the difficulties of working in poor nations as more logistical and cultural than political. He told future volunteers, “That’s the least we can do — know the history of a place, and its culture.”

Magaziner advised young activists that they would fail, and learn resilience from failure. That they should push themselves “to do the hard things.” And that they should be sure to make those in authority angry.

He praised Farmer for the Partners in Health model of public service and activism, which rests on three concepts: Work within a community, be respectful, and run a low-overhead operation.

He called global health only one of “your generation’s defining issues,” and then named two other “things you cannot escape.”

Global poverty is one — an untenable state of affairs, with “two-thirds of the world’s people getting poorer,” he said. Climate change is the other. “It’s coming up on us faster than we thought 10 years ago,” said Magaziner. “This is serious, serious stuff — and it’s going to be upon us in our lifetimes.”

Vietnam was over by the time he started college, said Farmer, who is 47. But activism wasn’t dead for him — and it shouldn’t be either for the present generation, which has been miscast as disengaged, and which has technical savvy unknown to earlier activists.

“We have to have a big-tent approach for problems that are this big,” said Farmer. “I’m optimistic about this generation.”

Magaziner added: “If you are doing something you believe in — that’s the easy part. It gives you energy.”

Without a life of meaning, said Farmer, “I would not be able to sustain this level of engagement.”

He offered his own list of “very troubling things going on,” including the Iraq war, climate change, and “a lack of basics” in much of the world. Those include reliable health care, clean water, roads, jobs, and gender equity.

But “a habit of engagement” can start early, said Farmer, and does not have to wait until the end of school or professional training. At Partners in Health, he said, “we built our organization out of student involvement. Postponing things to get things just right in your education is not going to be good for the planet.”

At the same time, keep up with scholarship, Farmer added. “You’ve got to pack that toolbox of activism with everything you can.”

Moderating the conversation were two examples of student engagement, both seniors at Harvard and both with extensive internship experience overseas: Matthew Basilico, president of the Harvard AIDS Coalition, and Connie Chen, the coalition’s vice president.

In activism, the personal matters, said Magaziner. In an “interdependent world,” he said, righting wrongs is important for both national and personal security.

The young activist today should bring foreign aid down to a personal scale, in defiance of lagging official aid, said Farmer. “That’s your generation’s job — to want to be different.”