Feature Story | 10-Jan-2023

Paul Farmer Collaborative to amplify work and honor legacy of global health champion

Cummings Foundation commits $50 million to support global health alliance between Harvard Medical School, University of Global Health Equity in Rwanda

Harvard Medical School

A $50 million gift from Woburn, Mass.-based Cummings Foundation will build upon and amplify the work of the late Paul Farmer, a champion of global health.

The gift establishes the Paul Farmer Collaborative of Harvard Medical School and the University of Global Health Equity (UGHE) in Rwanda. It will be divided equally between the two institutions.

Farmer, a physician and medical anthropologist, was the Kolokotrones University Professor and chair of the Department of Global Health and Social Medicine in the Blavatnik Institute at HMS, chancellor of UGHE, and co-founder and chief strategist of PIH, an international health and human rights organization. He died on Feb. 21, 2022, at the age of 62, while teaching at UGHE, an initiative of PIH.

“During his all-too-brief time here with us, Paul was the vital physical link between Harvard and UGHE,” said Joyce Cummings, who co-founded Cummings Foundation with her husband, suburban Boston real estate magnate Bill Cummings. “In Paul’s absence, it is critical that we act to ensure that this bond and his work endure.”

“This gift will allow us to continue Paul’s transformative work and honor his vision to reshape health care delivery for marginalized populations and to connect HMS with the University of Global Health Equity,” said HMS Dean George Q. Daley. “This gift is a powerful reminder that as a global community, we are only as strong as the most vulnerable among us, which Paul understood better than anyone.”

The Paul Farmer Collaborative

The gift is intended to build on Farmer’s legacy and enable researchers at both institutions to deepen their exploration of social medicine, a field focused on the many factors influencing a person’s health, and pursue fundamental questions about social determinants of health and humane caregiving. The overarching goal of the collaborative is to catalyze the development of sustainable, equitable health systems that improve health care delivery to underserved populations.

The program, named in Farmer’s honor, will build on existing multifaceted collaborations between HMS and UGHE.

Cummings Foundation’s gift, to be paid over 10 years, will fund:

  • Independent and collaborative research, teaching, and education at both institutions.
  • Exchange of students, postdoctoral trainees, and faculty between the two institutions.
  • An annual global conference and workshop on health equity, global health delivery, research, education, and social medicine.
  • An endowed Cummings Foundation Professorship of Global Health Equity at HMS to continue advancing Farmer’s ideals and objectives.
  • Clinical training opportunities for medical students and residents, with an initial focus on building surgical capacity and surgical health innovation in low-resource settings. Long-term, the training could expand to include other clinical specialties such as mental health, obstetrics, gynecology, pediatrics, internal medicine, dermatology, and anesthesiology.

The relationship between HMS and Rwanda has deep roots. In 2005, PIH was asked to help the Rwandan Ministry of Health fight HIV, improve maternal and child health, and bring integrated, high-quality health care to people in the nation’s rural districts.

Since then, Farmer and global health and social medicine and clinical faculty at HMS and affiliated hospitals have also collaborated with Rwandan health care providers and researchers on a number of efforts combining research, clinical innovation, and training.

In 2012, HMS faculty and collaborators from the Rwandan Ministry of Health launched an intensive global health delivery course at the Rwinkwavu Hospital Training Center,  modeled on the Global Health Delivery Intensive Program developed at Harvard. The HMS master’s program in global health delivery has hosted students from Rwanda, and has been adapted as a program at UGHE. And in 2022, a team from HMS and Rwanda won the National Institutes of Health Technology Accelerator Challenge for Maternal Health for a project to develop artificial intelligence tools that help community health workers identify patients at risk for surgical-site infections.

“This remarkably timely, generous, and transformative gift from Cummings Foundation will sustain and build upon the ongoing collaboration between our department and the University of Global Health Equity,” said Allan Brandt, interim head of the HMS Department of Global Health and Social Medicine and the Amalie Moses Kass Professor of the History of Medicine at HMS. “The Paul Farmer Collaborative will ensure that our faculties and students partner to extend the goal of global health equity and assure that those most in need receive the highest quality care.”

One of the latest academic and medical collaborations between the two institutions is the newly launched Center for Equity in Global Surgery at UGHE. The center aims to develop solutions to correct the imbalance in access to care through research and innovation, education and training, policy, advocacy, and global collaborations, according to a paper describing the launch of the center in early February2022. The paper, co-authored by Farmer and colleagues from HMS and UGHE, is one of Farmer’s last pieces of published research.

The Paul Farmer Collaborative will strengthen the efforts of the HMS Program in Global Surgery and Social Change and the UGHE Center for Equity in Global Surgery, an effort that the paper described as a vehicle for global surgery solutions developed in Africa through research, education, advocacy, and training.

In the days before Farmer died, he gave two remote talks at the University of Hawaii from the campus of UGHE, where he was excited to be doing rounds with the first class of third-year medical students at the school.

One of his presentations was on his latest book, Fevers, Feuds, and Diamonds: Ebola and the Ravages of History, in which he discusses the complex social, historical, and economic context of the West Africa Ebola outbreak. Another was on the importance of focusing on equity and social justice to improve health, drawing heavily on examples of his collaborative work in Rwanda. In the question-and-answer periods of both talks, Farmer shared several lessons learned in his decades of work on global health equity.

“We need to shift the conversation to what we’re hearing from poor people,” Farmer said. “I hear people saying, we want schools for our children, we want clean water, we want jobs, and we’d like to have our kids go to places like the UGHE.”

He also described the kinds of things he often heard from people, including many who work in the field of global health. They often listed things they thought were not possible in places like rural Rwanda: you can’t treat cancer, you can’t have an ICU, you can’t build a hospital or a medical school, many people told him.

Farmer noted that he was speaking to his audience in Hawaii from a thriving academic medical center campus, built in a rural area in Rwanda that didn’t even have electricity just a few years ago.

“This place is blossoming,” Farmer said. “We need to stand up to people who say ‘you can’t do this,’ because it’s being done.”

Landmark funding

To effect real change, collaboration must include material support, not just  symbolic solidarity, Farmer said. Empathy is essential, he noted, but it takes “staff, stuff, space, systems, and support” to deliver the promise of modern medicine to people everywhere.

In dollars and time commitment, this support from Cummings Foundation funds one of the most significant relationships that HMS has in Africa.

“It is incredibly exciting to have a nearly 400-year-old institution collaborating at such a significant level with a seven-year-old institution,” said Joyce Cummings. “Meaningful international partnerships are essential to effectively teaching global health, so Harvard will benefit immensely from solidifying its relationship with a top-notch university in such a highly desirable locale for learning and teaching about global health delivery. And UGHE will enjoy enormous reputational benefits, affording it greater visibility to major international life sciences and pharma firms seeking appropriate sites for investment, operations, and collaboration.”

“UGHE is training a new generation of leaders who will bring together the best evidence and a strong commitment to equity to improve health systems in East Africa and beyond,” said Jim Yong Kim, co-founder of PIH and newly appointed successor to Farmer as chancellor of UGHE. “Cummings Foundation’s visionary gift will greatly facilitate the exchange of knowledge between students and faculty in Boston and Butaro. We are so grateful to Bill and Joyce Cummings, and we know that their gift will be transformative.”

Kim previously served as president of the World Bank and of Dartmouth College. Like Farmer, he earned his MD and PhD at HMS and served as chair of its Department of Global Health and Social Medicine.

“Rwanda was our family’s home for many years, and it is where Paul left us,” said Farmer’s wife, Didi Bertrand Farmer. “I am honored that this collaboration between Harvard/HMS and PIH/UGHE bears Paul's name in the pursuit of social justice and equity in health, to which he devoted his life. I am so thankful for the generosity of Bill and Joyce Cummings.”

Created by PIH, UGHE was launched in 2015 with substantial support from Cummings Foundation, the Bill & Melinda Gates Foundation, and the Republic of Rwanda. The government donated land for the magnificent rural campus, plus major new roadways and improved access to water, electricity, and internet connectivity.

In addition to the new $50 million gift, Cummings Foundation has contributed $2 million to UGHE to construct a residential facility for visiting faculty on its campus in rural Butaro, Rwanda. The 10,000-square-foot structure will offer about 10 apartments and a faculty lounge to facilitate connections among full-time and visiting professors.

Support for UGHE has grown significantly in recent years, with the largest donations coming from Cummings Foundation and the Bill & Melinda Gates Foundation. Prior to this year, Cummings Foundation contributed more than $27.5 million to UGHE while the Gates Foundation donated more than $18.5 million to help establish the university’s flagship degree programs.

In September, the Gates Foundation committed $50 million toward the Paul E. Farmer Scholarship Fund for UGHE, which will cover the tuition, room, board, and expenses of 3,000 students over the next 25 years.

With the new gift, Cummings Foundation also honors Larry Bacow, Harvard’s 29th president, who in June announced plans to step down from the role on June 30, 2023.

“Harvard is so grateful for Cummings Foundation’s support to carry on Paul Farmer’s important work,” said Bacow. “Through their thoughtful and generous philanthropy, Bill and Joyce have improved the lives of countless people throughout the world. This gift will build on their important work.”

“We are so pleased to honor the legacies of both Paul and Larry, two dear friends,” said Joyce Cummings. “Our hope is that this long-term funding will help to carry on their commitments to leadership and service on a global scale.”

Adapted from a Cummings Foundation news release.

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