Graduates Step beyond Medical Training

“We started losing friends our own age,” remembers Dr. Paul Farmer, a co-founder of Partners In Health.

In a grey vest bearing PIH’s logo, he leans on a wooden podium in Boston’s Brigham and Women’s Hospital and describes working in Haiti in 1983, where he watched a friend die from undiagnosed cerebral malaria. A ruptured spleen killed another with typhoid.

“Stupid deaths,” Farmer often calls them. Deaths that modern medicine can prevent but that readily afflict people living without proper health care.

Farmer’s audience includes four young physicians who are graduating this day from a Brigham and Women’s Hospital residency program—the Doris and Howard Hiatt Residency in Global Health Equity and Internal Medicine—in which they’ve seen firsthand how poverty affects the health of people and their communities.

The graduates’ practicing ground has been the clinics and hospitals where PIH staff work. Since 2011, they have traveled between the U.S. and poor countries, qualifying as specialists and gaining skills to practice in impoverished places. Whether on a remote mountain or the slums of a city, they’ve learned to provide care where there are few resources.

“The surgeons at the Brigham—we don't ask them to build their own operating rooms,” Farmer tells the group. “We don't ask them to buy generators and fuel for those operating rooms. We don't ask them to figure out how to get the staff, the stuff, the space, and the systems they need to do surgery. But global health equity residents often do get drawn into that part of the work.”

As he speaks, photographs of the graduates are projected behind him. In them, Ryan Schwarz, a father, pediatrician, and internist, lights a candle with colleagues at a patient’s bedside in Nepal. Daniel O’Neil, 32, an internist, leans over paperwork in a crowded waiting room in Haiti.

Morgan Espérance, a mother of two, a pediatrician and internist, sits with a Haitian patient, talking intently, her stethoscope dangling from her knee. And Omar Amir, 35, smiles and waves from a truck in Liberia. The internist worked with Last Mile Health in the eastern district of Konobo during the height of the Ebola crisis. Another photograph shows a note pasted on his door, “Dr. Omar Amir. Welcome to Konobo, the land of the brave.”

“All of them have been called to step beyond the traditional bounds of medical training,” says Farmer.

The residency honors Howard Hiatt, 91, a pioneering microbiologist and leading figure in Boston’s preeminent medical institutions. The program aims to increase the number of physicians who dedicate their careers to improving the health of impoverished people in the U.S. and around the world. Previous residents have strengthened health services in rural Malawi; built a graduate medical education program in Haiti; and developed treatment protocols for Ebola treatment units. Many continue to work at PIH sites around the world.

The vast majority of the program’s 41 graduates—soon to be 44—still work in global health. This was the dream of Farmer and others. When Farmer started his residency in the same hospital, working abroad wasn’t an option—at first.

Another photograph flickering on the wall, taken in the early 1990s, shows him and Jim Yong Kim, another co-founder of PIH who is now president of the World Bank, with Marshall Wolf, then director of medical residency training at the Brigham.

Wolf allowed the aspiring global health physicians to do something different. He agreed to their request to be part-time practitioners at the hospital, while spending the rest of their time with their fledgling nonprofit in Haiti.

That nonprofit was Partners In Health.