Summary: On February 8, 2011, the International Women’s Health Coalition (IWHC) held its annual gala at 583 park Avenue in New York City. More than 300 friends and supporters joined us in honoring Partners in Health co-founder Dr. Paul Farmer, who has provided quality health care to those most in need for more than 20 years. These are his remarks made at the event.

DR. PAUL FARMER: The best kind of friends, I've learned, are those who instead of being irritated by cheek or impertinence, actually listen to you. So Aryeh, thank you for listening to that letter that I wrote to you 13 years ago. 

I'm going to speak about gender equity, what the IWHC does, and why this is so significant to me, but first, I just want to say one thing that I think is relevant to the struggle before all those concerned with gender equity and breaking the cycle of poverty and disease. The Tomsk example, the Siberia example, is not insignificant. When Aryeh and other visionaries decided that one way to promote prison reform might be to focus on the enormous health crisis inside the Russian prison system, that was breathtakingly innovative in my view. In other words, how could we promote prison reform? One answer was to help provide basic and good medical care. And the kind of suggestion that I made was a very technical one. It was that if we have the wrong prescription we will not cure patients, and we will certainly not impress our colleagues in the penal system, in the prison system.

And so the year that Open Society Institutes and Aryeh were good enough to invite me to be a part of this, the case fatality rate inside a tuberculosis treatment unit in Siberia was 26 percent. Now what does that mean? That means that a quarter of all these young people died inside a treatment program. And when I had the backing of Aryeh and George and others to change the prescription, the case fatality rate went from 26 percent to zero within one year.

That is, people stopped dying of tuberculosis. And I want to talk a little bit tonight about our work around the promotion of gender equity as almost a tool to break the cycle of poverty and disease. I would like to say to IWHC, with its goal of saying a just and healthy life is every woman's right, thank you for letting me for letting me bathe in the light of a statement like that because I believe in it with all my heart.

I don't see, in fact, how we can advance our work without embracing such bold, if simple, principles. I'd like to now tell you three stories, epiphanies. 

The first one is about a young woman that I saw this weekend who was born with HIV.  Years after she was born, Daphne became ill, again and again and again. In 1995, when I was training in medicine at Harvard, the hospitals were full of people sick or dying from HIV.  HIV is a chronic illness for which we don't have a cure but we do have therapies. Daphne eventually went on these therapies. That was at least 10 years ago, I would say when she was 15.

Many years later, when she was about 20, we were talking. I said, "Daphne, what do you want to do with your life?" She said, "I want to be a businesswoman. I want to start businesses." I'd just like to say that she had become a businesswoman, and has started a business.

That's the kind of work that I find most compelling: When someone, through no fault of her own, is born with everything stacked against her but can succeed with the right kind of support.  In Daphne's case, it's a modest support; providing standard of care to a child with AIDS. This is not something someone should win awards for. To say that a girl like Daphne who has an illness for which we have a therapy should receive it is not worthy of a prize. The trick is finding out how to do it. This is why I'm proud to be associated with IWHC, because [they know this work cannot succeed] without a rights-based paradigm-it's only one of many paradigms, but it's an important paradigm. It's the social safety network paradigm that we have.

There are others. What are they? Well, I could argue to a head of state that you will not break the cycle of poverty and disease without investment in education, especially in girls' education. It won't happen. And we need to master these arguments. And we need collectively to get better at identifying all the ways in which investments in gender equity [can break this cycle], from the prenatal care to family planning, to girls' education, to providing opportunities for women to start their own businesses, to higher education.  This is something I think all of us can believe in.

In 1986, I was a medical student working on a project on gender equity and HIV. We made a film called  "Chercher la vie, détruire la vie"  which means "Looking for life, destroying life." It was about gender inequality, poverty and HIV in the pre-treatment era.

And along with this soap opera style video, I was lucky enough to do some interviews with women living with HIV.  I remember one woman saying to me, "You want to stop HIV? You want to do HIV prevention in Haiti? Then you should just focus on giving women jobs." And I thought, "Do you really need a PhD in anthropology or sociology or political economy or history to figure that out?" A lot of our efforts since then have in fact been spent on trying to create economic opportunity for women.

When I look at the wonderful decrease in the rate of HIV in Haiti, I wonder what made that happen.  Was it all of our AIDS prevention campaigns? Was it safe blood transfusions? Was it promoting condoms? Or was it strengthening the hand of women, the hands of women, to control their own destinies through job creation?  I think that's a really complex and interesting question, because we don't know how to decide in what order of importance should we intervene. Obviously we should do all these things.

Second story:  In 1990 I was lucky enough to be involved in starting a women's health clinic in Haiti. It was a complicated process because we were looking for funding, and they wanted us to do a family planning clinic. And we said, "of course it's going to be a family planning clinic." But women come in with many other demands as well. Some women come in and say their "chief complaint" is infertility. And sometimes the funders would say, "Well, we don't really wish to work on funding a treatment for infertility." And I would say, "Well, we don't really wish to replicate your desires." We're there to work for Haitian women, most of whom do want to limit fertility. And if you look at the data coming out of Haiti then, 20 years ago, and now, it's very clear. Women want access to family planning.

I'd been working in Haiti for seven years in 1990 when a woman in her late thirties came in. I went through the whole checklist. I checked her blood pressure and examined her. She had had many pregnancies, had six living children, and was now in her thirties. And she said, "I want family planning." We went through the medical checklist, and it turned out that an oral contraceptive was the one that would have been recommended medically.

So off she went with her family planning. About three months later, she came back in, and she said, "You know, I think I'm pregnant." I remembered her very well. You'd see 50 people a day sometimes, but I remembered her very well. [We did a test] and sure enough, she was pregnant. 

[When I asked her what happened], she said to me, "I didn't have any water to take my pills in the morning." And I thought that there are so many social and economic barriers for poor women, and that this is just one.

I didn't anticipate talking about family planning tonight, but whether you're talking about starting a small business or going to primary school or going to university, there are so many barriers that poverty and gender inequality add.  It was another one of those epiphanies for me where I thought it would be better to spend less time on educational campaigns for women who already know what they want, and more time on making sure that they have easy access to the things that they need. That was 1990.  

In the years since, I've been lucky enough to work with thousands of people, and I want to introduce one of my colleagues. She'll be mortified, but I'd like to introduce Nancy Dorsinville, my Haitian colleague who has worked tirelessly to promote basic rights for women in Haiti. I'd like to say that gender equity involves a lot of things. We know about the right to vote, we know about the 19th Amendment in 1920. We know about the struggle for equal pay, we know about the need to break glass ceilings. I think we know a lot about how to promote, and certainly the IWHC knows a lot about how to promote, gender equality. 

What you're doing at IWHC is creating a climate in which it is not tolerable-or less tolerable, at least-to accept gender inequality as a matter of course. That means that anybody who fights for gender equity in the field, whatever their field is-United States, Afghanistan, Haiti, you name it-you  make our lives easier. You make our lives better. You make us more effective.

Last, I want to make a very specific point about the right to basic services. And again, I want to thank Aryeh because he's sharpened my thinking about this, as have many other people. The right to vote, the right to participate in shaping your world and shaping your lives and shaping the lives of your children and parents and families and consociates, is a critical thing. We need to do more to make sure that women living in poverty have access to these basic services.

They may range from education to healthcare to clean water, to financial services. They do range along these levels. Think about cervical cancer, just for a minute. Cervical cancer has been the leading cancer killing poor women in significant parts of the world. Cervical cancer is something for which we have a preventive. We have a vaccine now. And if we can send people to the moon, it seems impossible to me to think that we could not vaccinate every girl on this planet against HPV, which is causative for a very significant number of cervical cancers.  

Our group, Partners in Health, started a campaign to introduce a vaccine which was called too expensive by many, as if God set the prices for vaccines on little tablets made of stone. We were told it's $X hundred per course. When I was a student or an intern or a fellow or a resident, I used to be very intimidated. People would say, "it costs $275 a dose," and I'd say, "Oh, boy, that's bad."

But then I started asking, "Oh really? What's it made out of? Who makes it? Where can you make it? Can we make it more cheaply? Can we make it in larger batches? Can we do other things to make sure that access is important? Could we envision alternative ways of financing this?"  And of course the answer to all of those questions is "yes." It is possible to envision a world in which a new technology like this vaccine is made available as a public good for public health, at the very least, or even better, as a right.

So I want to thank the IWHC because what you have done-and certainly I'm honored to be honored by you-is to try and change the climate, to make it not so acceptable to say, "well, you know, we can't use cervical cancer vaccine"- as I'll call it-"in country X, Y, or Z because I happen to work with the people in country X, Y, and Z."

My happy story for you to think about as you enjoy your dinner is that we started a cervical cancer vaccine program in Haiti for girls living in poverty. And we worked with the industry. They helped us. And then the earthquake happened. The first dose went in, maybe a week before the earthquake, and then everyone said we would never get the second dose in. But I want you to know that, as far as we can tell, 78 percent of the girls who received the first dose got [the second dose] the rest of the complement, which is about two times higher than what happens in the United States. We need to do better in the United States as well.

I want to leave you with a message, an optimistic message that fighting gender inequality and promoting the rights of women everywhere, especially women living in poverty, is certainly well within our grasp. We have the tools.  I mentioned some medical tools, but we know that we can advance gender equity in business, small businesses and big businesses, in education. And we have a lot of work before us. And I feel very, very emboldened and gratified that you would choose to honor me tonight. Thank you very much.

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