Release date: May 31, 2007

Farmer Addresses Inequities, Challenges at Emory Commencement

The complete, unedited keynote address given by Paul Farmer on May 14, 2007:

Congrats class of 2007, and lest we forget, Happy Mother's Day. Where would you be without your mamas? Forgive me, dear graduates and families and friends, if I'm a bit intimidated about being your commencement speaker. I consider it a great honor, of course, but you'll have to admit there's been a fair amount of flak about this part of the festivities. I'm accustomed to being second choice, and don't mind losing out to major contributors to higher education, such as, say Will Ferrell or the Rock. Sometimes, it's surely better to be in second place: one year, I'm told, it was me or Condi at BC, and the fact that I went first is probably why she has never asked me to come work at the State Department. And look what's happened there!

In any case, friends here have sent me copies of the editorials and letters in your campus newspaper, The Wheel. So I know that Emory is at least polite about such matters as who should give your commencement address. When the president of George Washington University was announced as a speaker, I read, again in the wheel that

He was labeled a "con-artist" and a "spawn of Satan" on Facebook groups created to protest his decision. At Emory, students maintained their respect for President Wagner while protesting his decision.

The Emory administration was also able to respond to student concerns with a greater deal of success. Commencement at George Washington will continue without a keynote speaker… That's fine, quoting from the Emory Wheel, which is never wrong, right?

Emory, on the other hand, was able to recruit an outside speaker, Paul Farmer, who, while not widely recognized by students, at least fits the ideals of the University he will be addressing.

Where art the medical students – you group better have my back. Where's Rollins? So here I am, not widely recognized by anyone here, it would seem, and not as appealing as a big-name celebrity or a political figure. By the way, last night I was told that 2000 copies of a book about me (Mountains Beyond Mountains, by Tracy Kidder) were handed out by students who borrowed a golf cart and drove around campus. But even The Wheel offers hope that I might have something useful to impart and has been kind enough not to publish any Facebook commentaries suggesting that it is I who am the spawn of Satan. Good news for me. And some good news for you: my remarks will be brief, contain a true story with a plot line, and attempt to reflect some of the ideals that Emory, as much as any American research university, is attempting to cultivate. And though you can't please everyone at commencement -- and just look at the diversity of interests and values and experience around you -- I will try to avoid focusing only on the dreary topics in which I alas, have, some expertise. Oh, don't worry: I wouldn't know how to give a speech without referring to runaway epidemics and to pestilence in general; to war, racism, and other sorts of violence. I wouldn't know how not to speak about people I've met by being a doctor. But, following the rules of commencement addresses, I will seek to refer to these horrors in a cheerful way. Also in keeping with the rules, I won't talk about Virginia Tech or gun control; I won't talk about religion or politics, at least not a lot; I will scarcely mention global warming.

But what, exactly, are the ideals of the University I will be addressing? Why was I invited here? Since the creation and dissemination of new knowledge through research and teaching -- a big part of my job -- are taken as givens in a research university, and a bit ho-hum for commencement, I'm hoping I was chosen because of my interest in the university's role in service beyond its walls. This university has promised to advance an agenda that links the development of new knowledge to the betterment of the world. And it can and it should: with the CDC, CARE, the Task Force for Child Survival, the Carter Center practically on the premises, the possibility for service, both local and global, is almost limitless. It is perhaps this proximity that has led Emory to ask important questions about the role of a research university in a world driven by violence and the persistent and complex plagues I deal with in my day job as a doctor in Haiti or Africa or Boston.

Mission statements promising to promote such ideals are easy; making them happen entails great struggle. How do we set priorities? We have to look back and forward. It's another rule of graduation speaking that one should never, ever use a Latin turn of phrase or refer to the classics. But I'm going to cheat and quote Cicero: "Not to know what happened before one was born is always to be a child." Others have commented that, as a people, Americans are short-memoried. I'll confess right here that I have no memory of anything that was said at my college graduation, and I am worried you'll forget my comments by tomorrow, which would be better than being, labeled the spawn of Satan on Facebook.

So I'm going to tell a story about one family's struggle.

It's a story about courage and commitment, friendship and generosity. It's a story about immigration to this country, and it links, in no more than a dozen years, four very different countries. It's a story that leads from Haiti to the United States via Guantanamo, where we have a military base, and then on to Iraq. Four countries, twelve years ago I said I wouldn't be talking about the war much, and I won't. I said I wouldn't talk too much about disease and violence, and I won't. I'll focus on a courageous and generous young man, whom I'll call "Joe" since he's still in Iraq. He's 24 about the same age as many of you graduating today. I've told his mother's story before, but, never his before today.

I met Joe because of a 1991 coup in Haiti, where I'd been working since graduating from college. Joe's parents were poor, but able to read and write and interested in service to others. They were involved in a mass-literacy movement that had taken root in Haiti about the time of that country's first democratic elections, which occurred in December 1990. Seven months after a landslide victory brought a liberation theologian to the presidency, a violent military coup brought an end to democratic rule in Haiti. The ensuing repression was fearsome. Refugees streamed out of the cities and into the hills; over the border into the Dominican Republic, where they were unwelcome; and onto the high seas.

Of course no one desired to leave home, least of all a young couple with two small boys. But on April 27, 1992, Joe's mother, Yolande Jean, was arrested and taken a police station. She was pregnant with her third child, was beaten, and miscarried. She did not receive medical attention and decided that, if she survived detention, she would flee the country. She was released from prison the following day. Shortly thereafter, she entrusted her sons to a kinswoman and headed for northern Haiti. Her husband remained in hiding, and she did not see him again.

The next part of the story brings in two more of the four countries: the United States and Cuba. Why Cuba? Because that's where a U.S. Coast Guard cutter took Yolande:

I took the boat on May twelfth, and on the fourteenth they came to get us. They did not say where they were taking us. We were still in Haitian waters at the time. We thought they might be coming to help us… there were sick children on board. On the fourteenth, we reached the base at Guantanamo.

Haiti was full to overflowing with people just like Yolande Jean. Soon Guantanamo was full to overflowing as well. On May 24, 1992, I was a young physician having not too long ago finished my own training; President Bush issued Executive Order 12,807 from his summer home in Kennebunkport. Referring to the Haitian boats, he ordered the Coast Guard "to return the vessel and its passengers to the country from which it came… provided, however, that the Attorney General, in his unreviewable discretion, may decide that a person who is a refugee will not be returned without his consent." As an attorney for the Lawyers Committee for Human Rights wryly observed, "Grace did not abound; all Haitians have been returned under the new order."

Not all were returned: Yolande was among that small number who, deemed political refugees, were also found to be positive for HIV. I won't go through her story today, which is too painful, but suffice it to say she was stuck on a military base against her will. The plight of Haitian refugees became enough of a cause célèbre during the 1992 elections to spur the candidates Clinton and Gore, in their official platform, to call for an end to forced repatriation of Haitian boat people and to the detention of HIV-positive refugees on Guantánamo. I'm for that, I thought, taking heart, for I was disturbed by the reports coming out of our military base there. But the camps were not closed down until federal judge Sterling Johnson heard the case brought against the U.S. government by the Haitians and their advocates. The more depositions he heard, the more convinced he became that the detention of the HIV-positive Haitians represented "cruel and unusual punishment" in violation of the Eighth Amendment of the our Constitution. In his 1993 ruling on the case, Judge Johnson described Haitians detained in Camp Bulkeley as follows:

They live in camps surrounded by razor barbed wire. They tie plastic garbage bags to the sides of the building to keep the rain out. They sleep on cots and hang sheets to create some semblance of privacy. They are guarded by the military and are not permitted to leave the camp, except under military escort. They are confined like prisoners and are subject to detention in the brig without hearing for camp rule infractions.

Yolande was eventually released, along with the others, to cities in the U.S. I visited her and other Haitian refugees in New York and Boston after this particular ordeal was over. When I first met Joe, he was about 12; his brother, 10. I mostly talked to their mother and seem to recall that they found it more absorbing to talk to my brother, who was then a professional wrestler with World Championship Wrestling and thus himself a resident of this city and a frequent visitor to Emory. (Some of you will recall that whenever I'd come here to give a talk, he'd get all the attention from my nerdy friends on the faculty. Not that I'm jealous). My brother being the size of a Brahma bull, Haitians ask "same mother, same father?'

A decade went by, and I confess I didn't think much about Joe. But just before Christmas 2005 I received, via a close friend of his, a check in the amount of $250. Joe said he wished to support the work of our group, Partners In Health, in Haiti and to help us one day in serving the destitute sick there.

I was grateful for the contribution, for we certainly needed the help in Haiti. What struck me most, though, was that Joe was in Fallujah. He'd joined the Marines and been sent to Iraq.

I wrote back to him and we stayed in touch through email and, once in a while, by phone (those Halliburton call centers do work, I guess, probably 7 cents per minute-to you, the taxpayers, although heaven knows how high the bills are). For a year, we corresponded almost every day, but we didn't talk much about the war or his daily reality. He took great pains to let me know that, by the time I began inquiring anxiously about his safety, he no longer went out on missions "beyond the wire," but was responsible for supplying another group of Marines out on patrol. He didn't say much, over email, about his activities, noting only how relieved he felt when his "guys" returned safely to the forward-operating base in Fallujah. More often than not, he'd tell me that I was the one who needed to be careful, since he knew a lot of what was happening in Haiti. Thereafter I got to enjoy a long reunion with Joe, to meet his girlfriend, and see his brother briefly. Joe allowed, during the course of a long meal that included what I reckoned to be the first red wine he'd had in a while, that the main reasons he was planning to stay in Iraq were to look after his mother, who he knew might fall ill at any time; to send his brother to a proper college; and to be able to buy a home and have a family. "I want to look forward, not back," said the irrepressibly optimistic Joe. Some things we didn't discuss, including the fact that Joe is not yet a U.S. citizen. But we did discuss his brother's plans. Whenever he had trouble making ends meet, Joe's brother thought about joining the military too. "Do that only as a last resort," advised Joe. "I'll find the money for you to finish college." There was so much left to talk about that we called each other every day during his leave. He is now back in Fallujah, and I spoke with him just yesterday, after arriving here for commencement.

So what, exactly, is this story about? What, as we used to say in medical school, is the take-home message?

Let me offer three take home messages. I've already confessed that I don't recall any of the points made by my own class's commencement speaker, so you're forgiven in advance if you forget these.

First, it's a story about connections. As you head off to lives full of promise, remember that the connections you've made here at Emory need to be sustained and nourished. I let Joe fall out of my life for a decade, and his mother and brother too. Thankfully, Joe's generosity brought us all back together. I won't lose track of them again; friendship is too precious a gift.

There are of course other, less sentimental connections visible in this story. I've written a lot about the intimate links between my country and Haiti, this hemisphere's two oldest republics. It's not the stuff of congratulatory addresses, either. And I hear connection between our country and Iraq will cause us grief, I fear, for generations. Fallujah is a case in point, and is already a proverb. Just two weeks ago, one U.S. colonel in Anbar province explained his approach to counterinsurgency: "fix Ramadi, but don't destroy it. Don't do a Fallujah."

But what about our peculiar military base in, of all places, Cuba? Just last month, a friend of mine gave a talk about Gitmo at Harvard. Here's his description of the place:

A bay, a harbor, a hideout, a home, a military base, a sanctuary, a prison; an outpost on the threshold of nations where neither Cuban, nor U.S., nor international law applies.... Guantánamo Bay has been there all along--when the Taino Indians met Columbus, when Caribbean pirates preyed on the shipping of newly consolidated states, when Spain clashed with Britain, when the U.S. defeated Spain, when Kennedy confronted Castro, when George W. Bush set out to vanquish terror. To know Guantánamo is to know ourselves--as citizens, as a country, as individuals in a world of states.

Guantánamo is a place outside the reach of constitutional protections, so you might think of it as a place of disconnection; but the very disconnection connects you and me to that place and what is done there. I hope you will all take on the responsibility of remembering how closely we are connected to the things that should disquiet us. Remember Cicero's injunction about history as you go out from Emory into the world.

Second, Joe's story, like his mother's, is for me a parable about the kind of country we want to live in. Look around you. Look at the way Emory looks today compared to the way it looked, say, only 50 years ago. You know, probably, that Emory was founded in the first half of the 19th century by people who owned slaves. But did you know that Emory was forbidden by state law from educating African-Americans at the same time it enrolled white students? Did you know that it was only in 1962, when about half of those present today were already alive, that Emory brought suit against the state of Georgia and won the right to enroll students without regard to race?

Emory's rise to greatness could never have happened without that struggle. Coke helped, but it takes more than great wealth to make a great university. How do you want Emory to look in the future? I have a friend who's a journalist at CNN, lives right here in this city, and I asked him what points he thought I should underline here today. Every day he has to read about Iraq, shooting sprees on college campuses, crude comments from talk show hosts. "It's about respecting people," he said, "and reaching out to others." He paused, a second and added, "If everyone around you looks exactly like you, there's something wrong."

Although our elite universities are less homogeneous than they were a few decades ago, they remain islands of privilege with far too few people like Joe. And although his younger brother has aspirations to attend a decent college, it's unlikely he could transfer here from the community college he now attends, especially given that he's working an almost full-time job on top of his studies. But still: look around you and wonder what this place would look like if we were not a country of immigrants. We ought to be celebrating this heritage with gratitude. But one can read in this month's Harper's Index that no fewer than 305 new U.S. anti-immigration groups have formed since January 2005.

What kind of place do we want our country to be? I ask this knowing that not everyone here is a U.S. citizen. Then again, neither is Joe, even though he's serving in Iraq. If you're here today you are somehow part of this country, this great experiment in modern democracy. Granted, our nation's reputation is not impeccable. But until quite recently the United States have often served as a beacon of hope in many parts of the world. How do we wish to be seen by others? Or, to refer again to The Wheel, what are the ideals we hold dear? Do we want to have camps like those on Guantánamo? Do we want America to be a place known as violent at home, even on college campuses, and violent abroad? Or do we want to try and change even those hearts which, unlike the polar ice caps, show little sign of melting?

Third, remember people like my uncomplaining, brave and generous friend Joe. I know some of the reasons he's in Fallujah rather than in Haiti or in New York, and I think you do too. The forces that tore his family asunder and sent his mother to an "HIV-positive concentration camp" are not unrelated to those that would ten years later lead him to Iraq, even if he himself focuses largely on issues such as family strife or economic necessity. If you're the praying sort, please pray for Joe and for all those souls who, regardless of nationality, now find themselves within the borders of Iraq.

But the reason I mention Joe today is his generosity. In the midst of all that he's been through, he's still able to think about service to others, including people in the poverty-stricken country he has not seen since he was a child. Even in Iraq, Joe is still able to remember those less fortunate than himself. These are worthy ideas, and not unrelated, I suspect, to the notion of service that Emory espouses.

To what extent does Emory espouse such notions? Well, take the Global Health Institute, which was launched by friends of mine, anthropologists and doctors and public-health specialists from across the university. It's as good an example of how a research university can link its strengths to service to the poor as any I can think of, and has the strong support of President Wagner and the Emory administration. I also have the good fortune of knowing some of the graduates here today; others I have met or read about. Here among you for example is a young woman, Julie Rosenberg, graduating from the school of public health. Before even attending college, she worked for a year among some of the poorest children in urban Peru. She let these children, and their families, change her life: although she's only in her mid-twenties, she has for several years raised funds and awareness on behalf of these families. Some of you have read about college seniors Elizabeth Scholtys and Robbie Brown. Liz has been working among street kids in Poona, India, and her notion of "pragmatic solidarity" was expansive enough to include building an orphanage. So when her classmate Robbie, formerly editor of The world's finest campus newspaper, was awarded a no-strings-attached $20,000 prize, he turned around and gave the entire amount to Liz for her work in India. Both may be tired of having their generosity praised but what a remarkable example. There are also important collectives represented here today: because Emory is a major site of basic research leading to drug development, and because some of these drugs are of obvious importance to people in my line of work, I am excited to know that Universities Allied for Essential Medicines is active here. Just how important this is, is clear when you learn, as I did from students at the school of public health, that 80% of today's prescriptions for AIDS medications include at least one drug covered by Emory intellectual property rights. How can we get there drugs for our most destitute patients? Allow me to quote from Emory's Strategic Plan: "A destination university internationally recognized as an inquiry-driven, ethically engaged, and diverse community, whose members work collaboratively for positive transformation in the world through courageous leadership in teaching, research, scholarship, health care, and social action… unequalled at translating medical breakthroughs into service and patient care."

There is, in your students and faculty, enormous promise for the world in which all of us must live, are privileged to live.

The Wheel's recent editorial about today's festivities concludes, "we hope the Commencement ceremonies give our graduates a send-off to remember." I know I won't forget your allowing me to share this day with you, and am grateful for the chance to reflect about connections, about the need to think of the less fortunate, even from a place like Iraq, and about the need to keep alive the utopian ideals that would make this world a better place for all of us. I don't doubt that some of you in the audience today have reached this stage after a journey not unlike Joe's, a passage across national borders, over class lines, through hardship and adjustment. And it wouldn't surprise me to learn that Emory has inspired and shaped all of you--those who came here with all the advantages no less than those who came here with few. That is part of the utopia that gives our country its meaning, that gives the university based on research and teaching its value. As you go forth from these extraordinary years of freedom and discovery, I ask you to keep alive in your minds the curiosity that brought you here, and to revive it from time to time by forging new connections to the others who would have done well with the same opportunities, had they been so fortunate.

Congratulations on the outcome of your hard work, the support of your families and friends, your desire to improve. And thank you for the honor of sharing this day with you.

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