Begin. The rest will follow.

Lessons in leadership from a public health champion and relentless optimist

Photo by Claudia Altamimi on Unsplash

For the better part of October, I had a blank document open on my computer. Multiple to-do apps reminded me to draft, revise, and share a reflection on the life and leadership of Paul Farmer. Paul was the visionary co-founder of Partners In Health and one of the world’s best-known and most effective public health advocates. He was also my boss, mentor, and friend for the 16 years I worked for PIH and for many years after. Paul died unexpectedly in February of 2022. Rather than observing the anniversary of his death, I like to remember and celebrate his birthday, so I set myself a late October deadline to write and share some of what I learned from Paul.

A number of factors, real and imagined, prevented me from writing. Paul’s birthday, October 26th, has come and gone and now it is mid-November. For a few days I berated myself for procrastinating, but I knew my delay was about more than poor time management. In truth, some part of me felt that my reflections about Paul were pointless. What could I add to all that has been written about him, both before and after his death, by people who knew him better, or are smarter and more thoughtful than I am? 

I was ready to give up and set my writing aside completely when a friend suggested I look for a lesson in my own procrastination. Surely even the great Paul Farmer missed a deadline, or questioned his contributions from time to time? 

I couldn't answer that question, but my friend’s prompt reminded me of one of Paul’s superpowers: his relentless optimism. This is most on display in a video clip of him touring the ruined remains of a USAID clinic that PIH planned to rebuild in central Haiti. Watching him, it is obvious that even as he surveys the crumbling walls and the dirt floors, he already sees the end result. He can see the finished clinic: the white tile, the shady waiting area, the koi pond in the courtyard. He almost seems to wink at the camera as he says brightly, “We don’t have the money yet. But we’ll get the money!”

Paul’s trick for getting the money was a simple one: start. Do something to get things going. Enroll a patient in a pilot program, dig a hole, lay a foundation. Begin, and the rest will follow. Commit, and the very act of your commitment will bring energy and interest and materials and, yes, money, for what comes next.

If I’m being honest, Paul’s optimism could be challenging for those of us who skewed more practical, and for those of us (like me!) who were responsible for equipping the imagined finished clinic. While we believed in Paul and in his vision, we also knew that you couldn’t schedule a sea container shipment based on optimism. In retrospect, though, the inevitable tension between the vision and the execution created a space where our best work was done, and where I learned the most. 

The leadership lesson I took from these experiences is that most people don’t want to risk being first. It’s hard to be the first person to demand appropriate treatment of drug-resistant tuberculosis. It’s hard to insist that the poor deserve the same cutting-edge HIV treatment as the wealthy. But Paul was never afraid to be the first voice in any room to call for justice, equity, and moral action. His leadership and courage - so often expressed as fait accompli optimism - gave the rest of us permission to add our voices to his. 

Through my work with Paul and PIH, I learned that people respond to possibility. Paul’s gift was in demonstrating not just that a big thing could be done, but that in fact it’s already begun. And if you don’t join in, the risk you face is missing out on being part of something transformative. 

So in that spirit of starting, I sat myself in front of this blank page, and began.