Public Health with Empathy
Ophelia Dahl, awarded the 2023 Radcliffe Medal, discusses Partners In Health.
When Ophelia Dahl was 18, she traveled from her home in the English countryside to poverty-stricken Haiti. In rural Haiti, she witnessed conditions that she described as “positively medieval”: little access to water, poor housing conditions, and rampant devastation caused by diseases that were already curable in the developed world. There, she met Paul Farmer, then a Harvard medical student and budding ethnographer. Over the next few years, the pair conducted a door-to-door Haitian health census, laying the listen-first-fix-after groundwork for the nonprofit they co-founded, Partners In Health (PIH).
Nearly 40 years after its founding, Partners In Health’s community approach to public health has helped treat millions of patients for HIV, multidrug-resistant tuberculosis, and other diseases, improving the standard of care for impoverished communities. On Friday, the Radcliffe Institute honored Dahl with the Radcliffe Medal for her lifelong leadership of PIH. In the afternoon award panel, she appeared alongside John Green, bestselling author and PIH trustee.
Partners In Health operates through “systems building”—investing in local healthcare infrastructure and training local staff to provide care. From a young age, Dahl recognized the importance of engaging communities in healthcare. Her mother, actress Patricia Neal, suffered a severe stroke while pregnant. Her father, author Roald Dahl, recognized that a few hours of speech or physical therapy would not adequately take care of Neal. So, he “asked neighbors and friends to come and they spent eight hours a day with her—an hour each—for about a year,” Dahl said. Now, that accompaniment model to healthcare helps PIH treat patients with empathy, while also withstanding national-level instabilities (ranging from natural disasters to frequent government turnover).
Public health is an inherently frustrating field: the problems are large and the progress is slow. PIH avoids the temptation of flashy, quick projects, instead opting for deep, extended commitments to local communities. Green, paraphrasing Dahl, noted that “long-term problems demand long-term responses, that systemic problems demand systemic responses, that short-term, time-limited interventions are simply not as effective as long-term, open-ended support.” To stay confident during slow change, Dahl described seeking an “important titration between patience and impatience”: understanding that partnerships take time to forge but demanding action quick enough to save lives.
Throughout her work in the world’s most impoverished and desperate locales, Dahl remains optimistic and hopeful about the future. She and Green discussed how, although conditions remain poor in many places, PIH has made significant progress in its communities. In the early 1990s, PIH expanded to Peru and treated people for multidrug-resistant tuberculosis, despite the World Health Organization (WHO) saying that the disease was too hard to treat in impoverished locales. More than 80 percent of PIH’s Peruvian patients were cured, and the organization cut costs by producing generic drugs; by 2002, the WHO adjusted their guidelines to suggest treatment regardless of resource level. “How can you not be hopeful,” Dahl asked, “when you look at the burden of disease and then you see that change over time?”
At the end of their discussion, Green shared an anecdote from the pair’s recent trip to Sierra Leone, where Partners In Health is working to reduce maternal mortality. Green and his brother, Hank, fundraise for PIH’s under-construction Maternal Center for Excellence in the nation’s Kono District (Green wore a pair of Awesome Socks on stage, one of many ventures that support the Center). In 2018, Green met a 16-year-old named Henry who, due to his untreated tuberculosis, was about the same size as Green’s eight-year-old son, also named Henry. After returning in 2023, Green again saw Henry, who is now cured of tuberculosis and is in college studying human resource management (“which sounds horrible, but it’s his interest,” Green joked). “The fact that he was able to access the newest regimen of TB drugs and survive TB after a thousand consecutive days at Lakka [Government Hospital] is a testament to what Partners In Health is doing, said Green. PIH “flew the drugs from Lesotho to Sierra Leone so that Henry and several other patients could receive the care that they need, that all people deserve, and as a result, all of them are here today and otherwise wouldn’t be.” This year, over 1.5 million will die of tuberculosis, Green reminded the crowd, but Dahl and Partners In Health are a significant reason why that number continues to decrease.
Radcliffe Dean Tomiko Brown-Nagin concluded the event by presenting Dahl with the Radcliffe Medal. The award citation reads:
Radcliffe Medal awarded to Ophelia Dahl
She is a bold leader who uses the power of imagination to envision solutions that others overlook. She is a compassionate advocate for the poor who challenges us to acknowledge that our own abundant good fortune often rests on the misfortune of others. She is a determined optimist who rejects pessimism as a luxury of privilege.