The Mandela Century

By Paul Farmer

Harvard University
Midyear Graduates Recognition Ceremony
10 December 2013

Thank you for inviting me to share this day with you. For a month, I planned to write something fitting, something memorable for you. But even if I had been as industrious as planned, which has never yet come to pass, I still would have re-written my remarks as to link your graduation with the end of an era.

It started in 1918 and ended last Thursday, when Nelson Mandela drew his last breath.

So much has happened in these 95 years that the sheer weight of memory threatens to oppress or overwhelm us. And so we retreat into specificity and forget about even the recent past. The specificity is OK, and helps us to reflect, as we’re called to do at any graduation. But we’re thinking, always, about the past.

Think, for just a second, of 1918. The war, on land, was a grotesque carnage of a scale never yet seen. Across the Atlantic and other pitch-black or otherwise terrifying waters, new and cunning weapons sank thousands of ships full of young men and sometimes civilians. I think, had I been here, I would’ve thought these dark times.

But in a small village in the Transkei, South Africa, a baby was born. He wasn’t born to dire poverty, perhaps, but in a bountiful country in which want stalked the land, a nation divided by deepening divisions of race and class and tribe. And who among the wise, if they were counted wise, then guessed that this boy would shape the coming century, the century you’re about to leave behind? In 1918, who among those leading the wintry world to war—and they were of course mostly men, and mostly counted wise, even as a generation of young men, boys really, were cut down like so much chaff—who would have guessed that in the southern reaches of Africa, where summer stole quietly over the veldt, that this infant, this baby boy, would shake the counsels of the great, his name to be chanted across that continent and across this world? Who would have imagined, 95 years ago, that today, Tuesday, December 10th, as you take your leave from snowy Harvard, this man would lie in state in Johannesburg as a gray drizzle upon hundreds of thousands, from across that country and across the world, paying, today, their final respects?

I might add, as a flourish, Who’d have guessed that this boy would spend long years in prison? But that, alas, was a fate more easily divined, as it is here, today. The likelihood of surviving childhood was bit better for a boy born to a family like Mandela’s than that faced by black families living in even deeper poverty, with scant chance of attending even primary school. But Mandela’s odds were diminished nonetheless, just as his chances of prison time, though smaller than those facing African-American men in this bountiful America, right here and now, were upped.

But Nelson Mandela defied most odds, and today the great and the good, and the not-so-great and not-so-good, and yes, a sprinkling of the neither-great-nor-good, gather to mark the passing of a freedom fighter who found it in his heart to forgive while refusing, mostly, to forget.

Who could have foreseen it? To use medical terms, how do you diagnose greatness at birth? You don’t and you can’t. For greatness in this world is not, as some social fictions have it, ours to claim or reject at birth. Nor is it often thrust upon us brusquely, although any historian or epidemiologist or statistician might argue forcefully that the chances of some grim fate or a happier one are shaped by place and time and social station at the beginning of life. Greatness is usually forged, in sometimes dramatic but in often humble ways; greatness, like its neglected sibling, goodness, is cultivated over years spent with others, families and friends and colleagues and comrades. Both the great and the good within us can be cultivated, even behind prison walls.

And goodness, that instinct of fellow-feeling and open-heartedness and compassion, is, I’d argue here, not only required for true excellence in any pursuit, but yours, ours for the cultivating. Goodness is of course social; it requires us to think with empathy of others. Mandela said this often enough; he also lived it. In times like his, greatness, like goodness, required recognizing the humanity and dignity of others even when the others in question fail to recognize yours.

“In times like his.” Ten thousand days bereft of freedom. That’s doing time, for sure. The best speeches are often the shortest ones, as Lincoln at Gettysburg, but Mandela’s at the 1964 Rivonia trial, when he was sentenced, along with others, to life in prison, was a longer exercise in rhetoric. Everyone should read the peroration, especially since we know he wrote it to win his case in the course of international public opinion: “During my lifetime I have dedicated myself to this struggle of the African people. I have fought against white domination, and I have fought against black domination. I have cherished the ideal of a democratic and free society in which all persons live together in harmony with equal opportunities. It is an ideal which I hope to live for and to achieve. But if needs be, it is an ideal for which I am prepared to die.”

“Times like his” makes it sound dramatic, and it was. The solidarity movement to free Mandela and to end apartheid swept this campus, or at least dusted it as if in a fine coat of snow, as it did most others in the United States and Europe. It reached, like Mandela’s name and image, Harvard and Haiti and Peru and all of the places I’ve had the good fortune to study and then to work as a physician. And the story has been told, many times and in often discrepant accounts, of what came to pass long after Rivonia: international sanctions against the apartheid governments and local organizing in townships and elsewhere within South Africa; Mandela’s negotiations from Robben Island and, later, from a more gilded prison (but a prison nonetheless) to end apartheid and seek to begin a democracy that might include all, including the poor; the first free elections, with its unforgettable images of people lined up for miles and miles, lines snaking across the country but also, through these images, into hearts hardened by the very process of exclusion; the tough and halting political transitions; and the violence, including the violence done by poverty and exclusion and laissez-faire attitudes, pandemic in the world, regarding the right to enough to eat and a safe place to live and a decent job; the rise of AIDS and of tuberculosis, problems worsened and gravely so, by labor migration and the dissolution of families across the region; the inaction and worse of the fledgling governments and its partners (and their antagonists) in addressing these pathogens and pathogenic forces.

Times like his: the Mandela Century includes all of this promise and peril and we are condemned, in his fresh and wrenching absence, to confess that the promise has not yet been realized while the perils have multiplied and continue to spread.

To salt our wounds: are we so sure that we don’t live in “times like his” now? What will follow the Mandela Century is in your hands, not his. These are the very sorts of perils, or challenges if you prefer, you in this room might address if you are part, as Mandela was, of a broad social movement. After all, these perils are not as specific to apartheid South Africa as most of us choose to believe, and no miracles have yet come to pass. Whether you pursue work and training in global health, as will Jen Chu, or a career in business or teaching or whether you choose to press on with yet more training. For growing an economy that compensates people justly for their labor and includes all those who wish to participate remains a challenge in southern Africa, a part of the global economy for as many centuries as Harvard counts since its founding, is a goal yet to be met, as Mandela knew early in his term (meaning the economics part, rather than the 1636 part).

Meeting this goal without trashing the environment has yet to be realized, either, just as the building of equitable and high-quality health systems has not yet come to pass, either here or there. As you go forth with these degrees, please remember we’re counting on you: these challenges surpass the talents and capabilities of those who’ve preceded you, including the great and the good, but it doesn’t mean they have to.

The problem of social safety nets, as mundane as it may sound, is as daunting as the ones that faced young Nelson Mandela before the Rivonia trial and after. Safety nets and social justice are not unrelated, as he learned when, in 1988, he fell ill with tuberculosis in prison. Imagine if he had been a prisoner without access to diagnosis and treatment. Without them, would we speak today, December 10th, 2013, of a Mandela Century?

This is not meant as a rhetorical statement. With all of the pronouncements and recollections flying about these past few days, let me close with a doctor’s reminiscence of President Mandela. Or this doctor’s account, at least. Mandela was cured of tuberculosis but he knew, even then, that many were not so fortunate. When he went into prison, in 1964, this airborne disease was a major threat to black South Africans, in rural homesteads, in informal townships, in mines, in hospitals and prisons, everywhere; it was likely the world’s leading infectious killer of young adults. When he emerged from prison, in 1990, tuberculosis, by then curable for decades, took more South African lives than ever. But it had been eclipsed and worsened by HIV, which was linked not only to epidemic tuberculosis but also and as irrevocably to the social disparities and poverty of the region. By the end of Mandela’s term as president, South Africa was home to more people living with HIV than any other country on earth. AIDS would later claim his only surviving son.

These two diseases conspired to undo some of the social and economic gains of democratic South Africa. But there was so much to be done to save millions of those already sick in South Africa and beyond. One of these actions would be to “roll out” both AIDS treatment and aggressive efforts to prevent the spread of HIV infection. Both called for billions of dollars in southern Africa alone, requiring national and international consensus. This was hard to build in the “rainbow Republic,” and required sacrifice and principled activism. But this was true right here in Cambridge, too. When we published, in a fairly obscure medical journal, a “Harvard Consensus Statement” about integrated AIDS prevention and care, eventually signed by 141 faculty members, some joked that the term “Harvard Consensus” was an oxymoron.

But President Mandela was on-board. To quote him: “It is never my custom to use words lightly. If twenty-seven years in prison have done anything for us, it was to use the silence of solitude to make us understand how precious words are and how real speech is in its impact on the way people live and die.” He said this in 2000, a year after his presidency and during an international AIDS conference held in the seaside town of Durban. For most in attendance, at least most of my medical peers, it was the first time hearing, live, a veritable icon of the struggle for social justice. We so needed his words right then. He chose them not with the judicial intent of a lawyer, nor with the judiciousness of the icon he’d become. Still less was he a conventional politician. No, his gravitas and discernment were of a different order, linking goodness to greatness and calling for less sterile debate and more solidarity with people living with HIV.

Like his American counterpart, who launched his post-presidency work in 2000, Mandela made both AIDS and tuberculosis central to his charitable work. Indeed, in time he came to decline most speaking engagements, except those related to these and closely related matters. He lent his considerable clout to the cause, but also remained personally involved after Durban. One of my own friends, a founder of the Treatment Action Campaign named Zackie Achmet, refused to take ART until all of his fellow South Africans had access. As Zackie fell ill, as we feared he would, we begged him to reconsider. But he received a telephone call from President Mandela, who made a simple request: “Zackie, please take your pills.” To show his support more clearly, the former president wore a white t-shirt, emblazoned with “HIV-positive,” and visited Zackie and others working in townships with heavy burdens of AIDS and TB. Madiba was there; these were, after all, “times like his.” Today, South Africa probably counts more people on publicly-funded treatment than any other nation on earth. The tide may be finally turning, although tuberculosis, including its most drug-resistant forms, will be hard to rein in.

And like his American friend and counterpart, Mandela attended subsequent meetings of the International AIDS Society. He was there in Barcelona, as the Global Fund to Fight AIDS, Tuberculosis, and Malaria was finally moving resources to some of the poorer countries and to poor people in middle-income ones, and he was there in Bangkok, to hear about the success of some of its first treatment programs and to sound the alarm about tuberculosis. We will miss him for many reasons. What I will miss most about this steel-forged and persistent man is his smile, shining forth like the sun peeking around the edges of a storm cloud.

But we can all draw on his memory. For “times like his” are never really behind us, even though his century has drawn to a close even as you set off on new adventures and face old perils and new ones.

It’s raining today in Johannesburg, but the summer sun will soon shine there again. And may it shine for you as you go forth into lives full of satisfaction not simply of whims or passing fancy but of the quest for meaning and for justice. This comes of seeking to do good in the world. None of you is likely to face the trials of imprisonment or privation. But you will all face trials, as sure as the sun shines, and all of you will make decisions, good and bad. It is my hope that you make them with goodness in mind, and enjoy, as Nelson Mandela surely did, the plenitude of a meaningful life.

Good luck and thank you.