I grew up with five brothers and sisters in a trailer park in Florida. We lived in a bus. My father was a schoolteacher who taught neighbors to read and always rooted for the underdog. My mother, who is very well-read, worked in a local grocery store. They always encouraged us to engage with larger issues, and all my siblings made it to college.

Before medical school I made a trip to Haiti. Having grown up around migrant farm workers, some of whom were Haitians and all of whom were poor, I used to ask: 'What could possibly be so bad about home that would make these workers travel so far to work under such inhumane conditions?" Haiti was an incredible education for me. It taught me about "structural violence" and the impact on health. Structural violence might be defined as a series of large-scale forces, ranging from gender inequality and racism to poverty, which structure unequal access to goods and services. Of course, such violence makes people sick, and the sickness I saw in Haiti was truly dreadful. Two years later, in 1985, a group of friends and medical school classmates began working with local people to build a health clinic in Haiti's Central Plateau. It now serves 35,000 patients a year, many of whom are landless peasants.

I've chosen to do most of my work outside the United States, simply because I no longer make many nationalistic distinctions. Many of my co-workers agree: the only allegiance we have is to the poor, the ignored, the victimized. It's my privilege, when in the U.S., to work in the inner- city. However, I feel more needed working in rural Haiti where--unlike in Boston--I know there is no one who can take my place. In Haiti, people simply will go untreated if I'm not available.

In 1993, as a result of some research and writings on the health consequences of economic and political marginalization, I was awarded a MacArthur Foundation grant of $220,000-no strings attached. Aside from being pleasantly shocked (one cannot apply for a MacArthur Fellowship--the entire grant process is conducted in secrecy), my immediate reaction was, "It's not my money." I knew the entire amount needed to go to Partners In Health, the organization we'd set up to administer our clinic work in Haiti, Peru, Mexico, and Boston. Thanks to the MacArthur grant, we were able to create the Institute for Health and Social justice to broaden our work in Haiti.

Friends and colleagues teased me about not spending some of this money on myself. To be sure, I'm no ascetic. But increasingly, I've come to wonder how the accumulation of personal wealth can be a morally sound endeavor in the face of such stark inequality.

I've never made much of a distinction between my life and my work, so it gave me great pleasure to give this money to an institution that will preferentially serve the poor and always try to side with them. I've been told I'm the first MacArthur recipient to give away the entire grant, which surprises me. More than anything, I just feel like it's not my money. In a world full of suffering, how can you horde the wealth when someone right next to you needs it so much?

- Paul Farmer