Mountains Beyond Mountains: Healing the World: The Quest of Dr. Paul Farmer

by Tracy Kidder

published

September 9th 2003 by Random House

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binding

Hardcover, 336 pages

isbn

0375506160 (isbn13: 9780375506161)

description

Tracy Kidder is a winner of the Pulitzer Prize and the author of the bestsellers The Soul of a New Machine, House, Among Schoolchildren,...more

[close] Tracy Kidder is a winner of the Pulitzer Prize and the author of the bestsellers The Soul of a New Machine, House, Among Schoolchildren, and Home Town. He has been described by the Baltimore Sun as the “master of the non-fiction narrative.” This powerful and inspiring new book shows how one person can make a difference, as Kidder tells the true story of a gifted man who is in love with the world and has set out to do all he can to cure it.

At the center of Mountains Beyond Mountains stands Paul Farmer. Doctor, Harvard professor, renowned infectious-disease specialist, anthropologist, the recipient of a MacArthur “genius” grant, world-class Robin Hood, Farmer was brought up in a bus and on a boat, and in medical school found his life’s calling: to diagnose and cure infectious diseases and to bring the lifesaving tools of modern medicine to those who need them most. This magnificent book shows how radical change can be fostered in situations that seem insurmountable, and it also shows how a meaningful life can be created, as Farmer—brilliant, charismatic, charming, both a leader in international health and a doctor who finds time to make house calls in Boston and the mountains of Haiti—blasts through convention to get results.

Mountains Beyond Mountains takes us from Harvard to Haiti, Peru, Cuba, and Russia as Farmer changes minds and practices through his dedication to the philosophy that "the only real nation is humanity" - a philosophy that is embodied in the small public charity he founded, Partners In Health. He enlists the help of the Gates Foundation, George Soros, the U.N.’s World Health Organization, and others in his quest to cure the world. At the heart of this book is the example of a life based on hope, and on an understanding of the truth of the Haitian proverb “Beyond mountains there are mountains”: as you solve one problem, another problem presents itself, and so you go on and try to solve that one too.

“Mountains Beyond Mountains unfolds with the force of a gathering revelation,” says Annie Dillard, and Jonathan Harr says, “[Farmer:] wants to change the world. Certainly this luminous and powerful book will change the way you see it.” [close]

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Meg rated it:

(review of isbn 0812973011)

11/21/07

5 comments

Miguel rated it:

(review of isbn 0812973011)

09/06/07

Read in September, 2007

recommends it for: people that can read small small

I am not really sure where to begin when it comes to this book. Let us just say that Tracy Kidder writes a mean biography/account of perhaps one of the most influential people of our (Generation iPod/big box stores) time. This book really encapsulates what I imagine Paul Farmer's credo is; that is to say, fuck the idea of appropriate technology, sustainability and cost-effectiveness this is human suffering that we are flapping our tongues about...get real.

Sheer eloquence I know...

I...more

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Sarah rated it:

(review of isbn 0812973011)

08/26/07

Read in August, 2007

For anyone who yearns to "make a difference" but feels overwhelmed at where to start, this book will inspire you, maybe even shock you. Doctor Paul Farmer decided at the age of 23 to devote his life to treating the poor. He established a clinic in one of the most impoverished parts of Haiti called Zanmi Lasante. Over the next twenty years, he treated not just the poor in Haiti, but expanded to treat the poor in Peru and prisoners in Russia, leading efforts to address "impossible&q...more For anyone who yearns to "make a difference" but feels overwhelmed at where to start, this book will inspire you, maybe even shock you. Doctor Paul Farmer decided at the age of 23 to devote his life to treating the poor. He established a clinic in one of the most impoverished parts of Haiti called Zanmi Lasante. Over the next twenty years, he treated not just the poor in Haiti, but expanded to treat the poor in Peru and prisoners in Russia, leading efforts to address "impossible" diseases like multi-drug resistant TB and AIDS. His attitude from the beginning has been "the current way's not working. I'll do it my way." When he first encountered the corrupt and ill-run Haitian clinics, he decided, "I'm going to build my own fucking hospital. And there'll be none of that there, thank you." At an international AIDS conference in South Africa where a banker commented that Africans must learn to curb their sexual appetites, Farmer responded, "I want to talk about other bankers, not the World Bankers, but bankers in general. My suspicion is they're not getting a lot of sex, because they spend a lot of time screwing the poor"
Farmer allows one to believe that one can "follow one's heart" AND be effective. Of course, he had more than ideals. He also has a medical degree from Harvard and a level of commitment few of us can even imagine. He still makes house calls to the poor in Haiti, trekking for hours up and down mountains. He loves Lord of the Rings and maybe this is what inspires him! But now, vivified in this book, he's a symbol to inspire others. There's so much to take away from his story. For me, it speaks largely to the power of purpose and a commitment to action in the name of that purpose. Ignoring those who would question and discourage, the "Are you sure that's a good idea?" questions and trust one's inner bidding. We are all so well-trained in being cynical, in doubting. But if we want change, we have to bring something of our own to the table to believe in. And start focusing our energy on that, not on the crap that already exists that we don't like. Farmer has done that and it's really, really worked. ...less

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Catherine rated it:

(review of isbn 0812973011)

08/10/07

Read in August, 2007

I wish I had known. Paul Farmer, the subject of this book's adoration, spoke at Columbia's commencement ceremony this past May. At that time, I had never heard of him. If I had known, I would have gone and been able to see first-hand who he is.
"Mountains Beyond Mountains" is neither biography nor non-fiction, but is more a commentary on the author's time spent with Dr. Paul Farmer. It briefly browses through his life story: very unusual upbringing, extremely well-educated genius, qui...more I wish I had known. Paul Farmer, the subject of this book's adoration, spoke at Columbia's commencement ceremony this past May. At that time, I had never heard of him. If I had known, I would have gone and been able to see first-hand who he is.
"Mountains Beyond Mountains" is neither biography nor non-fiction, but is more a commentary on the author's time spent with Dr. Paul Farmer. It briefly browses through his life story: very unusual upbringing, extremely well-educated genius, quirky but charismatic personality. It also browses through each of the projects Dr. Farmer has been involved in: TB and later AIDS in central Haiti, TB in Peru and Russia.
Like too many quasi-biographies I've read, this one glorifies its subject while simultaneously de-personifying him. I have no idea what Dr. Paul Farmer is really like, but now at least I can imagine that he's a heroic, driven, relentless, brilliant, caring, wonderful doctor and advocate for the poor around the world. The author may want us to believe that Farmer is completely selfless, and perhaps he is, but I must admit that in his appearance, personality, and actions, the description of Farmer in this book reminded me most of Ayn Rand's perfect, ideal egoist hero. I wish I could know what he is really like, because people like the man idolized by this book don't exist.
Perhaps I should have read this by choice instead of because it was assigned. Perhaps I should have read it before spending two months in Guatemala instead of after. Perhaps I should have read it in a single afternoon (which is perfectly feasible - it's a decent read) instead of spread over 10 days. But I just couldn't get into it because I felt the whole time that I was being sold a vision that I don't share. Whatever problems there may be with world-wide health, a lot more could be accomplished by everyone doing a little than by one man driving himself beyond all reasonable limits.
My overall view: an interesting narrative of Dr. Farmer and his ideas and work around the world, but not one that I'd choose to read again for fun...less

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Anna rated it:

(review of isbn 0812973011)

07/08/07

Read in March, 2007

This is required reading for all PC health volunteers. Just remember “If Paul is the standard, we are all fucked.” Farmer is a doctor working in rural Haiti, a land that many have forgotten and others are willfully ignoring. Tracy Kidder is a journalist who runs across Farmer while on assignment covering the political turmoil of Haiti in 1994. Kidder unexpectedly finds a man many would call (and have called) a saint. A enigmatic figure in jeans and a black shirt, Paul Farmer has taken on cri...more This is required reading for all PC health volunteers. Just remember “If Paul is the standard, we are all fucked.” Farmer is a doctor working in rural Haiti, a land that many have forgotten and others are willfully ignoring. Tracy Kidder is a journalist who runs across Farmer while on assignment covering the political turmoil of Haiti in 1994. Kidder unexpectedly finds a man many would call (and have called) a saint. A enigmatic figure in jeans and a black shirt, Paul Farmer has taken on crippling rural poverty, institutionalized racism (or classism), TB and HIV and largely won. By focusing on the individual patient and with a clear understanding that the poor deserve no less than the rich, he has surpassed every expectation of what can be accomplished.
A TB patient stops his treatment. Instead of trusting the axiom that the poor believe they are cured once the symptoms stop, he investigates deeper to find their family was starving. TB medication is important, but feeding your children will always be a priority. Faced with a new challenge, he decided to treat the malnutrition by providing food for the families of his patients, and went further to provide a floor and a roof for their homes, potable water systems to avoid water born illnesses, and basically anything any of his patients asked of him. His methods are far from what we like to call sustainable. What would Farmer say to that? “Fuck You.”
Paul Farmer did not set out to change the world. He just wanted to help people, and he has, millions of them. He did not design his project for imitation or broad appeal. He just viewed every person individually and tried to picture each one as himself. Using this simple method of human decency he has created one of the best clinics in the world, in a country with no health care to speak of and no governmental support. He has moved on to other projects internationally, in Peru, Mexico, and Russia. Lauded by all who know him personally, and attacked by those whose worldview he disturbs.
Tracy Kidder has strong presence in his book. It is the first time, says the reader’s guide, that he has chosen to write in first person narrative. In doing so he allows himself personal bias. He connects us to the characters and gives us a strong sense of how amazing and unique Paul Farmer is. He lets us know its okay to feel annoyed at Farmer for his disregard for the norms. He lets us know its okay to feel guilty for not being able to dedicate our lives so fully to the poor.
Despite having spent the last year working in Public Health, I never really understood it and its global implications until I read this book. For Farmer healthcare for all is a moral imperative. It makes me feel a little bit better about the work I’m doing, while at the same time making me feel like I could never quite do enough.
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bruin rated it:

(review of isbn 0812973011)

01/25/08

bookshelves: health, sustainability

in my opinion our construction of heroes in this world leaves a lot to be desired. and while paul farmer might indeed being doing incredible work with an incredible attitude/perspective, i tired quickly of this book's idolation and unquestioning worship.

this is *not* how we will create more heroes among ourselves and others. this is precisely how people like dr. king have been removed from the people and pedastalized to the detriment of our movements and our visions for change.

get a g...more

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carrie rated it:

(review of isbn 0812973011)

04/27/08

Read in April, 2007

If you would like to feel like you are self-centered and haven't accomplished much, read about Doctor Paul. I was going to try to cure Africa of TB, but I just haven't had time lately. I need to meet this guy, if only to hear more stories about growing up on a bus. This book unfolds in a grabbing way, and reads easily despite a telling of facts and events.

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Erin rated it:

(review of isbn 0812973011)

03/11/08

Read in January, 2007

This book was amazing. Dr. Paul Farmer is my hero. This story really gives you a new perspective, it is very inspiring.

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Rose rated it:

(review of isbn 0812973011)

04/27/08

Mountains Beyond Mountains is a biography of Dr. Paul Farmer, a Harvard educated physician who, in the face of seemingly insurmountable odds, set out to bring life-saving, 'first-world' medical practices to the desperately poor in rural Haiti. This book has almost become essential reading for those who have even the most cursory interest in fields often referred to as global health, social medicine, or public health.

Paul Farmer is a unique doctor who seems genuinely called to a life of servi...more Mountains Beyond Mountains is a biography of Dr. Paul Farmer, a Harvard educated physician who, in the face of seemingly insurmountable odds, set out to bring life-saving, 'first-world' medical practices to the desperately poor in rural Haiti. This book has almost become essential reading for those who have even the most cursory interest in fields often referred to as global health, social medicine, or public health.

Paul Farmer is a unique doctor who seems genuinely called to a life of service to the poor. He grew up in an unusual family and environment and is undoubtedly a brilliant man. While an undergrad at Duke he first visited Haiti and this experience changed him profoundly. During medical school at Harvard, he spent half his time working in a clinic on the island. Later, he had the good fortune to meet a Boston millionaire who, over the course of a couple decades, has given nearly his whole savings to Farmer to use in Haiti and various other countries where Farmer's organization, Partners in Health (PIH), sponsors community medical projects. He was also surrounded by several close friends who have also dedicated their lives to Paul and his vision (one of whom was Ophelia Dahl, daughter of British author Roald Dahl, who plays a fascinating part in the story; I wish the book told us more about her).

I think a reader can safely say that Farmer is a visionary. He saw the shocking state of healthcare in rural Haiti and dreamed of raising the standard of care in that area. Since then, he has devoted his life to building a sustainable healthcare network in the Cange and erradicating the area of infectious diseases long since cured in the first world. Haitians hardly experience an equitable standard of care to what we have in the United States, and perhaps never will, but this hasn't stopped Farmer from trying. For example, the most rampant infectious disease in the Cange was tuberculosis (TB), which was expensive to treat because of a low supply of pricey first-line drugs. The drug companies didn't make many of these drugs because there was little to no demand for them by those who could afford to pay. Farmer and PIH worked to convince the drug companies to increase the supply and drop the prices, while simultaneously convincing the World Health Organization (WHO) to purchase and distribute the supply and treat those in impoverished countries who were suffering from a treatable disease. This was no easy task, but PIH proved to the world that it is possible to successfully provide the poor with quality medical care.

The book is painfully long but, I think, ultimately worth the struggle. I applaud the author, Pulitzer Prize winner Tracy Kidder, for taking on such an enormous subject. The book breaks down medical terminology and practice, while also tackling some pretty enormous political and social issues. And as if that were not enough, Farmer himself is a larger-than-life character. Half the time I can't tell if Kidder loves him or loathes him, and Kidder himself probably doesn't even know. Farmer's life is inspiring because he has accomplished so much in very little time. But at the same time, the man is no saint, despite the fact that people regularly call him such to his face. He is absolutely infuriating. He seems to have an answer to everything. At one point, Kidder writes several pages about the "language" of PIH, which incorporates unique acronyms, words, and made-up phrases. Kidder explains that one "could hang around the inner circle of PIH for a long time without understanding what the rules were and feeling excluded" (Kidder 217). Famer responds that "'If so, it's surely the most inclusive damn club in the world, being full of people with AIDS, WL's galore, tons of students, church ladies, lots of patients, and it's a club that grows and never shrinks" (217). Sure, Farmer has a memorable response ready, but it's total bullshit. If you weren't in PIH, you wouldn't know that "WL's" stands for "white liberals," a group upon which he reluctantly relies for funding and regularly mocks. Farmer preaches humility, but says things like "Every account is partial [...:] except mine" (252).

What seems most tricky about Paul Farmer, however, is that his model for building PIH and creating large-scale community health projects is not replicable, but he has become one of world's most sought-after experts in global health. What I mean is that, when starting PIH, Farmer happened to have a non-restricted, ready supply of cash from a generous private donor, a truly rare situation for a non-profit start-up company with no established organizational structure. When the money ran out, he stole medical supplies from Boston's most wealthy hospitals. He literally stole hundreds of thousands of dollars in medications. For a good cause? Sure. What this proves is that sometimes the people with power don't need a little push, but need to be shoved off a cliff, to make the world change. But how can someone who built a medical treatment program around theft lecture others on building sustainable global health projects? I'm sure Farmer would have a memorable response to my complaint, something that made me feel like a real jerk and used some cryptic acronyms to make me feel excluded from his inner circle. But these complexities are what make him so provocative and, thus, the subject of a biography worth reading....less

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Avie rated it:

(review of isbn 0812973011)

04/07/08

bookshelves: ethnography

Read in April, 2008

recommends it for: Medical anthropology students, everyone in general

A Narrative of Guilt

In a nutshell, this is a downright unnerving book, especially for someone like me, whose accustomed readings are foreign policy analyses instead of ethnographies. For a start, Kidder’s book begins with him ‘narrating Haiti.’ Curiously, around the same time I read Kidder’s book, my other class on U.S. foreign policy was also deep in a discussion regarding Haiti. The highlight was repeated U.S.-led interventions to the country. Seeing them as a dismaying series of ...more A Narrative of Guilt

In a nutshell, this is a downright unnerving book, especially for someone like me, whose accustomed readings are foreign policy analyses instead of ethnographies. For a start, Kidder’s book begins with him ‘narrating Haiti.’ Curiously, around the same time I read Kidder’s book, my other class on U.S. foreign policy was also deep in a discussion regarding Haiti. The highlight was repeated U.S.-led interventions to the country. Seeing them as a dismaying series of failures, my professor, a distinguished retired U.S. Major-General whom I am really fond of, had remarked, quite honestly and abruptly, that he actually disliked discussing Haiti. ‘In the last 100 years, we Americans have fixed Haiti six times.’ He shrugged and then signaled with his waving hands (a gesture he usually uses when he wants to dismiss or shake off something unpleasant) that he was tired of Haiti. I have seen that kind of gesture elsewhere. I remember several weeks earlier I had attended a session in which former Ambassador Robert Barry expressed the same sentiments about Timor-Leste (another country which has witnessed repeated international interventions). Knowing the complexities of reality, I understand their frustrations, but what does it mean to be ‘tired’ of Haiti? Tired of Timor-Leste? I suspect it is very easy to be tired of other people’s sufferings when you view it from (what I perceive to be) a perspective of charity; that you are doing the other a favor out of your generosity (or some altruistic interests in the case of foreign policy). This kind of perspective usually burns out whoever subscribing to it as it is not sincere; people are highly prone to feeling a compassion fatigue.

Reading Kidder as he narrates Dr. Paul Farmer, a reader realizes that in fixing world’s problems, we cannot avoid some cost to ourselves (p. 40). Differing from other people, what makes Dr. Farmer tick and able to serve the poor in a seemingly superhuman mode, is because he views his life and work through a perspective that sees beyond charity. For him, service to the poor and destitute is something that was born out of the discomfort and guilt regarding the ‘structural violence’ that determines the unjust distribution of wealth and medicine in the world today. I think what makes Kidder’s book brilliant is his ability to capture this aspect from Farmer. Poverty in a place like Haiti is rendered to appear as if it is in front of the reader and thus gives it a reality. In a nutshell, the power of this book is in making any reader who is in the possession of health and wealth (at least, relatively compared to the poorest of the poor like the Haitians) should feel downright guilty. As Kidder rightly observes, with the exception of his patients, Paul Farmer was not put on earth to make anyone feel comfortable. And no one should feel comfortable. A lot of times, ‘stupid’ and unnecessary deaths (as Farmer put it) are the result of mere laziness and selfishness of those advantaged by the global structure of capitalism. Unapologetically, Farmer advances a geography of blame (p. 106); pointing to the ability of those living in the richer parts of the world in distancing and depersonalizing themselves from the sufferings of others (the Haitians, the homosexuals, the hemophiliac, heroin users, etc).

Reading the book, many times I was reminded of Roméo Dallaire’s memoir which illustrates his experience in Rwanda circa 1994, a time when the West ignored the mass slaughtering of the Tutsis in a country deemed too far away and lacking strategic interest. The ethical question Dallaire posed is echoed by Farmer, ‘Are the lives of certain people [those in the West and mainly White:] more valuable then the rest?’ People in the developed world seem only genuinely concerned once the boat people arrive onshore and make the distant global threat suddenly ‘local.’ In this regard, the poor resembles an entity which the Italian philosopher Giorgio Agamben describes as homo sacer, one whose life theoretically cannot be sacrificed but in practice can be allowed to die (or be killed) anyway. Placing his central argument on poverty as a structural violence (something which Philippe Bourgois also attempts), Farmer firmly endorses the guilt rich people feel toward the poor (p. 93). Advocating a preferential option for the poor, he knows exactly where to put his sympathy and not to put distance between those who suffer and ‘Americans who can go home’ (p. 80).

Of course, celebrating Farmer does not mean imitating him. Sacrifice such as one that Farmer demonstrates is extremely costly (especially in personal terms; parts of the book that pictures Farmer’s relationship with Ophelia Dahl strongly make this point). In fact, Kidder himself as the author, forwardly expresses early on p. 29 that, ‘I’d feel sorry that so many Haitian children still died of measles… but I’d also feel that I could never be sorry enough to satisfy him [Farmer:]’ (I imagine the book to be his mea culpa to Farmer, and probably that is the primary reason why unlike in his other works, he established himself as a character in the book). Farmer is meant as an inspiration, as a compass sketching out what things should be done instead of as a manual regarding how to do them.

‘The Anthropologist Within’

From the medical anthropology point of view, there are simply too many important takeaways from this book. One of the most interesting passages is one which depicts how Farmer due to his training both as a doctor and an anthropologist (he was among others, a student of Arthur Kleinman) is able to operate in a flexible manner in a society that is 90% Catholic and 100% Voodoo (p. 105) and captures meanings instead of obsessing about measurement (p.72). Treatment must be comprehensive, and on that note, a doctor should not mind giving, among other things, sorcery consult (p. 27). Combining anthropology and medical knowledge has indeed given Farmer a powerful tool of ‘intervention’ (p. 83). Tragedies such as one that has befallen on Lia Lee are happily averted because Farmer worries more about his patients’ material circumstances than about their beliefs. Indeed, beliefs and ideologies seem to not matter in the ‘management of poverty’ and delivery of health services. The case of Cuba, which has a surprisingly functioning healthcare system despite its poverty, is a sobering testimony to this. For Farmer, delivering health services is more a matter of political will than a political belief, as can be observed in Farmer’s remark about Marxism on p. 195, ’It’s an ology, after all… And all ologies fail us to a point.’

Farmer’s distrust of all ideologies, including his own, is also helpful in that it enables him to see the biases and shortcomings of Western scientific medicine that he himself practices. This is most illustrative in how Farmer (in a relatively short time, unlike in the case of Lia Lee) was able to figure out that the direct observed tuberculosis short-therapy (DOTS) programs have indeed been the cause of MDR (multi drug resistance) in tuberculosis cases in Peru. Another interesting account is regarding Farmer’s dismissal of the artificial dichotomy between prevention and treatment (p. 256), viewing the division as another lame excuse for inaction. On an end note, anchoring on Virchow as a model, I think Farmer has managed to locate and address human sufferings on a much comprehensive canvass than medicine and anthropology allow. Inevitably, what started as community health projects touch upon politics, not only in national level, but as seen from the development of the Partners in Health, they eventually affect global politics, once again confirming Mead’s forewarning to, ‘Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it's the only thing that ever has.’ The challenge is to keep the force of change for the good sustainable (and institutionalized?) as opposed to having it relying upon personal charisma of a fleeting individual.
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Juliet rated it:

(review of isbn 0812973011)

09/23/07

bookshelves: faves

This was such an engrossing book. I think my response to Paul Farmer was a bit like author Tracy Kidder's - fascinated admiration mixed with a feeling of personal inadequacy leading to a blend of irritated fan worship. How could I ever be like this guy? Isn't he amazing? And liberation theology - wow, what a concept but how does preferential option for the poor work in real life? It seems so "all or nothing." Give up my bread -so to speak- like Farmer, so the poor can eat?

Which ult...more

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Shoshanapnw rated it:

(review of isbn 0812973011)

01/12/08

bookshelves: 2007, medicine-medical, memoir-biography

+ Satisfying tone and pace, an uplifting and far-flung narrative
- Nothing substantive to critique

Highly readable and very satisfying, this is, to the best of my knowledge, the first of Kidder's books in which he appears other than as a distanced narrator. While House and The Soul of a New Machine were certainly very enjoyable, Mountains beyond Mountains is simply engrossing. This is due not only to its subject, the eccentric, opinionated, and deeply generous Dr. Paul Farmer, but also to Ki...more + Satisfying tone and pace, an uplifting and far-flung narrative
- Nothing substantive to critique

Highly readable and very satisfying, this is, to the best of my knowledge, the first of Kidder's books in which he appears other than as a distanced narrator. While House and The Soul of a New Machine were certainly very enjoyable, Mountains beyond Mountains is simply engrossing. This is due not only to its subject, the eccentric, opinionated, and deeply generous Dr. Paul Farmer, but also to Kidder's participation as an active player. Given the subject (poverty, disease, and class bias), Kidder's vulnerability, sometimes-irritation with Farmer, and willingness to slog over Haitian mountains hour after hour to visit patients with him lend the narrative a personal immediacy that is both consonant with those foci and serves as an enactment of the effects of Farmer's works: The event may be a world AIDS conference with global implications, and Kidder reports both the unfolding medical policy decisions and his concern about having offended Farmer with an offhand remark.

Farmer is a character, and Kidder gives the reader ample opportunity to see his many facets: Brillian intellectual, maddening boss, odd duck, lovable eccentric, annoying narcissist, and others. Farmer is a man with a vision, one with an admirable talent for sitting down and whipping out such seminal works as Infections and Inequalities and Pathologies of Power: Health, Human Rights, and the New War on the Poor in record time. Clearly deeply committed to his work and to humanity, Farmer seems like a hard person to live with, and I admire both his deeds and the people committed to supporting him in them.

Central to Farmer's work, and hence to Kidder's narrative, is the question of triage: How are resources allocated? Who is first in line? To what extent should affluent nations provide external (non-sustainable) resources for poor nations? Less well-treated, but amply alluded to, is the question of the balance between indigenous and Western allopathic medical practices. In this regard, The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures is an excellent companion piece. I will be re-reading and reviewing it shortly.

Kidder's voice, self-reflection, and observations here were sufficient to make me buy his next book, My Detachment: A Memoir, which treats Kidder's Vietnam service.
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Mona rated it:

(review of isbn 0812973011)

04/16/07

bookshelves: life-stories, nonfiction, politics-social-sciences, science-health, social-justice

Read in February, 2005

I had to read this book for my political science class on contemporary political issues. The book was part of the section on power. Although I started the book reluctantly, to my surprise I put off my pleasure reading to finish it in three days. The book is nonfiction and tells the story of Paul Farmer, a young doctor and Harvard professor who starts a comprehensive health care system called Zanmi Lasante ("Partners in Health" - also the name of the parent organization based in America...more

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Jenna rated it:

(review of isbn 0812973011)

09/11/07

Read in August, 2007

recommends it for: everyone

I feel like I didn't really understand this book. Some of the arguments that the book makes (e.g., the argument that "cost-effective" thinking is no good, or the argument that trekking into the mountains to visit individual patients is a better use of Paul Farmer's time than doing health-policy work that could save many more lives) just didn't seem very convincing, as though they wouldn't hold much water if delivered into the talons of a rigorous logician. That being said, this book ...more

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Ryan rated it:

(review of isbn 0812973011)

07/15/07

Read in August, 2007

Great portrait of an inspiring yet complicated man, Paul Farmer, who has a reverential following among many young people interested in global public health. This biography is great (won the Pulitzer Prize in 2003) in part because it presents a more complicated picture of Farmer, where a mere glorification would be easier and possibly better received.

The interesting thing to me is that Paul Farmer's dedication is inspirational, and yet I totally disagree with him on some points - for example...more

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kevin rated it:

(review of isbn 0812973011)

07/29/07

bookshelves: non-fiction

Read in July, 2007

recommends it for: everyone

Haiti is a complex nation with a heroic history often sullied and distorted by former colonial powers. Kidder's book is as much a profile of the struggling communities of Haiti's central plateau as it is a biography of the tireless Doktè Paul Farmer.

Kidder offers a balanced view of Farmer's astonishing work for the reader to honor, question, criticize, and admire without didactic hand-holding. I particularly enjoyed the details of Farmer's day-to-day life. Following the doctor's relentle...more

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Kerry rated it:

(review of isbn 0812973011)

10/16/07

Read in October, 2007

recommends it for: people who want proof that there is good in the world

This biography of Paul Farmer is a fascinating account of an inspiring individual. Tracy Kidder's writing is what makes this book so interesting to read. His honest, realistic take on how people react to this driven, dedicated medical anthropologist/doctor/public health advocate is part of what makes this book so riveting. The author's account of his struggle to keep up with the doctor who is willing to travel around the world for his cause, forgo sleep for work, and hike hours to remote huts...more

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Holly rated it:

(review of isbn 0812973011)

04/03/08

bookshelves: adult, nonfiction

Read in March, 2008

recommends it for: my sister

This was a book for book club, and it's not something I would have picked up on my own. I'm so glad I read it though--it's all about Paul Farmer, a doctor who has devoted his life (and I mean every minute of his life) to taking care of the poorest people in the world. Haiti is his favorite place, where he first realized his calling, and he spends most of his time there. But he travels all around the world, incessantly, treating MDR tuberculosis and AIDS in particular. We had our book club meetin...more

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Stacie rated it:

(review of isbn 0812973011)

11/06/08

bookshelves: favorites, non-fiction

You could imagine after seeing this blog that the most popular presents I received this holiday season were books. Mountains Beyond Mountains was special because my gentleman friend’s grandmother gave it to me as a gift. When I opened it she informed me that her other grandson – my gentleman friend’s cousin – had known Dr. Paul Farmer, the person the book was about, from Harvard Medical School. She’s so proud of her grandsons -- and they are all brilliant -- so I was excited to read th...more You could imagine after seeing this blog that the most popular presents I received this holiday season were books. Mountains Beyond Mountains was special because my gentleman friend’s grandmother gave it to me as a gift. When I opened it she informed me that her other grandson – my gentleman friend’s cousin – had known Dr. Paul Farmer, the person the book was about, from Harvard Medical School. She’s so proud of her grandsons -- and they are all brilliant -- so I was excited to read the book.

What I found is the story of one man truly trying to heal the world. Fans of the amazing guitarist Warren Haynes know that he is referred to as the “hardest working man in rock ‘n’ roll.” Well, Paul Farmer has to be the hardest working man in medical anthropology. And even that title does him no justice.

Tracy Kidder depicts Farmer’s works through about a fifteen-year span, from when a young Farmer was finishing his medical degree to developing into a global force on behalf of the world’s poor. Along the way, Kidder describes the patients, doctors and adversaries that Farmer touched and was touched by along the way.

What sets Farmer apart from many other doctors is his belief that socioeconomic situations have a direct link to illness and health matters. Farmer was one of the first people to work based on the theory that just treating illness is not enough. Certain circumstances breed illnesses (i.e. TB, malaria, AIDS) more than others. Just treating the symptoms does nothing to curb these epidemics. There is a reason why TB is rarely seen these days in the United States. But it is the number two killer among infectious diseases in the world after HIV/AIDS, according to Mountains Beyond Mountains.

Farmer began his work in Haiti, where he set up a model that was eventually transplanted to other regions of the world. This model was based on raising the standards of living – as much as was possible – in impoverished areas to help treat the people of those regions. It was not enough to give them the drugs they needed if they had no potable water to drink. It meant nothing to stitch wounds if there was no food. As common se