Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World

by Tracy Kidder

“The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.”

To build a school was to unite the practical and the moral.

Some people said that medicine addresses only the symptoms of poverty. This, they agreed, was true, and they’d make “common cause” with anyone sincerely trying to change the “political economies” of countries like Haiti. But it didn’t follow, as some self-styled radicals said, that good works without revolution only prolonged the status quo, that the only thing projects like Cange really accomplish is the creation of “dependency.” The poor were suffering. They were “dying like smelt.” Partners In Health believed in sending resources from the United States to Cange, down “the steep gradient of inequality,” so as to provide services to the desperately poor—directly, now.

Lives of service depend on lives of support.

Meager incomes don’t guarantee abysmal health statistics, but the two usually go together. Many of the groups of people living on the wrong side of the great epi divide have brown or black skin. Many are female. What they all have in common is poverty. Absolute poverty, the lack of almost every necessity—clean water and shoes, medicine and food—in a place like Haiti. Relative poverty in a place like New York.

about two billion people, one-third of humanity, have TB bacilli in their bodies,

I remember signing the oath to assist the patient and do him no harm. I don’t really remember signing that I would do it in a cost-effective way.”

“There are more billionaires today than ever before,” Jim declared. “We are talking about wealth that we’ve never seen before. And the only time that I hear talk of shrinking resources among people like us, among academics, is when we talk about things that have to do with poor people.”

MDR treatment was cost-effective in a place like New York, but not in a place like Peru.

The World Health Organization serves as the coordinating body for virtually all the world’s ministries of health. It sets guidelines and standards, publishes recommended approaches, acts as an advisory group. It’s where all the information about health and a lot of the complaints go, and it performs some crucial functions well, such as the collection and dissemination of worldwide epidemiological data. But it is perennially short of money, and like most parts of the United Nations it is infamously, inevitably, tangled in bureaucracy. It has a tendency to freeze in the face of controversy.

“Resources are always limited.” In international health, this saying had great force. It lay behind most cost-effectiveness analyses. It often meant, “Be realistic.” But it was usually uttered, Kim and Farmer felt, without any recognition of how, in a given place, resources had come to be limited, as if God had imposed poverty on places like Haiti. Strictly speaking, all resources everywhere were limited, Farmer would say in speeches. Then he’d add, “But they’re less limited now than ever before in human history.” That is, medicine now had the tools for stopping many plagues, and no one could say there wasn’t enough money in the world to pay for them.