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

by Tracy Kidder

By contrast, everyone in the group that received the cash stipends and other services made a full recovery.

the equivalent of about five American dollars—to

“There’s a WL line—the ‘They’re poor but they’re happy’ line. They do have nice smiles and good senses of humor, but that’s entirely different.”

Education wasn’t what he wanted to perform on the world, me included. He was after transformation.

expressed a fundamental law of epidemiology: “If disease is an expression of individual life under unfavorable conditions, then epidemics must be indicative of mass disturbances of mass life.”

curing Upper Silesia was “full and unlimited democracy.” This meant, among other things, establishing Polish as the official language, taxing the rich instead of the poor, getting the church out of the business of government, building roads, reopening orphanages, investing in agriculture. The government fired him. Virchow would write, “My politics were those of prophylaxis, my opponents preferred those of palliation.”

He had a knack for aphorism. “Medicine is a social science, and politics is nothing but medicine on a large scale.” “It is the curse of humanity that it learns to tolerate even the most horrible situations by habituation.” “Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community.” “The physicians are the natural attorneys o...

It would make sense to provide medicine in the places that needed it most,

creation of “dependency.”

“People read the Gospel as if it pertained to another place and time, but the struggles described there are in the here and now. The oppression of the poor, the abuse of the vulnerable, and the redemption that comes with fighting for what is right—what ideas could be more relevant in our dear Haiti?”

“Excuse me, Ken, but why do you qualify my talk as provocative? I just said we should treat sick people, if we have the technology.”

Don’t let perfect be the enemy of good.”

“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.”

Margaret Mead once said, Never underestimate the ability of a small group of committed individuals to change the

world.” He paused. “Indeed, they are the only ones who ever have.”

“People think we’re unrealistic. They don’t know we’re crazy.”

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.”

he took on more than he could fix, so of course he wanted reassurance.

Among a coward’s weapons, cynicism is the nastiest of all.

For him, the reward was inward clarity, and the price perpetual anger

I’m sorry, I can’t, but I’m gonna keep on trying, comma.”

At moments like that, I thought that what he wanted was to erase both time and geography, connecting all parts of his life and tying them instrumentally to a world in which he saw intimate, inescapable connections between the gleaming corporate offices of Paris and New York and a legless man lying on the mud floor of a hut in the remotest part of remote Haiti. Of all the world’s errors, he seemed to feel, the most fundamental was the “erasing” of people,

the “hiding away” of suffering. “My big struggle is how people can not care, erase, not remember.”

Embracing a continuity and interconnectedness that excluded no one seemed like another of Farmer’s peculiar liberties. It came with a lot of burdens, of course, but it also freed him from the efforts that many people make to find refuge and

distinction from their pasts, and from the mass of their fellow human beings.

“If the reason most of them are locked up is degeneracy, then how come the number of prisoners rises so much during times of great social and economic crisis or change?”

“But you forgive everyone.” “I guess I do. Do you think that’s crazy?” “No,” I said. “But I think it’s a fight you can’t win.” “That’s all right. I’m prepared for defeat.” “But there are the small victories,” I said. “Yes! And I love them!”

“Paul has created technical solutions to help the rest of us get to decency, a road map to decency that we can all follow without trying to imitate him,” Jim told me, explaining the message on the wall. “Paul is a model of what should be done. He’s not a model for how it has to be done. Let’s celebrate him. Let’s make sure people are inspired by him. But we can’t say anybody should or could be just like him.” He added, “Because if the poor have to wait for a lot of people like Paul to come along before they get good health care, they are totally fucked.”

But it comes in handy in my line of work. To like people.”

time he learned to make the transition more calmly. “After a while I realized I could do just as good a job treating my patients without getting angry,”

“And you know what they say? They say, ‘Look how much they care about us.’

later. He said he thought that hospitals like Mass General had a responsibility to provide free care to patients like John. “And I think free care serves an important purpose, in that it centers people. Poverty in a place like Haiti is difficult

“You know, people from our background—like you, like most PIH-ers, like me—we’re used to being on a victory team, and actually what we’re really trying to do in PIH is to make common cause with the losers. Those are two very different things. We want to be on the winning team, but at the risk of turning our backs on the losers, no, it’s not worth it. So you fight the long defeat.”

If you spend all your time arguing about that stuff, defending yourself, you don’t get your work done.

because if you say that seven hours is too long to walk for two families of patients, you’re saying that their lives matter less than some others’, and the idea that some lives matter less is the root of all that’s wrong with the world.

“You have to believe that small gestures matter, that they do add up.”

“Isn’t it amazing,” Farmer says to me, “that this simple fact has eluded all the many commentaries on Voodoo?”