Mountains Beyond Mountains

the Quest of Dr. Paul Farmer, A Man Who Would Cure the World
by Tracy Kidder

I admit I'd never heard of Paul Farmer before, although I recoginzed this title. He was a brilliant doctor and anthropologist who as a medical student had already traveled to third world countries, and appalled by the lack of medical care for poor people, started doing something about it. In particular he focused his efforts on a community in Haiti that lived above a lake caused by a dam which had flooded their farmland. Most of them never moved anywhere else, just up the hillside, and suffered from starvation because they could no longer grow enough food. Widespread tuberculosis and other diseases were exacerbated by poor nutrition and squalor. Farmer set up facilities and procedures to treat and cure tuberculosis among hundreds of impoverished families, but he did so much more than that. He learned about their native culture especially voodoo beliefs and how it affected their view of illness. He traveled personally (sometimes hiking an entire day to read isolated huts) to visit the sick in their homes, especially entire families affected by tuberculosis. He made efforts to provide the poor with clean water, concrete floors and tin roofs for their modest homes (replacing dirt and leaking thatch), and dietary supplements. He conducted studies to find out exactly what types of treatment would have the best results, and worked tirelessly to bring the plight of thousands to the attention of the global medical community, raised money, started programs in other countries. Peru and Russia are featured large in the book although Haiti was always his base. It amazed me that he was so dedicated to his patients- insisted on treating people even when medication for tuberculosis was expensive, unavailable to the poor- and of course they couldn't pay- and proper treatment took years. Missed or late doses caused drug-resistant strains of TB to arise (it's a bit more complicated than that) so Farmer would often personally go find the patients to find out why they had missed their appointments- sometimes tracking them down to prison and extracting them in order to give them medical care (his phraseology). I learned so much more about tuberculosis than I ever wanted to know.

I am in awe at the work this man did, the far-reaching influence he extended, even when others didn't believe in his methods at first. For example, when he found out how horribly expensive medication to treat drug-resistant strains of TB were, he personally did things to drive the price down. And it had a cascading effect. He also worked with AIDS patients in parts of the world and among impoverished communities that no one else wanted to touch, saying it wasn't worth the effort. This book is kind of a jumble- it leaps around some, tells of the author's connection with Farmer, but not much explanation about how he managed to earn the role- travelling around with Farmer to learn what he was doing in order to write this book- reminiscent to me of In Africa with Schweitzer by Dr. Edgar Berman- also his habit of questioning Farmer about his views and then noting them down in the text. Several chapters tell of Farmer's childhood and how he got to where he was when Kidder met him. The rest is a complex, eye-opening account of his life's work, ranging from squatting in mud-floored huts to take the blood pressure of his patients to flying around the globe for various meetings and conferences in his quest to do whatever it takes. Wow. (Another similar read: Witness to War by Charles Clements, inasmuch as they both deal with bringing medical care to marginalized people who desperately needed it). Did I mention? Farmer founded Partners In Health, and was a renowned infectious disease expert (among other things). There are a lot of other people in this book, who worked alongside Farmer or donated or otherwise helped with his cause, but I can't possibly name them all. You have to read the book!

Rating: 4/5           322 pages, 2003

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