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

I haven’t read Tracy Kidder since The Soul of a New Machine which I loved. Obviously that was a mistake. This book is excellent and its subject, inspiring: the life and work of Paul Farmer makes me believe that all the big problems of the world would be soluble if people had attitudes similar to his—and that he’s capable of infecting anyone who gets anywhere near him, maybe even just reading this book. People don’t of course generally have Farmer’s attitudes, but still he has accomplished much by a relatively simple philosophy—that it’s wrong (and unnecessary) for there to be desperately poor people in the world. For him that translates into bringing top notch medical care to every citizen of the planet. He thought that could be done without the usual rational for how to help the poor: doing the greatest good for the greatest number with the resources you have. Farmer’s biggest success was convincing the medical world that they were wrong in thinking the best way to fight TB was to concentrate on drug programs for those with TB which could be cured by the most common (read “inexpensive”) drugs and ignoring (i.e. leaving to die) those with MDR (multi drug resistant TB) which needed careful diagnosis to figure out which combination of very expensive drugs were necessary. In Farmer’s world view, every person on the planet deserved the same medical care; he was impervious to anyone who tried to suggest to him that that wasn’t “practical”. In the MDR case, he found a test site in Peru and proved his point, not the least of which was that if the MDR cases went untreated, they would facilitate the spread of the most dangerous kind of TB. Farmer also thinks there’s no population with AIDS that does not deserve to be treated with the latest drugs. Along the way he’s brought dying children from Haiti to Boston for treatment and cures and brought open-heart surgery to the poorest part of Haiti. The organization he founded, Partners in Health, perpetrates his messianic philosophy of medicine.

Farmer works in two very disparate worlds he very much wants to bring closer together: Harvard Medical School and the top notch Boston hospitals that give him access to and his clinic in the central highlands of the poorest country in the western hemisphere—Haiti. He started the work in Haiti before he even went to medical school himself and obtained his medical degree plus a PhD in anthropology at the same time, while spending significant amounts of time at his Haitian clinic. He’s clearly one of those smart, driven and extremely energetic souls whose drive to accomplish is nothing short of miraculous.

Kidder doesn’t say how he chose Farmer as a subject for his book, but it’s clear his research extended over several years during which he visited Farmer in Haiti and Boston many times—and traveled with him to international conferences and to places where Farmer was working such as the slums of Lima, Peru and the prison system of Russia. Kidder is one of those writers whose books evolve organically, without a clear chronology or even a topical outline. If there’s one organizing principal it’s Kidder’s own experience with Farmer, from his first impressions through his broadening understanding of a complex man and his work. The book is a joy to read and Farmer’s life is nothing short of an inspiration. This book may be the perfect melding of superb writer and worthy subject.