Posted by: Rita | April 10, 2016

Book Fifteen: Mountains Beyond Mountains by Tracy Kidder

mountains beyond mountainsThe story of Paul Farmer, as told in Mountains Beyond Mountains by Tracy Kidder is extraordinary — not simply because it tells the story of Paul Farmer and the work he has done to improve the health and lives of  the poorest of the poor in Haiti and elsewhere, but it is extraordinary in its literary narrative.  Kidder takes you inside — not just inside the health clinic that Farmer build in Haiti, or the prison he visited to treat TB in Russia, or the organization he started with Ophelia Dahl and Jim Kim (Partners in Health)  but inside the heart and soul of an amazing man, Paul Farmer.

Farmer’s work in Haiti and around the world has changed how medical care is provided to the poor — in developing world countries like Haiti, Rwanda, rural Peru — but also in inner-city Boston. He believes that we should have a preferential option for the poor — the basis of liberation theology (which he teaches more about in his amazing book Pathologies of Power.) He also believes — and practices the idea — that we should listen to the people who need the health care — they hold the key to how to ensure that they get the care they need. Farmer listened to his patients in rural Haiti and upended the idea that they should come to the doctor to get their TB meds – and instead he trained local villagers to take the medication out to those who needed it – increasing “compliance” and also giving neighbors a way to help each other and themselves while living in crushing poverty. It is a beautiful thing — social justice in action.

I have given this book as a gift more times than I can count, and am reluctant to say much more about how great it is — because then some might think it was okay to just read the reviews and not read the book; but no review can capture the importance of this book, and no writer does justice to the excellence that Kidder achieves here.

I had the opportunity to interview Kidder once — here’s an excerpt from the Q&A that was published on Etude (an on-line literary magazine at the University of Oregon in the early 2000s that seems to no longer be on line):

How did you chose Paul Farmer as a topic for this book?

I didn’t really pick him — fate put me in his path. I was doing a story on American soldiers in Haiti, and he showed up at an army outpost. I ran into him a few weeks later when we were on the same flight to Miami and we got to talking. I got so absorbed in the conversation — he was so friendly, so helpful. I saw him one more time after that, and kept in touch — at a distance — although my daughter says that I talked about him quite a bit. I didn’t pursue him for 6 years — though I got to know the outlines of his life well enough to believe it probably would be worth writing about.

I think I may have been hesitant about the story because Haiti shocked me. I’d been a soldier in Vietnam, but Haiti was so much worse. I’d never seen so much suffering and unnecessary death, and after I got back, I tried to reconcile the fact of Haiti with my very privileged life, which I thought I had earned. I knew if I started following Farmer around, it was going to disturb my life.

Somewhere in the late 90’s, 1999, I started hearing more about Farmer. Just as I say in the book, I heard that he was doing something notable in international health, something to do with tuberculosis. And it seemed to me that I’d waited long enough to try to approach him, and that I’d willfully turned away from a good story. So I did approach him, and he wasn’t eager to be written about. His two closest colleagues, in particular Jim Kim, encouraged him to do so. I think they felt, not so much that it would be good for Partners in Health, but it might be a way for them to get a little more attention, and maybe a way to help them raise more money which they are always in need of.

I traveled with [Farmer] for a month and wrote a profile for the New Yorker (“The Good Doctor” July 10,2000) which I think worked, but I was unsatisfied because there were so many stories yet to tell. So I asked him if he’d give me access to do a book and after some months he said yes.

Has your book had an impact on Farmer’s work?

I don’t really know. But Ophelia Dahl [Partners in Health Executive Director] tells me it that has brought attention, and a lot of fresh inquiries [to Partners in Health.] But unfortunately, a lot of the inquiries haven’t been accompanied by checks. At least not so far. It’s been a lot of people just wanting to volunteer for Partners in Health, but the problem is that PIH is so small that they are really not set up to take on the volunteers.

You do a wonderful job in the book of showing that Farmer is a human being, not a saint – was that difficult?

Thank you. It was clear to me, by the time I started writing –part of it came from a remark by a friend — that the reader would need an “everyman.” I needed someone to acknowledge, first of all, that this guy is for real, and also to acknowledge what anyone less virtuous is bound to feel in the company of someone who is so dedicated.

But built into this work is a kind of distance. It is an inherently unequal transaction because we’re talking and having a conversation about our lives and I’m taking notes and he is not.


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