Mountains Beyond Mountains

On the recommendation of my crossroads professor, Dr. Boyle, I picked up Tracy Kidder's book Mountains Beyond Mountains to read. Its subject matter is a good fit for our class, and it's a very readable book as well--he manages to keep it very interesting, while still working in a technical overview.

Kidder's book follows Dr. Paul Farmer and his organization, Partners in Health, as they grow and look to impact the status of tuberculosis in locales such as Haiti and Peru, among others. His particular focus is on multiple drug resistant strains.

What's interesting about Farmer is that he shirks traditional cost-benefit analysis and the sort of by the numbers public health view in favor of an eclectic mix of influences which ultimately culminate in the individual patient being of primary almost singular importance. MDR tuberculosis is/has been in the past very expensive to treat, and it has often been a death sentence in many low income countries--even where NPOs are at work. In one section of the book, Farmer takes a "Robin Hood" approach to procuring supplies for his clinic--smuggling in lab samples to American labs, taking pharmaceuticals before they're paid for, and swiping technology from his school labs. Farmer incorporates a unique world view; part Malcolm X part Mother Theresa. He doesn't just accept idealism and volunteerism. He relates to the populations he treats on a whole other level, and in my mind much of this is owing to his own unique upbringing as well as his training as an anthropologist.

He takes inspiration from many different sources. I particularly enjoyed the section describing his transition from the realm of Duke and elite East Coast medical schools to the dusty roads of Haiti, where he is simply Dokte Paul or simply a "blan". His affinity for Ruldolf Virchnow is no great surprise either. Before reading this book though, I'd never heard of him. After reading though, I am certainly interested.

Farmer exhibits a fire behind the idealism. He does not simply live to better the world, but he is outraged by the situations that most commonly affect the outer edges of society as a result of the actions of the so-called world powers. He is strongly impacted by liberation theology--he had a Catholic upbringing, but does not clearly identify. Visit this link for more info and scroll down to Introduction and Overview: http://liberationtheology.org/ (don't try and use Wikipedia, I think that explanation is particularly inaccurate). In Haiti he holds up an example of a damn created by the US military that completely disrupted and upset the ecosystem and lifestyle of that community. He also looks at how US politics has often supported corrupt and brutal regimes through their funding. His anger is manifested in his use of terms like, comma (used as a sort of damn the system phrase), WLs (white liberals or those who donate and support but never really make a permanent, active contribution directed at the root of a problem), and his slight asides that aptly sum up the situation at hand.

Farmer knows no boundaries. He is so whole-heartedly tied to his cause that he is single-minded to a fault, yet even so he has a hand in so many different fields from poverty and health in Haiti to MDR tuberculosis in Peru to the prison populations of Russia. It leaves me wondering how he manages to handle the vast amount of projects he takes on without delegating more. We talk about how multi-disciplinary public health is, but Farmer is truly an epitome of public health's renaissance man: anthropologist, behavioral scientist, environmental scientist, epidemiologist, health policy and administration, etc. The amount he manages to take on and handle as a single person is both inspiring and amazing.

If you get the chance pick it up and give it a read. I don't think you'll regret it.