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Volume 2, Issue 3
Autumn 2006:

Mountains Beyond Mountains by Tracy Kidder

Review by: Alexander Wong

Cell 2 Soul. 2006 Autumn; 2(3):a14

Random House (2003); 336 pages; ISBN: 0-375-50616-0

Mountains Beyond Mountains

Amidst our comfortable lives filled with stocked grocery store shelves and reality television, where the gripe of the moment is the "ridiculous" price of gasoline at the local pump, how many of us take the time to reflect on the suffering and tragedy of our fellow humanity in places less fortunate? From Africa to Latin America to the streets of our own cities, millions upon millions of people live each day without access to the basic necessities of life: clean water, food, clothing, medicine, housing, schools. Those who live in such poverty face the additional challenge of uncontrolled disease: HIV, tuberculosis, malaria, malnutrition. It is a crisis so overwhelming in scope that it is almost instinctive to say in a tone of resignation, "What difference can I make? can't change the world." I will be the first to admit feeling completely powerless under these circumstances. Then, I read this book…

Tracy Kidder's biography of Dr. Paul Farmer, Mountains Beyond Mountains, shows us how much difference one individual with unshakable idealism and perspective can make. Farmer wears many hats: world-renowned infectious diseases specialist at Brigham and Woman's Hospital in Boston, professor of medical anthropology at Harvard, global advocate for the less fortunate, and caregiver to countless individuals who view him as a saint. Beginning with Farmer's roots in rural Florida (where he spends most of his teenage years living in a bus transformed into a trailer), Kidder details Farmer's initial visits to Haiti as an undergraduate student at Duke, where he first recognizes how political turmoil combined with inequality and poverty are a recipe for poor health outcomes. Haiti instantly becomes Farmer's passion - even after he enrolls in medical school at Harvard, he continues to travel regularly to provide care in isolated settlements along Haiti's Central Plateau, the poorest area in the country. He co-founds Partners in Health (PIH) along with his confidante Ophelia Dahl in Boston while still in medical school, a non-profit organization dedicated to providing health care to those in poor countries.

Farmer's crowning achievement is Zanmi Lasante (Creole for "Partners in Health"), a sprawling concrete complex administrated by PIH which includes a 104-bed general hospital, a women's clinic, a large church, a school, a kitchen that prepares thousands of meals each day, and a facility dedicated to the treatment of tuberculosis. From its humble beginnings as an outpatient clinic tucked away in the small village of Cange, Zanmi Lasante now provides primary health care to nearly one million peasants who live in its catchment area. Zanmi Lasante's growth and reach has mirrored Farmer's success as a diplomat, a fundraiser, and as an advocate for those in need. In the face of widespread international skepticism, Farmer and his colleagues have worked tirelessly to establish Zanmi Lasante as a modern-day model of efficient and effective health-care delivery for poor communities worldwide, proof that we can care for people once thought to be beyond our help. Kidder's account of Farmer's dogged persistence, both at the bedside of his beloved patients and in front of hundreds in the conference room, makes for stirring reading.

Beginning in Peru and later in Haiti, Farmer and his colleagues also help to focus international attention on the widespread problem of multi-drug resistant tuberculosis (MDR-TB). In working to establish a series of successful pilot interventions designed to cure patients infected with MDR-TB and ultimately curb its spread in poor nations, Farmer receives further international funding and support for his initiatives. In light of his success with MDR-TB, Farmer launches similar initiatives for the treatment of HIV patients in Haiti and elsewhere which continue to develop to this day.

Despite his incredible successes at the international level, we are continually reminded how Farmer's priority always remains his patients. An emotional account of a desperate struggle by members of a PIH team mentored by Farmer to transport a young Haitian child with nasopharyngeal carcinoma to Boston for life-saving surgery ends in heartbreak when the child's cancer is discovered to be too widespread to cure. The final chapter of the book describes a "housecall" by Farmer that requires a day-long trek across the challenging terrain of the Central Plateau, one of hundreds he has performed. He sees and treats only two families this day (almost unthinkable in modern-day medicine), yet we realize that there is nothing else that Farmer would rather be doing. He is "doing the right thing" - helping people that no one else will help. "The best thing about Paul is those hikes," says Ophelia. "You have to believe that small gestures matter, that they do add up."

Kidder has crafted a powerful piece which is simultaneously sobering in its depiction of the world's poor and inspirational because of Dr. Paul Farmer, a stirring champion for those less fortunate and a tribute to the medical profession. Farmer is a living example that idealism is not futile, how one individual can make a remarkable difference in the lives of many, and how so much can be accomplished simply by doing all that we can for our patients. Consider reading this book and then reflecting on its lessons thereafter - you will find it to be time well spent.

Author's Note

For more information about Dr. Paul Farmer and his organization Partners in Health (PIH), including how to help or donate to the cause, visit the PIH website at http://www.pih.org.

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