This compelling and inspiring book, now in a deluxe paperback edition, shows how one person can work wonders. In Mountains Beyond Mountains, Pulitzer Prize—winning author Tracy Kidder tells the true story of a gifted man who loves the world and has set out to do all he can to cure it.
In medical school, Paul Farmer found his life’s calling: to cure infectious diseases and to bring the lifesaving tools of modern medicine to those who need them most. Kidder’s magnificent account takes us from Harvard to Haiti, Peru, Cuba, and Russia as Farmer changes minds and practices through his dedication to the philosophy that “the only real nation is humanity.” At the heart of this book is the example of a life based on hope and on an understanding of the truth of the Haitian proverb “Beyond mountains there are mountains”–as you solve one problem, another problem presents itself, and so you go on and try to solve that one too.
“Mountains Beyond Mountains unfolds with a force of gathering revelation,” says Annie Dillard, and Jonathan Harr notes, “[Paul Farmer] wants to change the world. Certainly this luminous and powerful book will change the way you see it.”
|Publisher:||Random House Publishing Group|
|Product dimensions:||5.70(w) x 8.30(h) x 1.01(d)|
|Age Range:||14 - 18 Years|
About the Author
Tracy Kidder graduated from Harvard and studied at the University of Iowa. He has won the Pulitzer Prize, the National Book Award, the Robert F. Kennedy Award, and many other literary prizes. The author of Mountains Beyond Mountains, My Detachment, Home Town, Old Friends, Among Schoolchildren, House, and The Soul of a New Machine, Kidder lives in Massachusetts and Maine.
Read an Excerpt
Six years after the fact, Dr. Paul Edward Farmer reminded me, “We met because of a beheading, of all things.”
It was two weeks before Christmas 1994, in a market town in the central plateau of Haiti, a patch of paved road called Mirebalais. Near the center of town there was a Haitian army outpost–a concrete wall enclosing a weedy parade field, a jail, and a mustard-colored barracks. I was sitting with an American Special Forces captain, named Jon Carroll, on the building’s second-story balcony. Evening was coming on, the town’s best hour, when the air changed from hot to balmy and the music from the radios in the rum shops and the horns of the tap-taps passing through town grew loud and bright and the general filth and poverty began to be obscured, the open sewers and the ragged clothing and the looks on the faces of malnourished children and the extended hands of elderly beggars plaintively saying, “Grangou,” which means “hungry” in Creole.
I was in Haiti to report on American soldiers. Twenty thousand of them had been sent to reinstate the country’s democratically elected government, and to strip away power from the military junta that had deposed it and ruled with great cruelty for three years. Captain Carroll had only eight men, and they were temporarily in charge of keeping the peace among 150,000 Haitians, spread across about one thousand square miles of rural Haiti. A seemingly impossible job, and yet, out here in the central plateau, political violence had all but ended. In the past month, there had been only one murder. Then again, it had been spectacularly grisly. A few weeks back, Captain Carroll’s men had fished the headless corpse of the assistant mayor of Mirebalais out of the Artibonite River. He was one of the elected officials being restored to power. Suspicion for his murder had fallen on one of the junta’s local functionaries, a rural sheriff named Nerva Juste, a frightening figure to most people in the region. Captain Carroll and his men had brought Juste in for questioning, but they hadn’t found any physical evidence or witnesses. So they had released him.
The captain was twenty-nine years old, a devout Baptist from Alabama. I liked him. From what I’d seen, he and his men had been trying earnestly to make improvements in this piece of Haiti, but Washington, which had decreed that this mission would not include “nation-building,” had given them virtually no tools for that job. On one occasion, the captain had ordered a U.S. Army medevac flight for a pregnant Haitian woman in distress, and his commanders had reprimanded him for his pains. Up on the balcony of the barracks now, Captain Carroll was fuming about his latest frustration when someone said there was an American out at the gate who wanted to see him.
There were five visitors actually, four of them Haitians. They stood in the gathering shadows in front of the barracks, while their American friend came forward. He told Captain Carroll that his name was Paul Farmer, that he was a doctor, and that he worked in a hospital here, some miles north of Mirebalais.
I remember thinking that Captain Carroll and Dr. Farmer made a mismatched pair, and that Farmer suffered in the comparison. The captain stood about six foot two, tanned and muscular. As usual, a wad of snuff enlarged his lower lip. Now and then he turned his head aside and spat. Farmer was about the same age but much more delicate-looking. He had short black hair and a high waist and long thin arms, and his nose came almost to a point. Next to the soldier, he looked skinny and pale, and for all of that he struck me as bold, indeed downright cocky.
He asked the captain if his team had any medical problems. The captain said they had some sick prisoners whom the local hospital had refused to treat. “I ended up buyin’ the medicine myself.”
Farmer flashed a smile. “You’ll spend less time in Purgatory.” Then he asked, “Who cut off the head of the assistant mayor?”
“I don’t know for sure,” said the captain.
“It’s very hard to live in Haiti and not know who cut off someone’s head,” said Farmer.
A circuitous argument followed. Farmer made it plain he didn’t like the American government’s plan for fixing Haiti’s economy, a plan that would aid business interests but do nothing, in his view, to relieve the suffering of the average Haitian. He clearly believed that the United States had helped to foster the coup–for one thing, by having trained a high official of the junta at the U.S. Army’s School of the Americas. Two clear sides existed in Haiti, Farmer said–the forces of repression and the Haitian poor, the vast majority. Farmer was on the side of the poor. But, he told the captain, “it still seems fuzzy which side the American soldiers are on.” Locally, part of the fuzziness came from the fact that the captain had released the hated Nerva Juste.
I sensed that Farmer knew Haiti far better than the captain, and that he was trying to impart some important information. The people in this region were losing confidence in the captain, Farmer seemed to be saying, and this was a serious matter, obviously, for a team of nine soldiers trying to govern 150,000 people.
But the warning wasn’t entirely plain, and the captain got a little riled up at Farmer’s denunciation of the School of the Americas. As for Nerva Juste, he said, “Look, that guy is a bad guy. When I do have him and the evidence, I’ll slam him.” He slapped a fist into his hand. “But I’m not gonna stoop to the level of these guys and make summary arrests.”
Farmer replied, in effect, that it made no sense for the captain to apply principles of constitutional law in a country that at the moment had no functioning legal system. Juste was a menace and should be locked up.
So they reached a strange impasse. The captain, who described himself as “a redneck,” arguing for due process, and Farmer, who clearly considered himself a champion of human rights, arguing for preventive detention. Eventually, the captain said, “You’d be surprised how many decisions about what I can do here get made in Washington.”
And Farmer said, “I understand you’re constrained. Sorry if I’ve been haranguing.”
It had grown dark. The two men stood in a square of light from the open barracks door. They shook hands. As the young doctor disappeared into the shadows, I heard him speaking Creole to his Haitian friends.
I stayed with the soldiers for several weeks. I didn’t think much about Farmer. In spite of his closing words, I didn’t think he understood or cared to sympathize with the captain’s problems.
Then by chance I ran into him again, on my way home, on the plane to Miami. He was sitting in first-class. He explained that the flight attendants put him there because he often flew this route and on occasion dealt with medical emergencies on board. The attendants let me sit with him for a while. I had dozens of questions about Haiti, including one about the assistant mayor’s murder. The soldiers thought that Voodoo beliefs conferred a special, weird terror on decapitation. “Does cutting off the victim’s head have some basis in the history of Voodoo?” I asked.
“It has some basis in the history of brutality,” Farmer answered. He frowned, and then he touched my arm, as if to say that we all ask stupid questions sometimes.
I found out more about him. For one thing, he didn’t dislike soldiers. “I grew up in a trailer park, and I know which economic class joins the American military.” He told me, speaking of Captain Carroll, “You meet these twenty-nine-year-old soldiers, and you realize, Come on, they’re not the ones making the bad policies.” He confirmed my impression, that he’d visited the captain to warn him. Many of Farmer’s patients and Haitian friends had complained about the release of Nerva Juste, saying it proved the Americans hadn’t really come to help them. Farmer told me he was driving through Mireba- lais and his Haitian friends were teasing him, saying he didn’t dare stop and talk to the American soldiers about the murder case, and then the truck got a flat tire right outside the army compound, and he said to his friends, “Aha, you have to listen to messages from angels.”
I got Farmer to tell me a little about his life. He was thirty-five. He had graduated from Harvard Medical School and also had a Ph.D. in anthropology from Harvard. He worked in Boston four months of the year, living in a church rectory in a slum. The rest of the year he worked without pay in Haiti, mainly doctoring peasants who had lost their land to a hydroelectric dam. He had been expelled from Haiti during the time of the junta but had sneaked back to his hospital. “After the payment,” he said, “of an insultingly small bribe.”
I looked for him after the plane landed. We talked some more in a coffee shop, and I nearly missed my connecting flight. A few weeks later, I took him to dinner in Boston, hoping he could help make sense of what I was trying to write about Haiti, which he seemed glad to do. He clarified some of the history for me but left me wondering about him. He had described himself as “a poor people’s doctor,” but he didn’t quite fit my preconception of such a person. He clearly liked the fancy restaurant, the heavy cloth napkins, the good bottle of wine. What struck me that evening was how happy he seemed with his life. Obviously, a young man with his advantages could have been doing good works as a doctor while commuting between Boston and a pleasant suburb–not between a room in what I imagined must be a grubby church rectory and the wasteland of central Haiti. The way he talked, it seemed he actually enjoyed living among Haitian peasant farmers. At one point, speaking about medicine, he said, “I don’t know why everybody isn’t excited by it.” He smiled at me, and his face turned bright, not red so much as glowing, a luminescent smile. It affected me quite strongly, like a welcome gladly given, one you didn’t have to earn.
But after our dinner I drifted out of touch with him, mainly, I now think, because he also disturbed me. Writing my article about Haiti, I came to share the pessimism of the soldiers I’d stayed with. “I think we should have left Haiti to itself,” one of Captain Carroll’s men had said to me. “Does it really matter who’s in power? They’re still gonna have the rich and the poor and no one in between. I don’t know what we hope to accomplish. We’re still going to have a shitload of Haitians in boats wanting to go to America. But, I guess it’s best not even to try and figure it out.” The soldiers had come to Haiti and lifted a terror and restored a government, and then they’d left and the country was just about as poor and broken-down as when they had arrived. They had done their best, I thought. They were worldly and tough. They wouldn’t cry about things beyond their control.
I felt as though, in Farmer, I’d been offered another way of thinking about a place like Haiti. But his way would be hard to share, because it implied such an extreme definition of a term like “doing one’s best.”
The world is full of miserable places. One way of living comfortably is not to think about them or, when you do, to send money. Over the next five years, I mailed some small sums to the charity that supported Farmer’s hospital in Haiti. He sent back handwritten thank-you notes on each occasion. Once, from a friend of a friend, I heard he was doing something notable in international health, something to do with tuberculosis. I didn’t look into the details, though, and I didn’t see him again until near the end of 1999. I was the one who made the appointment. He named the place.
Reading Group Guide
1. Paul Farmer finds ways of connecting with people whose backgrounds are vastly different from his own. How does he do this? Are his methods something to which we can all aspire?
2. Paul Farmer believes that “if you’re making sacrifices . . . you’re trying to lessen some psychic discomfort” (p. 24). Do you agree with the way that Farmer makes personal sacrifices? For what kinds of things do you make sacrifices, and when do you expect others to make them?
3. Kidder points out that Farmer is dissatisfied with the current distribution of money and medicine in the world.What is your opinion of the distribution of these forms of wealth? What would you change, if you could?
4. Farmer designed a study to find out whether there was a correlation between his Haitian patients’ belief in sorcery as the cause of tb and their recovery from that disease through medical treatment.What did he discover about the relative importance of cultural beliefs among his impoverished patients and their material circumstances? Do you think that this discovery might have broad application–for instance, to situations in the United States?
5. The title of the book comes from the Haitian proverb,“Beyond mountains there are mountains.” What does the saying mean in the context of the culture it comes from, and what does it mean in relation to Farmer’s work? Can you think of other situations–personal or societal–for which this proverb might be apt?
6. Paul Farmer had an eccentric childhood, and his accomplishments have been unique. Do you see a correlation between the way Farmer was raised and how he has chosen to live his life? How has your own background influenced your life and your decisions?
7. Compare Zanmi Lasante to the Socios en Salud project in Carabayllo. Consider how the projects got started, the relationships between doctors and patients, and the involvement of the international community.
8. Kidder explains that Farmer and his colleagues at PIH were asked by some academics, “Why do you call your patients poor people? They don’t call themselves poor people” (p. 100). How do Farmer and Jim Kim confront the issue of how to speak honestly about the people they work to help? How do they learn to speak honestly with each other, and what is the importance of the code words and acronyms that they share (for example, amc’s, or Areas of Moral Clarity)?
9. Ophelia Dahl and Tom White both play critical roles in this book and in the story of Partners In Health. How are their acts of compassion different from Farmer’s?
10. Tracy Kidder has written elsewhere that the choice of point of view is the most important an author makes in constructing a work of narrative nonfiction. He has also written that finding a point of view that works is a matter of making a choice among tools, and that the choice should be determined not by theory, but by an author’s immersion in the materials of the story itself. Kidder has never before written a book in which he made himself a character. Can you think of some of the reasons he might have had for doing this in Mountains Beyond Mountains?
A Conversation with Tracy Kidder, author of MOUNTAINS BEYOND MOUNTAINS
Q: How did you meet Paul Farmer, and what made you want to write about him?
A: I met him in Haiti in 1994. I was doing a story on American soldiers sent there to reinstate the country's democratically elected government. Farmer showed up one night at the barracks and got into an argument with the commander. I wasn't very interested in him then, but a few weeks later I ran into him on the plane to Miami and I began to learn some of the outlines of his life, which I found very interesting. Farmer was the second of six children, and spent most of his childhood in Florida, the whole family living on a bus and a houseboat that was moored in a bayou on the Gulf Coast. He went to Duke on a full scholarship, and then, while he was earning his M.D. and Ph.D at Harvard, he conceived and helped to build an amazing health care system in one of the poorest corners of Haiti. Around the time when I met him, he and his small band of colleagues were about to go to war against the dominant ideologies in international health — eventually they'd actually win some significant battles.
And I was drawn to the man himself. He worked extraordinary hours. In fact, I don't think he sleeps more than an hour or two most nights. Here was a person who seemed to be practicing more than he preached, who seemed to be living, as nearly as any human being can, without hypocrisy. A challenging person, the kind of person whose example can irritate you by making you feel you've never done anything as important, and yet, in his presence, those kinds of feelings tended to vanish. In the past, when I'd imagined a person withcredentials like his, I'd imagined someone dour and self-righteous, but he was very friendly and irreverent, and quite funny. He seemed like someone I'd like to know, and I thought that if I did my job well, a reader would feel that way, too.
My favorite teacher once used to talk about how writers often have their best stories bestowed upon them, seemingly by accident. I felt as though, in meeting Farmer, I'd been offered a rare opportunity.
Q: What was Farmer's initial response to your wanting to write a book about him and his work?
A: I think the idea made him uncomfortable. At any rate, it took him some months to make the decision. I can't speak for him, but I think he agreed mainly because he was persuaded by some of his closest friends that a book about his life and work might bring attention both to the issues that he cares most about and also to the little organization that he helped to create — Partners In Health.
Q: What was involved in doing the research for this book?
A: A lot of time in airplanes. I traveled with Farmer to Haiti more times than I can now remember. I also went with him twice to Moscow, and to Siberia, to Peru, to Cuba, to Paris, to Chiapas in Mexico, to Montreal and New York City and, many times, to Boston. And I went to Geneva, Switzerland, with one of his closest colleagues.
I also visited his mother and some of his siblings, and the places of his childhood. I interviewed dozens of people. And I read a great deal, about medicine and public health, about the places where Farmer works, especially about Haiti.
Q: What does the title, MOUNTAINS BEYOND MOUNTAINS, mean?
A: The title comes from a Haitian proverb, which is usually translated as: “Beyond the mountains, more mountains.” According to Farmer, a better translation is: “Beyond mountains there are mountains.” I first heard the proverb from Farmer, and I remember that he told me, “The Haitians, of course, use it in a zillion different ways.” Sometimes it's used to express the idea that opportunities are inexhaustible, and sometimes as a way of saying that when you surmount one great obstacle you merely gain a clear view of the next one. Of course, those two meanings aren't inconsistent, and I meant to imply both in the title. To me, the phrase expresses something fundamental about the spirit and the scale and the difficulty of Farmer's work. The Haitian proverb, by the way, is also a pretty accurate description of the topography of a lot of Haiti, certainly as I experienced it in my hikes with Farmer through the mountains of the central plateau.
Q: Farmer didn't have a conventional upbringing. Tell us more about that. Do you think Farmer's childhood was influential in the path he's chosen?
A: Farmer's father was a great big man, a ferociously competitive athelete nicknamed Elbows by people who played basketball with him, a sometime salesman and school teacher, with a lot of unconventional ideas and an absolutely pig-headed determination to have his family live by them. He took his family to a town north of Tampa, Florida, where for about five years they all lived in a bus in a campground. Then he took them to a bayou on the Gulf Coast where all eight of them lived in a leaky old 50 foot-long boat. As a boy, Farmer thrived in these unusual circumstances. He was a tall, skinny kid and he disappointed his father by not being much of an athelete, but he excelled in every intellectual department. He seems to have been precocious spiritually as well. At 11 he was given a copy of Tolkien's Lord of the Rings, which he read and then immediately re-read in the space of a few days. Then he took it to the public library and said to the woman at the desk, “I want more books like this.” She gave him adventure and fantasy novels and he kept coming back and saying, “This isn't it.” Finally, she gave him Tolstoy's War and Peace, which he devoured, at the age of 11. It wasn't adventure or fantasy that interested him; it was the epic struggle between good and evil. He didn't have the words to say that then. Returning the library's copy of War and Peace, he simply told the librarian, “This is it! This is just like Lord of the Rings.”
It was a childhood full of family adventures and misadventures and completely unconventional. Farmer himself didn't like to make too much of the connections between his background and the life he chose. At the very least, though, that childhood was good preparation for a life of travel and doctoring in difficult places like Haiti. He emerged from living on a boat in a bayou with what he called a “very compliant GI system,” and from dinners of hot dog bean soup without much fussiness about food, and from years of cramped quarters with the ability to concentrate anywhere. He could sleep in a dentist's chair, as he did at night for most of one summer in a clinic in Haiti, and consider it an improvement over other places he had slept, and I imagine that his fondness for a fine hotel and a good bottle of wine had the same origins.
There were other advantages, Farmer insisted. The kind of father who thought it reasonable to house his family in a bus, then a boat, was also the kind who saw no reason his son shouldn't keep a large acquarium inside. Farmer insisted that he never really felt deprived throughout his childhood, though he did admit, “It was pretty strange.” After living through some of his father's very public misadventures, it was hard to feel embarrassed or shy in front of anyone. He allowed that growing up as he did also probably relieved him of a homing instinct. “I never had a sense of a home town. It was, ‘This is my campground.' Then I got to the bottom of the barrel, and it was ‘Oh, this is my hometown.'” He meant the central plateau of Haiti.
Q: In your travels with Farmer, what most surprised and interested you? Did you learn something from the experience?
A: The thing about travel with Farmer is that you don't visit the brochure sights. His itinerary is pretty much restricted to visiting hospitals, slums, and prisons. The dreadful places of the world. I hadn't imagined that there were so many of those, and I hadn't known just how dreadful they were. But the trips weren't dreary and depressing, because Farmer and his colleagues were doing something tangible, something meaningful, something that was actually improving those places. This was especially true in Haiti and Peru. I'd say that I learned two things above all. That medicine and public health are a powerful lens for looking at the world. And that a small group of determined people can actually alter some of the pictures seen through that lens. I think that as a very young man Farmer chose to work in one of the most impoverished parts of Haiti because he was moved by the suffering he saw there. But if he'd wanted to prove a point about what is possible in public health, he couldn't have chosen a better site. If you can do a good thing in central Haiti, it stands to reason that you can do it anywhere. And what he and his friends have done and are doing in Haiti — and elsewhere - is nothing short of remarkable.
Q: Has your life or outlook about life changed as a result of spenind time with Farmer and writing this book?
A: One of my favorite characters in this book is a woman named Ophelia Dahl. She met Paul Farmer when she was 18 and he was 23. She told me that she remembered, from many years ago, deciding that Farmer was an important person to believe in. Not as a figure to watch from a distance, thinking, Oh, look, there is good in the world. Not as a comforting example, but the opposite. As proof that it was possible to put up a fight. As a goad to make others realize that if people could be kept from dying unnecessarily — from what Haitians call “stupid deaths” — then one had to act. I don't plan to give away all my worldly goods and go to work with Farmer in Haiti. For one thing, I'd just get in the way. But I can't tell myself anymore that the great problems of the world, such as the AIDS and TB epidemics, are beyond all hope of amelioration, or of repair. In other words, I don't think I can feel comfortable anymore in this world, by resigning myself to despair on behalf of billions of other people. There's always something one can do.
It's not my place to make a fund-raising pitch for Farmer and his organization, Partners In Health. Well, actually, I don't know why it isn't my place. I happened onto something remarkable and I sat down to try to describe it to others. I hope what I've written is artful. I believe it is at least accurate and truthful. And one true fact is that Farmer's organization, Partners In Health, represents a real antidote to despair. A person with a little money to give away can send it to Partners In Health and be certain that it will be used well. 95 percent of the money that's donated to Partners In Health goes to pay for direct services to people who are both desitute and sick — in Boston, in Russia, in Chiapas, in Peru, and especially in Haiti, where the poorest and the sickest people in our hemisphere reside. A donation to Partners In Health of, say, $200 will save an impoverished Haitian from dying a horrible death from tuberculosis.
Q: How does this book differ from your other projects?
A: Well, for one thing this book has a pretty large geographical spread, whereas all my previous books are set in New England. And all the others are about what might be called “ordinary people.” Of course, no one is ordinary. But Farmer is less ordinary than anyone I've ever met. This is the main reason I wrote this book in the first person, something I'd done in only one other book. After I'd spent a lot of time with Farmer, I began to feel that altruism was plausible after all, indeed maybe even normal. But the sacrifices he's made aren't usual, and I knew that readers of my book would need an everyman, someone a lot less virtuous than Farmer, to interpret him and to make him believable. Someone to testify, in effect, that this guy is for real, and someone who could register the occasional discomfort that anyone would feel in such a person's company. Finally, although I like to think that the subjects I've written about in my other books are important, I don't think there's much question but that the subject of this book is more important. After all, what it's about at bottom is the attempt of one small group of people to heal a sick world.
Q: Farmer doesn't work alone. He is surrounded by some extraordinary people. Can you tell us a little about some of them?
A: There are more than a thousand people working for Partners In Health these days. They range from Haitian peasants who have been trained as community health workers to extremely bright young American epidemiologists, medical students, and doctors, who have enlisted to work in places such as central Haiti and Siberia and the slums of Lima, Peru - some of them work for nothing, some earn much less than they could elsewhere and some raise their own salaries through grants. Ophelia Dahl has been involved in Farmer's work from the start, and she's a crucial member of Partners In Health, the manager, the peacekeeper. She's a warm and charming person, and she knows how to manage Farmer and Farmer's colleague, Jim Yong Kim. Kim is, like Farmer, a Brigham doctor. He joined up only a few months after Partners In Health was founded. He's brilliant, an inspiring speaker, a fountain of ideas, and indefatigable.
Finally, and maybe most important, there's a man named Tom White. He built a small family business into one of the largest heavy construction firms in Boston. He and Farmer met when Farmer was still a doctor in training. He founded Partners In Health along with Farmer and until recently provided most of the money for its projects, millions and millions of dollars over the past 20 years. White is in his eighties now, and has given away almost all of his large fortune. He told me once, “Sometimes I think how much money I used to have before I met Paul and Jim. But that's all right. If I go to a restaurant and they give me a steak, I can only eat half of it anymore.” He plans, he told me, to leave this life without a nickel. I think it's accurate to say that White has lifted death sentences from thousands of people, and the organization, the movement, that he helped to start may in the end save millions.
1. Paul Farmer finds ways of connecting with people whose backgrounds are vastly different from his own. How does he do this? Are his methods something to which we can all aspire?
2. Paul Farmer believes that “if you’re making sacrifices…you’re trying to lessen some psychic discomfort” (24). Do you agree with the way that Farmer makes personal sacrifices? For what kinds of things do you make sacrifices, and when do you expect others to make them?
3. Kidder points out that Farmer is dissatisfied with the current distribution of money and medicine in the world. What is your opinion of the distribution of these forms of wealth? What would you change, if you could?
4. Farmer designed a study to find out whether there was a correlation between his Haitian patients’ belief in in sorcery as the cause of TB and their recovery from that disease through medical treatment. What did he discover about the relative importance of cultural beliefs among his impoverished patients and their material circumstances? Do you think that this discovery might have borad application — for instance, to situations in the United States?
5. The title of the book comes from the Haitian proverb, “Beyond mountains there are mountains.” What does the saying mean in the context of the culture it comes from, and what does it mean in relation to Farmer’s work? Can you think of other situations–personal or societal–for which this proverb might be apt?
6. Paul Farmer had an eccentric childhood and his accomplishments have been unique. Do you see a correlation between the way Farmer was raised and how he’s chosen tolive his life? How has your own background influenced your life and your decisions?
7. Compare Zanmi Lasante to the Socios en Salud project in Carabayllo. Consider how the projects got started, the relationships between doctors and patients, and also the involvement of the international community.
8. Kidder explains that Farmer and his colleagues at PIH were asked by some academics, “Why do you call your patients poor people? They don’t call themselves poor people.” How do Farmer and Jim Kim confront the issue of how to speak honestly about the people they work to help? How do they learn to speak honestly with each other, and what is the importance of the code words and acronyms that they share (for example, AMC’s, or Areas of Moral Clarity)?
9. Ophelia Dahl and Tom White both play critical roles in this book and in the story Partners in Health . How are their acts of compassion different from Farmer’s?
10. Tracy Kidder has written elsewhere that the choice of point of view is the most important an author makes in constructing a work of narrative non-fiction. He has also written that finding a point of view that works is a matter of making a choice among tools, and that the choice should be determined, not by theory, but by an author’s immersion in the materials of the story itself. Kidder has never before written a book in which he made himself a character. Can you think of some of the reasons he might have had for doing this in Mountains Beyond Mountains?
Most Helpful Customer Reviews
This book is incredibly inspiring and should be read by anyone who wonders if there is any good left in the world. This is the true story about Dr. Paul Farmer. Through his strength of character, brilliant medical mind and deep love and admiration for people, he builds a medical community which to this day is operating in Haiti. Run primarily by Haitian doctors, Partners in Health has become a model for native medical care throughout the world. This book is amazing, a must read for anyone thinking of going into or working in public health. Kidder describes Haiti and the journeys of Paul Farmer with such finesse, beauty and curiosity and the book paints a vivid picture of the trials and tribulations of working in public health in a foreign world. Wonderful!
A book that clearly shows what is possible with rugged determination, hard work and and extraordinary sacrifice but also shows the myriad ways in which you may be called to help. Not everyone is called to emulate the life of Dr. Paul Farmer but all are called to live with the same passion and caring for human life as Paul had. We all can look to Paul's life as a testament to what can happen when you look beyond the labels that we like to place on people and become willing to stand up for their right to have their basice needs met. Paul had to be more than just a visionary but also had to be willing to do the hard work of making the vision a reality. The in-depth manner in which this book portrays the risks taken and energy spent year upon year should serve as an inspiration for those that are still in the earlier stages of trying to realize a vision and wonder whether their efforts are in vain. The real breauty of this book is the context in which it was written. Viewing Paul from the writer's perspective and how he experienced him was ingenious as it makes Paul much more real. It shows both his incredible talents and his pretty significant flaws. By doing so, Dr. Farmer becomes someone you can relate to and that you feel you can learn from though you may never be called to do what he has done. The book also shows that behind every public figure that's out making an impact there's an arsenal of individuals working diligently behind the scene. Individuals such as Jim Kim, Ophelia Dahl, and Tom White are just as critical to the successes experienced at Zamni Lasante and other projects as Paul was. It's great to see these individuals also profiled in the book and given the recognition that they deserved.
Tracy Kidder's brilliant biography of Dr. Paul Farmer is at once disturbing and exhilarating: disturbing, as it points out all the inequalities in living conditions and health care between the rich and the poor and the staggering statistics about disease and the lack of available medical aid in many parts of the world, and exhilarating to read the selfless commitment of one man to change these situations. Not only is the information in this inordinately readable book fascinating but also the superb writing style of Pulitzer Prize winning author Tracy Kidder is some of the best to be published in recent years. Kidder concerns his book with one Paul Farmer, a poor lad who grew up nearly homeless (unless one calls living on a riverboat a home) in Alabama, a gifted thinker who climbed out of his beginnings to discover the inequities in the big world, went to medical school at Harvard, and then proceeded to commit his life to changing the pitiful poverty and disease-ridded Haiti, establishing not only viable medical centers but also spreading his warm personality into the hinterlands of that little country making day-long walking housecalls for the poor families who as human beings deserve as fine a quality of medicine as those who live near the wealthy comforts of the major city medical centers. How Kidder accompanied and observed Farmer as he sought funding and supplies and training not only in Haiti, where the diseases of tuberculosis and AIDS were decimating the population while the world just silently watched, but also extending his beneficence to Peru and to the prisons of Russia, attack tuberculosis and AIDS with the same ardor is the basis of this book. Farmer's accomplishments created the Partners in Health organization that in turn stimulated the World Health Organization to wake up to the disasters that reign in the third world countries, eventually supplying the much needed medicines, cash, buildings and personnel to begin to make a change in the world health care. Kidder's gift as a writer lies not only in his detailed and well researched biography of a modern saint, but also in his ability to allow us to get to know the very human creature named Paul Farmer. He touches on his personal life, his struggles with his own diseases (he nearly died from hepatitis), and his indomitable spirit in facing a bureaucratic conundrum that prevented the poor of the world from receiving care. It is a touching story, it is a superlative investigation into one man's spirit and selfless commitment, and it is a book that demands our attention on many levels. Tracy Kidder's sharing of Dr. Paul Farmer's life is a poignant reminder that the individual CAN make a difference: it is a matter or devotion to an ideal that can become a reality despite obstructions the world places in the path. Highly Recommended. Grady Harp
This book takes the word inspiration to a new meaning. You learn not only about the significant accomplishments of Dr. Paul Farmer and the organization Partners in Health, but also about the unbelievable poverty that many cities face every day. You realize how lucky you truly are to even have access to the medical facilities that are in your area, and you begin to appreciate, if you have not already, even the slight knowledge that you have embraced about infectious diseases. Some of us believe we are poor and constantly drawing the short stick of every situation, but after reading this book the word "impossible" will completely leave your vocabulary. Mountains Beyond Mountains does not only inform you of a great cause and the awful conditions of 3rd world countries, but it will also set your mind into determination mode. Whether you are determined to help the global health community or any other subject matter that you are passionate about, I guarantee you will not stop until you have reached your goal.
Be forewarned that reading this book will change the way you see the world. This book is written is an easily accessible, narrative style. While the subject matter is very important and is a BIG concept, the writing itself is conversational: not too elevated or esoteric, and nothing snobby, and yet it is a profound tale, with many layers, and one that will change your outlook and your understanding of economics, medicine, politics, religion, social justice, family life, and business ethics. I found it easy to read and hard to put down. The story of Dr. Farmer's care for the least of his brothers and sisters caused me to ask myself, "What am I doing to make the world a better place??" I loved it and have shared it with many others, including my own physician.
Mountains Beyond Mountains, by Tracy Kidder, was very interesting and educational. Dr. Farmer is a miracle worker in Haiti. Dr. Farmer stole medicine, smuggled it into Haiti and them illegally administered it to Haitian civilians. Dr. Farmer is devoted to his job and his patients. I think that the Haitian government should be thankful for people like Dr. Farmer. Overall I thought that this book was very informative.
Tracy Kidder outlines Dr. Paul Farmer’s saint-like characteristics and his achievements in aiding the impoverished. The book illustrates that Farmer had done what no one else thought of attempting. Farmer was born with every odd against him. He was raised on a bus, then a boat, and also born into a destitute family. Dr. Paul Farmer triumphed from his underprivileged childhood to achieve greatness with his gift—intelligence. Farmer continued his path to salvation, but along the way he learns of deprivation in parts of the world. Farmer refused to let his country’s ignorance stop him from his life’s commitment of reversing poverty and disease. Dr. Paul Farmer earned an academic scholarship to Harvard’s medical school and pursued his goal to end world poverty. Farmer went on his first of many journeys to Haiti and established medical centers later to be known as Partners in Health. Besides creating modern medical centers, he developed communities enriched with his benevolence and servitude. While Farmer resided in Haiti, he treated thousands of tuberculosis, AIDS, and other diseased patients. Dr. Paul Farmer refused to turn anyone away from help; thus, he created an aura of compassion. Because Farmer created Partners in Health, it stimulated the world’s healthcare and forced countries to realize other country’s problems and start working towards a solution. Farmer’s work did not stop there. He traveled to Russia, Peru, and third-world countries aiding their medical troubles. During Farmer’s time traveling and living in different countries, he did not rest until every person was treated. While in Haiti, Farmer lived in a shack with a bed, sleeping only four hours a day and having no hot water. His life is just purely inspiring. I chose this book because I am going into the medical field, and Farmer’s life is especially amazing to someone with future aspirations in the same field. Tracy Kidder has done a wonderful endeavor in proving that one man can change the world.
Mountains beyond Mountains is an excellent account of one doctor's approach to humbly yet confidently solving the socio-medical issues of poor societies in various locations throughout the world. I found this book difficult to stop reading, as it is so interesting. I learned quite a bit about the factors which contribute to conditions of poor societies, geography, and tuberculosis. Although very educational, I would say the underlying theme of this book is the amazing accomplishment/improvements one person can make when one decides to achieve a goal.
You cannot read this book and come away with all of your old assumptions about poverty and public service intact. This is not the biography of a saint, however, but the story of one remarkable man and his amazing colleagues living out events that read more like a great novel. Dr. Paul Farmer is a driven doctor and anthropologist, who is universally admired and loved, but is also a flawed brother, son, lover, husband, father, and friend. He is able to define in simple terms the "moral clarity" for his own life of helping the poor, and he assails without pulling any punches, a world tainted by wealth and political corruption. His work to eradicate TB and AIDS among the poorest of the poor around the world illustrates the idea that you never know what you can do unless you just start doing it. If it is something that no one else had ever attempted, he would say, "Is there any data that proves it can't be done?" The takeaway is not that we should aspire to emulate Dr. Farmer's life and work, because his combination of genius and passion is truly unattainable for all but just a few individuals in any society, but that we can find our own passion and opportunities to serve the poor. Anthropologist Margaret Mead's famous words are mentioned in the book, and indeed are the theme: "Never underestimate the ability of a small group of committed individuals to change the world. Indeed, they are the only ones who ever have." The Pulitzer Prize winning author, Tracy Kidder, employs the unique point of view of an "insider," having spent years shadowing Farmer at work at Harvard, in Haiti, Peru, Cuba, and Russia. Their friendship and Kidder's honest, but relentless questioning lends authenticity and incredible detail to the story. Pair that with his meticulous research on poverty, world politics, and medicine, and you feel not only smarter, but truly inspired by the end of the read. I loved this book for two reasons: for renewing my faith that there are courageous individuals like Farmer and his Partners in Health fighting for a healthier life for all of us, and for the belief that I, too, can find a place to make a difference. Oh, yes, and a third reason for all of us who love books: it is a terrific read!
The author did a thorough job of research. The subject is inspiring. Everyone needs to read this book. While we can't all be Paul Farmers we can do something for others.
Incredible story of a man with rare determination, even obsession, to solve serious medical problems. He does it through his own hard work rather than through research alone. A must read for anyone interested in mission work, medical care for the poor, or successfully connecting to the disenfranchised. Reads as if Tracy Kidder is sitting across the kitchen table from you talking about his friend Paul Farmer, the doctor who had an unconventional upbringing, and continues to carve out an unconventional and highly successful healthcare mission for the poor of Haiti. It is heartbreaking, thought-provoking, and funny, too.
I loved this book. I didn't know about Dr. Farmer, but what an inspiration he is. Most of us do our work and think there aren't enough hours in the day to do everything we want to do. This man does it all and more! To cure TB, Aids/HIV in poor countries and finagle funding is truly a gift. I have read other books by Tracy Kidder and have been inspired by them all, including "The Soul of a New Machine" which at first glance would appear to be a pretty dull and boring subject, but Mr. Kidder brought the building of the computer to life, just as he does in this account of Dr. Farmer's life work.
I feel like Tracy Kidder wrote a wonderful book. It expresses great ideas and directs good positive expressions. It is a story about a man who was raised in a bus and on a boat. He knew the only way for him to make it in life was to use his intelligence. So he worked hard and recieved a acadimic scholarship from Harvard's medical school. Then he went on curing the people of Haiti from their infectious diseases. This was a good book to read if you have never been to another country.
This book has changed my life. I used to want to be a doctor, but after reading this I feel I would have to be just like Dr. Farmer. Dr. Farmer goes beyond his line of duty to help cure the world of infectious diseases. He never really spends time with his family or friends besides the ones he has made in Haiti. I would freak out if I had to leave my family for weeks to travel around looking and trying to obtain the almost impossible. I am happy there are people in our world today that can do that kind of job. I learned several new things from reading this book. I can not wait to read another book by Tracy Kidder.
In this book I have learned so many things. It has really mad me realize that there are people around the world really suffering. I can not believe how hard it is for Dr. Farmer to get medicine to those who are dying. I also can not believe how dedicated Paul is to helping others. He goes about curing his patients in a different way them most doctors. He gets to know each and everyone of his patients as individuals and really shows he truly cares foe their well-being. By going those few extra steps Paul has made a difference in the way doctors should be viewed. I loved this book and I have already recommended it to a few people.
mountain beyond mountains is a great peace of writing that teaches our society a lot of great things. the book shows how one can make a diffrence in the world. Dr. paul farmer did what no one else probaly is capable of doing. Dr. paul farmer had a big and loving heart that cared for others. After all he had what he wanted, a great career, a good paying job and a house. he did not need to go to haiti, Peru or other countries to help the people that needed help. He was like god to the people of haiti because there was no hope and Dr. paul farmer brought hope to the people. we al can make differnece if we chose too. even a little donation can help across the world. if we the people do not help the people than the question is who will. what goes around somes around. Dr. paul farmer did not help the people because he was getting money , he helpmed them because he knew that they needed help. Dr. paul farmer setted a great example of that there is nothing that can be done. if the effort is there than great thing will happen.
Mountains Beyonds Mountains is a good book because it has a lot of good points and meanings. It shows people that one person can make a difference in a lot of lives by just wanting too. This book is about Dr. Farmer's life and he provided healthcare to many poor people who couldn't afford it. I would recommend this book to people wanting to become doctors or anyone dealing with anthropology. Also, if people want to read about lifestyles in third world countries this would be a good book. However, I was not very interested throughout the book because it was hard to get interested in. The writing style was slow and basically just told a life story.
I like this book mountains beyond mountains, it tells about the courage of a man trying to make a difference in places that seem to be a lost cause. A man that started an orginization that helped people that needed it the most. Dr. Farmer goes beyond the call of duty to make sure that his patients get what they need.He is an extrordinary person that goes further than other people would.Not only does he help his patients but humanity as well. I have never seen such determination to acheive a goal that seems impossible to reach. I highly recommend this book to everyone.
This is simply an amazing book. Tracy Kidder gives us a very detailed look into Dr. Paul Farmer's life and work. Kidder's descriptions of Farmer building a hospital and treating patients in Haiti for free is awe inspiring and will make you want to do something too. Just read this amazing novel, you won't regret it.
This book was amazing. It goes to show that it only takes one person to make a difference. Dr. Paul Farmer made his life mission to take his knowledge and connections in the medical field and create a health care system that NEVER would have been in place other wise. After being to Africa myself, I know some of the difficulties and road blocks that he would have had to encounter along the way, but he never gave up, instead it gave him fuel to fight harder. I would encourage anyone to read this that has the desire to do something 'big' but is lacking the confidence to do so.
Dr. Farmer's quest to cure the world, at personal cost and sacrifice, is simply awesome. His ability to lead others and influence world leaders, coupled with his compassionate care of individuals is amazing. This book is an eye-opener to world health problems. TB, AIDS, and other diseases are so prevalent in underprivileged countries. The problems are so enormouse, that despair could set in, but for the efforts and energy of a Dr. Farmer. His life, his work, his leadership encourages all of us who care about the world. One person can make a difference!
¿Beyond mountains there are mountains¿ is apparently a Haitian proverb. Tracy Kidder¿s book covers his travels observing Doctor Paul Farmer, who grew up poor on a boat and bus, only to attend Harvard and also develop a public health clinic in Haiti. Farmer¿s career becomes a lens for Kidder to view the world¿s medical crises among the poor with a major emphasis on TB. Tracy Kidder brings the magnitude of the crises among the worlds poor into brilliant focus by highlighting Farmers life and dedication and, or obsession to cure the world's poor. Farmer works by treating patient by patient and yet his methods and expertise come to impact programs in Peru, the Siberian prisons of modern Russia, Cuba and his beloved Haiti. The book is able to give an excellent medical and political overview of the gap between the health and wealth of elite and the barren poor. Because Farmer is so intense with each individual patient it allows Kidder to illustrate the crises and the world¿s reaction dramatically, through many individual patient's. In reading I found I was amazed, angry, hopeful and depressed. It all reminded me of the ant pushing the large pebble up hill only to have it roll back down and over him. At the end of the book Farmer seems to sum up this overwhelming challenge by saying his is life spent in service to the ¿long defeat¿. Yet, along the way there are many small victories and some amazing people who join in the effort. People such as Tom White who owns a heavy construction firm in Boston who has given almost his whole fortune away to support Farmer¿s work. This book is mandatory reading for anyone in politics, public service, or feels they are entitled to have one more tax cut.
I was moved and amazed by the life of Dr. Farmer in this book. His compassion, brilliance, commitment and humanity come shining through Tracy Kidder's lucid writing. This biography of a life still in progress is organized more thematically than strictly chronologically (thank heavens!), and in the course of learning of Farmer's dedication to the poorest of the poor and sickest of the sick in the third world (particularly Haiti), the reader also learns so much about the multi-resistant strains of TB, pharmaceutical funding, international philanthopy, and geopolitics. This book places the inaninity of modern American life in stark perspective, and in so doing, it is life-changing. At the same time I was reading this book, I was also reading The Purpose Driven Life with an adult church school class; Dr. Farmer's life is a compelling testimony of what a purpose-driven life really looks like!
Amazing book, has stayed with me intently. As a nurse, and as one who has visited Haiti, the home of my husband's family it particularly moved me. I really enjoyed the level of detail in program development and the insight into Paul Farmer's motivation and inspiration. I would recommend it to many people for a variety of reasons. Inspirational, truly profound.
Published in 2003, this continues to be a powerful and inspiring biography of Dr. Paul Farmer (and Ophelia Dahl along with a team of physicians) who changed global health by their dedicated hard work in Haiti. Founders of Partners in Health, major inroads were made in the treatment of tuberculosis/HIV. Illustrates how passion and dedication does make a difference.