Customer Reviews

Mountains Beyond Mountains: Healing the World: The Quest of Dr. Paul Farmer

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Trace Kidder has written an excellent book about an extraordinary man. My one critique would be that Kidder has immersed himself so thoroughly in Farmer's life that I think he is at times incapable of believing that Farmer can make a mistake. The section with Farmer describing the virtues of the Cuban system of health care was accepted too uncritically for my taste. By the end, Farmer was even acting as a de facto cardiology consultant for Kidder during strenuous climbs in the Haitian mountains. Farmer must have an incredible personality, and I think it would be natural for this to happen to anyone who spent as much time with him. Still, it strikes an occasionally awkward tone. Please don't construe this to mean that the book is not enjoyable and worthwhile. It really is both.

As a physician myself, I probably read this book with less objectivity than most readers. On a certain level, a doctor like Paul Farmer is an indictment of the way most physicians in this country practice. Paul Farmer could, if he chose, be one of the highest paid consultant in the country. He has demonstrated the intellect and the force of will to succeed at any branch of medicine. And yet, he chose infectious disease and epidemiology as his twin callings, two of the lower-paying specialties within the field. Furthermore, he chose not just to dedicate superhuman effort to this profession, but to practice in one of the poorest of poor regions of the world, Haiti, where every newcomer is "blan" (white), even African Americans from the US. It's hard to read about such a man an not feel at times inadequate. After all, what have I done with my education that comes anywhere near what Farmer has accomplished?

I think even non-physicians might have this initial reaction. I think a common defense mechanism might also be one that occurred to me, to pathologize Farmer, to think of his drive to help others as a need to satisfy some kind of internal conflict. After all, if Farmer does what he does to "quite the voices", then the rest of us are off the hook.

In the end, I came to realize that this was grossly unfair. A reader does not know and never can know what drives a man like Farmer, we can only judge him by his works. And those works are amazing. Time and again in his career, Farmer chose to push for the absolute best care for the absolute poorest of his patients. He refused to accept that the best HIV and tuberculosis drugs were "inappropriate technology" for Haiti. Instead, by tirelessly fighting for his patients, he redefined how tuberculosis and other horrible diseases are treated. I would encourage a reader to look closest at this aspect of Farmer, as it can be applied to all of our lives.

To close, I am reminded of the old saying:

The reasonable man adapts himself to the world;
the unreasonable man persists in trying to adapt the world to himself.
Therefore all progress depends on the unreasonable man.
--George Bernard Shaw

Dr. Paul Farmer is an unreasonable man who has changed the world.

"Mountains Beyond Mountains" is no exception to Tracy Kidder's excellent body of work. I have been a fan since he wrote "Soul of a New Machine." Kidder impressed me then, as he does now, with his upfront investment of time before putting pen to paper. Fortunately for us, his hard work translates to first class storytelling.

The title "Mountains Beyond Mountains" is a metaphor for life - once you have scaled one mountain (challenge), there are more to come. This is especially true for Paul Farmer, MD, who has devoted his life to what most people call "the impossible." He has faced mountain after mountain in his quest to help mankind.

Farmer starts out devoting his life to providing the most rudimentary medical care to impoverished Haitians (the shafted of the shafted). By age 27, he had treated more illnesses than most doctors would see in a lifetime. With time, he finds himself on the world stage trying to find a cure for drug resistant tuberculosis, undertaking the difficult role of a global fundraiser, and fighting big pharma for lower drug prices. He is a modern day medical hero.

For me, Farmer serves as a startling contrast to Robert K. Maloney, MD, the well known Los Angeles ophthalmologist who has been featured on TV's "Extreme Make-over." Maloney, who was profiled October 26, 2004 in the Wall Street Journal, said that after he completed his medical training, he came to a disquieting conclusion: "I really didn't like sick people." Maloney has since specialized in LASIK refractive surgery (considered cosmetic surgery) and pampers his patients with 25 person staff, and a suit-and-tie concierge who serves pastries and coffee in the waiting room. He then follows up after his patients return home with a gift box of gourmet chocolate chip cookies and a mug bearing the invitation, "Wake up and smell the coffee." He says he now earns more than the $1.2 million in salary and bonuses he made during his last year at UCLA (several years ago), but he won't say how much.

Farmer serves as reminder of what medicine aspired to be - the buck as only a means to an end....ending poverty, ending tuberculosis, ending the plight of many humans who cannot receive treatment from a qualified and trained doctor. Dr. Maloney serves as a reminder of what medicine has become - the buck and celebrity as ends. We should all get one of Maloney's mugs so we, too, can "Wake up and smell the coffee" ...before it is too late.

Read "Mountains Beyond Mountains," if only to regain hope of what medicine can be.

In a world where it is easy to feel as though we are helpless in the face of everyday violence, war, greed, and inhumanity, the story of Dr. Paul Farmer and his colleagues is an important reminder of the power within all of us to contribute to a better, more just world. I suspect many people who read this book begin it with little or no knowledge of Haiti's history nor of its desperate situation today (not something we see in school curriculums!) and so the book also serves as a great "primer" for readers on Haiti and the impact of US policy there. Tracy Kidder does an excellent job of allowing us to "shadow" the steps of Paul Farmer as he moves in Haiti and around the world. I think Kidder's detailing of his own evolving relationship with Paul Farmer is particularly well done. He does an excellent job of chronicling the details of personalities, individuals, and events without ever letting the reader lose sight of the larger global context in which they are situated.

"Mountains Beyond Mountains" is no exception to Tracy Kidder's excellent body of work. I have been a fan since he wrote "Soul of a New Machine." Kidder impressed me then, as he does now, with his upfront investment of time before putting pen to paper. Fortunately for us, his hard work translates to first class storytelling.

The title "Mountains Beyond Mountains" is a metaphor for life - once you have scaled one mountain (challenge), there are more to come. This is especially true for Paul Farmer, MD, who has devoted his life to what most people call "the impossible." He has faced mountain after mountain in his quest to help mankind.

Farmer starts out devoting his life to providing the most rudimentary medical care to impoverished Haitians (the shafted of the shafted). By age 27, he had treated more illnesses than most doctors would see in a lifetime. With time, he finds himself on the world stage trying to find a cure for drug resistant tuberculosis, undertaking the difficult role of a global fundraiser, and fighting big pharma for lower drug prices. He is a modern day medical hero.

For me, Farmer serves as a startling contrast to Robert K. Maloney, MD, the well known Los Angeles ophthalmologist who has been featured on TV's "Extreme Make-over." Maloney, who was profiled October 26, 2004 in the Wall Street Journal, said that after he completed his medical training, he came to a disquieting conclusion: "I really didn't like sick people." Maloney has since specialized in LASIK refractive surgery (considered cosmetic surgery) and pampers his patients with 25 person staff, and a suit-and-tie concierge who serves pastries and coffee in the waiting room. He then follows up after his patients return home with a gift box of gourmet chocolate chip cookies and a mug bearing the invitation, "Wake up and smell the coffee." He says he now earns more than the $1.2 million in salary and bonuses he made during his last year at UCLA (several years ago), but he won't say how much.

Farmer serves as reminder of what medicine aspired to be - the buck as only a means to an end....ending poverty, ending tuberculosis, ending the plight of many humans who cannot receive treatment from a qualified and trained doctor. Dr. Maloney serves as a reminder of what medicine has become - the buck and celebrity as ends. We should all get one of Maloney's mugs so we, too, can "Wake up and smell the coffee" ...before it is too late.

Read "Mountains Beyond Mountains," if only to regain hope of what medicine can be.

You might think the story of a caregiver in the poorest country in the western hemisphere would be depressing. You might think that learning about the "Global ATM"-- aids, tuberculosis, and malaria-- and that these three diseases kill six million poor people a year, would be depressing.

Yet, the story of Paul Farmer is energizing, and will leave you breathless as you see the human potential of one person to make an enormous difference. Tracy Kidder is at his best in this book, and does a magnificent job covering different shades of character and events.

And finally, this book is also a love story with the Haitian people, a people cursed by 200 years of bad government and western imperialism, for whom even the smallest effort and assistance will save many lives.

Please read this book, and buy it as a present for those you love. It can change your world.

ps, see www.paulenglish.com/travel/haiti/ for info about my first trip to Haiti, taken as a result of this book.

Butler University in Indiana has required that all their incoming freshmen read MBM prior to orientation. Bravo! My high school French students sponsor a child in Haiti through Compassion International and we are reading it to gain insights into the culture there. But it has done more than that. It makes you THINK differently about how we view other people. Paul Farmer's aim is not just to educate, but to TRANSFORM. MBM is a "can't-put-it-down" incredible book. Tracey Kidder, the author, says, "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." Well, he sweated up and down the mountains trailing Paul Farmer to get this real and phenomenal story.

The mortality rate for children in Haiti is abominable. I think only 50% of the children reach their 5th birthday. Oprah and Mel Gibson should turn this story into a movie and broadcast it to the world....how a small group of thoughtful, committed people can change the world. Comma.

This book was a loan. It is a worthwhile and absorbing read, mostly because of Kidder's writing ability. The book exists on three distinct levels: the first is as a biography of an interesting man-Paul Farmer, the second is a story about Haiti, the abuse of both it's people and it's land over time and how that creates the modern morass, and lastly is the story of how Kidder became a Farmer fan or how i came to write this book. The book is tying these three levels, these distinct threads into an engrossing and fascinating story so that by the end you too are a Farmer fan.

Why do some, a pityfully few people, seem to do something with their lives, seem to matter in the long run, seem to get useful work out of their time here that others just seem to waster and squander? Is it technique, is it passion, is it ability and in their genes, is it just restless energy? The book offers a few insights into this complex and important topic. But mostly it is a straightforward biography of Paul Farmer, from an unusual childhood to travelling often from Haiti to Boston, from the bottom to the top of the social and material world, about a dichotomy expressed in the life of one man: love of these poor people and love of modern medicine and what it can do for patients as real people.

I appreciated the book, i can hope to read more like this, i can never hope to be like him and will remain a spectator of such people, who seem to exist on a plane of their own. I am glad they live among us and i would believe that their presence blesses the rest of us. But i will remain in the bleachers cheering them onward, perhaps i can write a few small checks to their works but i will always see them from afar. Kidder does all us avid readers a great service by writing down what he saw and heard, thanks.

I don't really recommend many books, tastes being what they are.
But let me tell you, that each person to whom I have given this book has been grateful for having had the chance to read it, and to pass it on.
I have never read a book that so truthfully explains the complex roots of poverty, and our complicity in it. In writing about Paul Farmer, Mr. Kidder uses brushstrokes that are sometimes gentle, and then he gives us a Paul Farmer truth to jolt us out of our comfortable chairs. As one reads, one sees Mr. Kidder himself transformed. And one also sees that, complex as poverty is, there are solutions. In reading Mountains Beyond Mountains, one finally understand that vital to its cure are working personally and in community with those who live it every day. I regret having to say that I had not heard of Paul Farmer before reading this book. I received it as a gift, out of the blue and for no special occasion. I will always be grateful, to the gifter, to Tracy Kidder and most of all, to Paul Farmer and the community around him.

It doesn't matter if you've never heard of Paul Farmer, if you have no interest in medicine or public health or third-world countries. I didn't. I only picked this book up (at the library---sorry Amazon, sorry Tracy Kidder) because I've read a few other things by Tracy Kidder and studied the genre of creative nonfiction. I'm very glad that I overlooked the topic to give the story a chance. What you get is a portrait of a man who rises from some interesting circumstances to become first a doctor, then a leader, then someone who changes the lives of thousands of people. It's moving, it's gripping, it's just really well written. And it gave me, at least, a glimpse of how it's possible---really, really possible---to make a difference in the world. I've been recommending it to my friends when we start devolving into that mid-30s life-going-nowhere-real-fast conversation. You know that conversation? Well, then, try this book and figure out which mountain is yours to climb.

This is a difficult book to review because there are conflicting messages. I participated in a blog discussion at the University of Washington on this book, and it left some students with a sense of hopelessness: that all the money they were spending in tuition was being wasted when it should have gone to truly needy people. Another commented that the students should at least focus on learning a skill before they tried to help others. The problem was that Tracy Kidder in awe put Farmer on such a high pedestal that it is hard for the average person to relate.

In the book we learn immediately that Farmer had taken the time to learn the local Creole dialect to communicate with his patients - and that is admirable. But Kidder keeps pedantically putting this in our face as though, by halfway through the book, we should all know Creole. We got the point the first time. There's an unusual episode where Kidder marvels about Dr. Farmer walking five hours into the mountains just to see if someone is taking their pills. On the other hand, I wonder how many people Dr. Farmer could have seen and treated in clinic during that time? And then there is his wife and son.... growing up alone in Paris. How many times has his son looked over to the sidelines of a soccor field or some school event to see if his dad was watching....

So there seems to be a naive disconnect between the actual consequences of Dr. Farmer's chosen life style and Kidder's unrealistic awe. On the bright side, the book has been a sensation, and in fact that is very good. It is very good because it is raising awareness of our need as the richest country in the world to "give back." But the readers of this book need not feel futile that they could never measure up. There are already thousands of people and doctors like Paul Farmer in this world who give up their security and comfort to give back. Operation Smile, Orthopedics Overseas, Doctors Without Borders.... and on and on. More important, we don't have to go to Haiti just to give back. The chance is here and now in everyday life: a kind word to a stranger, a smile, a small courtesy, an unexpected helping hand. If each person that read Mountains Beyond Mountains did just one unexpected act of kindness each day, the ripple effect of this would engulf the world.

Pierce Scranton Jr. M.D.
author, "Death on the Learning Curve"