Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World (Paperback)

~ (Author) "Six years after the fact, Dr. Paul Edward Farmer reminded me, "We met because of a beheading, of all things..." (more)
Key Phrases: health census, medevac flight, long defeat, Zanmi Lasante, United States, Partners In Health (more...)

Editorial Reviews

From School Library Journal

Adult/High School-Thought-provoking and profoundly satisfying, this book will inspire feelings of humility, admiration, and disquietude; in some readers, it may sow the seeds of humanitarian activism. As a specialist in infectious diseases, Farmer's goal is nothing less than redressing the "steep gradient of inequality" in medical service to the desperately poor. His work establishing a complex of public health facilities on the central plateau of Haiti forms the keystone to efforts that now encompass initiatives on three continents. Farmer and a trio of friends began in the 1980s by creating a charitable foundation called Partners in Health (PIH, or Zanmi Lasante in Creole), armed with passionate conviction and $1 million in seed money from a Boston philanthropist. Kidder provides anecdotal evidence that their early approach to acquiring resources for the Haitian project at times involved a Robin Hood type of "redistributive justice" by liberating medical equipment from the "rich" (Harvard) and giving to the "poor" (the PIH clinic). Yet even as PIH has grown in size and sophistication, gaining the ability to influence and collaborate with major international organizations because of the founders' energy, professional credentials, and successful outcomes, their dedicated vision of doctoring to the poor remains unaltered. Farmer's conduct is offered as a "road map to decency," albeit an uncompromising model that nearly defies replication. This story is remarkable, and Kidder's skill in sequencing both dramatic and understated elements into a reflective commentary is unsurpassed.
Lynn Nutwell, Fairfax City Regional Library, VA
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved. --This text refers to the Hardcover edition.

From The New England Journal of Medicine

Paul Farmer is a 44-year-old specialist in infectious diseases and an attending physician at the Brigham and Women's Hospital in Boston. His biographer, Tracy Kidder, read his book on the connections between poverty and disease -- Infections and Inequalities -- and wrote to him, "I'm reading your oeuvre." "Ah, but that's not my oeuvre," Farmer replied. "To see my oeuvre you have to come to Haiti." Indeed, Farmer founded a hospital and health center, Zanmi Lasante, in Cange, Haiti, hours from the capital and at the end of a gutted road in a region destitute even by Haiti's standards, as part of an extensive community-based health network linked to a hospital, Clinique Bon Sauveur (see Figure). For more than 20 years, Farmer has spent many months every year there, often taking care of patients himself and continually improving the treatments offered by the clinic. These now include antiretroviral drugs. Lasante is supported by a foundation based in Boston called Partners in Health, which is headed by Ophelia Dahl and largely financed by Tom White, the philanthropic owner of a large Boston construction firm. There is more. Through his patients in Cange, Farmer became interested in multidrug-resistant tuberculosis. From Haiti, he exported treatment of multidrug-resistant tuberculosis to Peru and then to Siberia, achieving cure rates comparable to those in the United States. Through the Institute for Health and Social Justice (the research and education division of Partners in Health) and his associate Jim Yong Kim, he started a movement to lower prices for the second-line drugs necessary to treat resistant tuberculosis and successfully lobbied the World Health Organization for changes in treatment recommendations for tuberculosis. Readers may have heard some of this story before (Farmer has received a MacArthur award and the American Medical Association's Dr. Nathan Davis Award) and may have wondered, as I did, where he came from and how one man could accomplish so much. Kidder traces Farmer's trajectory, starting with his unconventional childhood, which included living in a bus and on a leaky boat. He was given a scholarship to Duke, where he majored in anthropology and worked alongside poor Haitian farm workers in North Carolina's tobacco fields. After graduation he spent a year in Haiti, where he met Ophelia Dahl, and then went to Harvard Medical School. While in medical school and during his residencies and fellowships, he spent more time in Cange than in Boston. How does Farmer do it? Kidder provides some explanations: he works nonstop, hardly sleeps, sees his wife and child for a day or so every few months, inspires an uncommon degree of devotion and enthusiasm among collaborators and potential donors, and tolerates planes and airports for days on end. In addition, the Boston medical establishment has bent rules and regulations to accommodate his needs. Convincing? Maybe. There remains something miraculous about Paul Farmer. Should one go out and buy Mountains beyond Mountains? By all means. Not only it is it an enjoyable book, but it is also very likely that a part of the $25.95 spent in purchasing it will find its way back to Haiti. That is more than can be said about many books. In addition, readers looking for a worthwhile charity to support may be inspired to send some money to Partners in Health. Bernard Hirschel, M.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to the Hardcover edition.

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Product Details

• Paperback: 352 pages
• Publisher: Random House Trade Paperbacks (August 31, 2004)
• Language: English
• ISBN-10: 0812973011
• ISBN-13: 978-0812973013
• Product Dimensions: 7.9 x 5.1 x 0.8 inches
• Shipping Weight: 8.8 ounces (View shipping rates and policies)
• Average Customer Review: 4.6 out of 5 stars  See all reviews (228 customer reviews)
• Amazon.com Sales Rank: #8,669 in Books (See Bestsellers in Books)

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Most Helpful Customer Reviews

153 of 165 people found the following review helpful:

5.0 out of 5 stars A Contrast of What Should Be with What Is, November 29, 2004

By	Thomas M. Loarie (Danville, CA USA) - See all my reviews (TOP 500 REVIEWER)    (REAL NAME)

"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.

44 of 45 people found the following review helpful:

4.0 out of 5 stars An unreasonable man who has changed the world, December 15, 2006

By	David McCune "self-deprecating and proud of it" (Tacoma, WA) - See all my reviews (TOP 1000 REVIEWER)    (REAL NAME)

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.

38 of 39 people found the following review helpful:

5.0 out of 5 stars Mountains Beyond Mountains, September 10, 2003

By	Liz Paluzzi (Greensburg, PA) - See all my reviews

This review is from: Mountains Beyond Mountains: Healing the World: The Quest of Dr. Paul Farmer (Hardcover)

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.