56 pages • 1 hour read
Tracy KidderMountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World
Nonfiction | Biography | Adult | Published in 2003A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Key Figures
Dr. Paul Edward Farmer
Paul Farmer is an anthropologist and physician and co-founder of the non-profit healthcare organization Partners in Health. Born in 1959 in North Adams, Massachusetts, and raised in Florida, Farmer earned a bachelor’s degree at Duke University and master’s and doctorate degrees from Harvard University. The recipient of a MacArthur genius grant, among many other awards and recognitions, he is also the author of several books, including Infections and Inequalities, The of Haiti, and, most recently, Fevers, Feuds, and Diamonds, about the 2013-2016 Ebola outbreak in Western Africa.
Mountains Beyond Mountains tracks Paul Farmer’s growth from a brilliant child with a large family living in buses and boats to an internationally renowned doctor, anthropologist, and public health expert. Kidder presents Farmer as a prescient, moral voice who doesn’t care if his dedication to his mission puts others off. Farmer’s greatest strength is that he enjoys being a doctor. Unlike others of his stature, Farmer meets with patients for extended periods and maintains close contact even if they have severe diseases. At one point, Farmer escorts political protestors away from a crackdown and then returns to help others. Against the wishes of those who want him to take a more managerial role, he makes house calls in Haiti, spending hours walking to and from Zanmi Lasante; he notes this is “when I feel most alive” (295). Many Haitians recognize him as one of their own.
While Farmer is casual and irreverent, refusing comparisons to saints and only wearing business clothes on the plane because his overseas patients believe he represents them, he is hyper-focused on his goals. Farmer’s principles come from liberation theology and a moral sense that everything must be done to help the poor. He perceives inequality as a battle between good and evil, much like The Lord of the Rings. Kidder finds Farmer’s writings on the ties between medical care, poverty, and politics pointed, and the doctor sources every fact to ensure that there are no loopholes for critics. Medical, government, and philanthropic leaders see him as an idealist, but he sees himself as a pragmatist. There is plenty of wealth and frivolous expense that could go into improving living conditions for the poor—most people either don’t bother to learn, inflate their own problems, or hide behind cost-control measures. He sees taking equipment and drugs without permission as “redistributive justice.”
Kidder shows several of Farmer’s imperfections. Farmer’s dedication to his mission ultimately dooms his relationship with Ophelia as he refuses any romantic intrigue, and Farmer states, “You can’t sympathize with the staff too much, or you risk not sympathizing with the patients” (25). He becomes defensive and angry when he receives criticism, and he argues that writers will often make their subjects appear obsessive or flawed to justify the readers’ continued inaction. Farmer regularly works through injuries, with his only vacations resulting from serious injuries, and is flippant toward junta officials in Cuba. Although such behavior demonstrates his dedication, Kidder suggests it is also irresponsible because dying would be even worse for Farmer’s patients.
Kidder follows Farmer as he further expands his focus, traveling to Rwanda and West Africa in 2014 to address the Ebola epidemic. His work in the region over the decade, where policies focus on containment over treatment, became the subject of his book Fevers, Feuds, and Diamonds. During the 2020 Covid-19 pandemic, Farmer criticized the US response to the event, including the inconsistent protocols and the willingness to treat senior citizens and communities of color as acceptable losses. (Goodwin, Connor. “Paul Farmer on How We Tell the Story of a Pandemic.” The Nation, 23 Dec. 2020, www.thenation.com/article/culture/paul-farmer-fever-feuds-interview/.) This view reflects his comments at the end of Kidder’s work that such a mentality is the source of many of the world’s evils.
Tracy Kidder
Tracy Kidder (born 1945) is a nonfiction writer and contributor to The Atlantic, The New Yorker, and other literary magazines. He studied English at Harvard and later earned a master of fine arts degree from the University of Iowa. Kidder served as an intelligence officer in the Vietnam War, an experience that became the inspiration for his 2005 book My Detachment. His work often focuses on people of uncommon compassion and intelligence, from a schoolteacher in a depressed town in Among Schoolchildren (1989) to technology innovators in A Truckful of Money (2016) and the Pulitzer Prize-winning The Soul of a New Machine (1981). This work often requires shadowing his subjects over an extended period.
Kidder is both the author and a key figure in Mountains Beyond Mountains. Kidder meets Farmer by chance, and the doctor intrigues him as someone who abandons the path of a comfortable life but still enjoys its benefits. While Kidder contributes to Farmer’s cause over the years, he feels challenged by Farmer’s nearly insatiable commitment to the poor, noting, “The world is full of miserable places” (8). Once Kidder decides to write about Farmer, he observes Farmer in multiple roles: at the leading-edge Brigham and Women’s Hospital, the medical oasis Zanmi Lasante, and various medical conferences around the world. Kidder compares his limited stamina to Farmer’s, as the doctor shrugs off injuries while the author uses up his drinking water only a few miles into a countryside-crossing trek.
Kidder’s dilemma in Mountains Beyond Mountains is how to portray Farmer, a beloved, empathic, and brilliant figure with earnest but radical views about the world. Farmer is in a unique position that few can replicate—he donates all his earnings to his causes but has benefactors to fund his busy travel schedule—and various anecdotes show that he can be controlling and angry to allies. Kidder notes this trait when he refuses to challenge Farmer’s views of Lac de Péligre. In Cuba, the doctor threatens Kidder that critiquing his favorable views of the communist nation would ultimately harm the poor people he treats. In addition to the Cuba disagreement, Kidder condemns Farmer’s refusal to treat his hepatitis before it becomes a life-threatening issue. An expensive medevac flight for a gravely ill patient makes Kidder question whether PIH legitimately believes in saving every patient or if it was an excuse for dramatics. Despite his misgivings, Kidder recognizes when Farmer diagnoses the author’s comparatively minor illnesses that he cares about every patient regardless of origin, and the author feels that he can appreciate the “sheer impracticality” of Farmer’s work.
The Partners in Health Team
Mountains Beyond Mountains covers the development of Partners in Health from its launch in 1987 to its ascension as a leader in global healthcare for developing countries. Its Zanmi Lasante compound in Haiti is a model for medical care in the developing world, not only treating patients in clean facilities for free, but also providing food, housing upgrades, and education to its residents. Farmer notes, however, that the facility is still underfunded compared to those in countries like Cuba.
Much of Partners in Health’s policies reflect Farmer’s vision of healthcare. He insists that PIH cannot fire any personnel unless they strike a patient, and even then, he forgives one instance. While Farmer is more lenient on others taking vacation time than himself, he insists on maintaining a low administrative overhead of 5%, and the organization only begins to pay for overtime to meet industry norms. Farmer expresses concern that a new PIH intern questions the spending on a medevac flight, noting that it’s difficult enough to convince outsiders of the need for such expenses. PIH even sells its headquarters to fund treatments.
A core group guides Partners in Health’s mission. While Kidder focuses mainly on Ophelia Dahl’s romance with Farmer and the charms and strain of dating someone like him, Dahl has served as PIH’s executive director for 16 years with writing and speaking talents in her own right. Tom White, a Boston construction magnate who shares Farmer’s views about wealth and responsibility to the poor, is shown to enable PIH’s unmitigated funding to the poor. He died in 2011 after giving nearly all his fortune to the cause.
Jim Yong Kim, PIH’s vice-chairman and Farmer’s closest collaborator, is a Korean immigrant who explored his heritage and racial identity in his youth but became disillusioned after a trip to South Korea that showed little hardship. Farmer tells Kim that if he comes to Haiti, he’ll learn that he is “as white as any white man” (169). Kim shares Farmer’s passion for PIH, but they are often antitheses to each other. While Farmer often wishes that he can focus on one-on-one medical care and has a focused morality, Kim prefers management and is responsive to new ideas. Kim introduces PIH’s Peru program and is pivotal in reforming the DOTS program and lowering second-line TB drug prices. In separate Russian conferences, Farmer gives an off-the-cuff critique of American democracy to a general, while Kim gets the officials to join him in karaoke. After the book’s publishing, Kim became the director of the WHO’s HIV/AIDS department, the president of Dartmouth College, and the 12th president of the World Bank. (“Our Founders.” Partners in Health, www.pih.org/our-founders. Accessed 8 Apr. 2021.)
Critics of Partners in Health question the organization’s spending practices as well as whether it can survive without its star doctor. Kidder notes that standards at Zanmi Lasante lax when Farmer is away, and he also senses an inner circle within PIH that uses Farmer’s shorthands and potentially dismissive language for donors and ethnicities. However, PIH only opens Socios en Salud in Peru because Kim convinces Farmer to expand beyond Haiti, and Serena Koenig ultimately makes the same decisions he would make about the cancer patient with minimal input. Farmer himself warns against people emulating his path, and a covered-up sign in PIH’s office reads, “If Paul is the model, we’re fucked” (244).
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