Mountains Beyond Mountains

Pdf fan dd71f526917d6085d66d045bd94fb5b55d02a108dd45d836cbdd4abe2d4c043d Tap here to download this LitChart! (PDF)

Doctor Paul Farmer Character Analysis

The protagonist of Mountains Beyond Mountains, Paul Farmer is a brilliant doctor and anthropologist. Moreover, he’s a devoted humanitarian, to the point where he can’t imagine a life for himself that doesn’t involve taking care of the sick and injured in Third-World countries like Haiti and Peru. Farmer has always been interested in helping the downtrodden, and his most profound struggles have always concerned how best to help them. Unlike many of his colleagues at Harvard Medical School, Farmer is a proponent of liberation theology, an interpretation of Catholicism that supports active engagement in one’s community. At the same time, Farmer doesn’t believe in God: he embraces Catholicism and yet questions it deeply. Farmer’s conflicted relationship with science and religion makes him a natural fit for practicing medicine in Haiti, where he makes an effort to understand Haitians’ relationship with Voodoo. During the course of the book, Farmer also grapples with the ethics of cost-efficiency: for every patient he chooses to help, he’s effectively denying his treatment to hundreds of others. Ultimately, Farmer stands as a fascinating, complex figure: fiercely committed to Catholicism, yet agnostic; devoted to other people, yet almost a stranger to his wife and child.

Doctor Paul Farmer Quotes in Mountains Beyond Mountains

The Mountains Beyond Mountains quotes below are all either spoken by Doctor Paul Farmer or refer to Doctor Paul Farmer . For each quote, you can also see the other characters and themes related to it (each theme is indicated by its own dot and icon, like this one:
Cost-Efficiency vs. the Value of Life Theme Icon
). Note: all page and citation info for the quotes below refers to the Random House edition of Mountains Beyond Mountains published in 2009.
Chapter 2 Quotes

As Farmer was leaving the shelter, he heard Joe say to another resident, just loudly enough to make Farmer wonder if Joe meant for him to overhear, “That guy’s a fuckin’ saint.”

Related Characters: Tracy Kidder (speaker), Joe (speaker), Doctor Paul Farmer
Page Number: 16
Explanation and Analysis:

At several points in the book, characters will compare Paul Farmer to a saint. Here, Joe, a man who's been sent to a medical shelter in Boston, calls Farmer a saint for taking such good care of his patients, going far beyond the minimum requirements even for a doctor.

When Joe calls Farmer a saint, he means that Farmer devotes huge amounts of his time and energy to helping other people whom he's never met before. Yet throughout the book, Farmer insists that he's not a saint at all—on the contrary, he claims, he's just doing "his part" to help others. Farmer is so used to spending 20 hours a day caring for the sick that he considers himself just an average, decent human being—he's just doing what any intelligent, trained person should be doing to help alleviate the vast suffering in the world. One disturbing implication of Farmer's claim that he's not a saint is that we as readers—or anyone with education, wealth, time, or other resources—aren't doing remotely enough with our own gifts. It's easy for us to believe that Farmer is a saint because it absolves us of some of our own guilt at not doing more to help people in need—only a superhuman or saint could do what Farmer does. The troubling part is when we think that Farmer is just a normal human, doing what all normal people ought to do.

A+

Unlock explanations and citation info for this and every other Mountains Beyond Mountains quote.

Plus so much more...

Get LitCharts A+
Already a LitCharts A+ member? Sign in!
Chapter 3 Quotes

He made about $125,000 a year from Harvard and the Brigham, but he never saw his paychecks or the honoraria or royalties, both fairly small sums, that he received for his lectures and writings. The bookkeeper at PIH headquarters cashed the checks, paid his bills—and his mother’s mortgage—and put whatever was left in the treasury. One day in 1999, Farmer tried to use his credit card and was told he’d reached his limit.

Related Characters: Tracy Kidder (speaker), Doctor Paul Farmer
Page Number: 23
Explanation and Analysis:

Kidder notes some irony here: although Farmer contributes more to society than almost anyone (he literally saves lives almost every day), he's not rewarded for his actions with money or property. Instead, Farmer sends most of his income to other people. He's learned to live so simply that he has no use for extra cash.

The fact that Farmer doesn't feel any need to spend money makes us wonder—what motivates his quest to help the sick? Does he get any pleasure from doing so, or does he see it as a duty? While Farmer clearly gets a sense of joy and comfort from knowing that he's important to other people, he's also so regimented and rigorous in his routine as a doctor that he seems to treat curing the sick as a basic obligation, not a joy. Strange as it might seem, Farmer doesn't really enjoy his work—"enjoy" is the wrong word. Rather, Farmer seems to treat charity as the cornerstone of a normal, moral life—a life that few people emulate, however.

Chapter 4 Quotes

And then of course it dawned on him that he knew plenty of Americans—he was one himself—who held apparently contradictory beliefs, such as faith in both medicine and prayer. He felt, he said, as though he hung in the air before his patient, “suspended by her sympathy and bemusement.”

Related Characters: Doctor Paul Farmer (speaker), Tracy Kidder (speaker)
Page Number: 35
Explanation and Analysis:

In this quotation, Dr. Farmer travels to Haiti, where he researches the Haitians' beliefs concerning religion and science. Farmer discovers that many Haitians believe in Voodoo, a complex set of religious rituals. In the past, American doctors have concluded that the Haitian belief in Voodoo trumps any American efforts to introduce medicine in the country—and so they felt that there was no point in giving the Haitians pills if they don't believe that pills can cure disease. Farmer's insight is that a belief in religion doesn't preclude the belief in science and medicine. Indeed, plenty of Americans—including some of the American doctors who decided to stop shipping medicine to Haiti—believe in both Christianity and antibiotics simultaneously.

Farmer's insight here illustrates a disturbing form of racism. Americans, in Farmer's view, are looking for an excuse to dehumanize and deny help to Haitians. In their search for an excuse, they construct a shallow and condescending portrait of the typical Haitian—a narrow-minded individual who's incapable of believing in science and religion simultaneously. The implication of this portrait is that Haitians are less intellectually advanced than Americans (no one would ever question an American's ability to believe in God and science at once). In short, Farmer's predecessors' actions illustrate the condescension of many Western charity organizations, and the unfortunate eagerness of the people in power to deny their help to those in need.

Chapter 5 Quotes

By then Farmer had quit his fraternity. He wrote them that he couldn’t belong to an all-white organization. (“I received quite a frosty reply,” he would say, in a tone of voice that implied this still surprised him.) He’d come to admire his father’s distaste for putting on airs.

Related Characters: Tracy Kidder (speaker), Doctor Paul Farmer
Page Number: 56
Explanation and Analysis:

In order to get a better understanding of Dr. Farmer, Kidder focuses on Farmer's past. Even in college, we're told, Farmer showed signs of being a remarkably forward-thinking, progressive person. Although it was the norm at the time for white fraternities to exclude black students, Farmer didn't hesitate to quit his fraternity when he realized that it was a racist organization.

Farmer's decision to quit his fraternity for its poor racial politics illustrates his refusal to play along with racist "groupthink," an instinct that continues throughout his career as a doctor. Again and again, Farmer ignores the "common wisdom" about charity in Haiti or South America—i.e., that there's no point in helping the Haitians or South Americans because it doesn't make financial sense. One reason Farmer ignores other people's advice about nonprofit work is that he sees this advice as an extension of American racism and indifference to people of other cultures—a form of racism he's been avoiding at least since his experience with his college fraternity. Just as his frat excluded blacks, the powerful charities of the U.S. have an unfortunate tendency to buy into the myth that white Americans will always be better than their neighbors to the south. Farmer finds this latent racism disgusting.

Chapter 6 Quotes

But independence had been followed by nearly two hundred years of misrule, aided and abetted by foreign powers, especially France and the United States. (From 1915 to 1934, the U.S. Marines had occupied and run the country.) To Farmer, Haiti’s history seemed, indeed, like The Lord of the Rings, an ongoing story of a great and terrible struggle between the rich and the poor, between good and evil.

Related Characters: Tracy Kidder (speaker), Doctor Paul Farmer
Page Number: 63
Explanation and Analysis:

In this quotation, Farmer shows Kidder that he's both realistic and idealistic about his charity work. He explains how Haiti continues to suffer from the foreign policies initiated by Europe and later the U.S. Few people know that the United States ruled Haiti by military force during the 20th century—during this time, Farmer argues, American troops weakened Haiti's economy, leading to structural problems in the country that continue to cause poverty and disease to this day. Farmer's realism about the dangers of foreign policy, particularly American foreign policy, make him wary of accepting help from the American government or large American charities. Instead of partnering with organizations that have hurt Haiti in the past, Farmer works largely by himself, and accomplishes a great deal as a result.

But at the same time, Farmer's view of Haitian life is extremely idealistic: a life-and-death battle between the forces of evil (the U.S. and Europe) and the forces of good (the people of Haiti). The notion that American foreign policy accomplishes nothing but evil is just as naive as the notion that it causes only good. Farmer seems to need to believe in certain "useful" fictions, such as that of America's wickedness, in order to carry out his work. His belief in the idea that America is purely "evil," even if it's not entirely true, motivates him to work harder and perhaps leads him to accomplish more for his patients.

Chapter 7 Quotes

For a long time I thought I could live and work in Haiti, carving out a life with you, but now I understand that I can’t. And that’s simply not compatible with your life—the life you once told me you would like to lead even ten years ago.

Related Characters: Ophelia Dahl (speaker), Doctor Paul Farmer
Page Number: 66
Explanation and Analysis:

For many years as a young man, Dr. Farmer is romantically close with a fellow charity worker, Ophelia Dahl. But as he spends more and more time working with his patients, Farmer struggles to spend time with Ophelia. He makes it clear that he'll only be able to pursue a relationship with Ophelia if she can get used to a life of constant travel and work. In this quotation, Ophelia writes Farmer a letter in which she tells him that she can no longer pursue a relationship with him: she's just not ready for the life he wants to lead.

Ophelia's letter reminds us how difficult Farmer's life is—contrary to what he always claims. There are few people who could spend their entire lives traveling the world, meeting with hundreds of strangers a day, and devoting incredible amounts of time to dangerous or thankless tasks. Indeed, Ophelia's letter establishes the basic sacrifice that a "saint" like Farmer must make. Farmer must choose between his family—a small group of people with whom he's very close, such as Ophelia—and his profession—a life spent circling through a huge group of patients, none of whom he's very close with. While most people choose to give most of their love and attention to the small number of people in their immediate family, Farmer takes a different path. Ironically, in choosing a career that, on the surface, seems incredibly noble and loving, he shies away from love for a family—a basic form of love that almost every human being expresses.

Chapter 8 Quotes

He was already attracted to liberation theology. “A powerful rebuke to the hiding away of poverty,” he called it. “A rebuke that transcends scholarly analysis.” In Haiti, the essence of the doctrine came alive for him. Almost all the peasants he was meeting shared a belief that seemed like a distillation of liberation theology: “Everybody else hates us,” they’d tell him, “but God loves the poor more. And our cause is just.”

Related Characters: Doctor Paul Farmer (speaker), Tracy Kidder (speaker)
Page Number: 78
Explanation and Analysis:

In this passage, Farmer gives an eloquent explanation of liberation theology, the strain of Catholicism that defines his approach to charity work in Haiti. In many conventional interpretations of Christianity, poverty should be ignored altogether, because it's unimportant in the "grand scheme of things" (no point worrying about your paycheck on Earth when you're going to Heaven for eternity, anyway). Farmer disputes this interpretation, arguing that it's vitally important to focus on improving life on Earth, here and now. To allow the people of Haiti to live in poverty is, in essence, to support suffering and misery—an obvious violation of the spirit of Christianity. Armed with liberation theology, Farmer devotes huge amounts of his time to working with the poorest Haitians, recognizing that their need for medical attention is great.

Chapter 9 Quotes

On the way back they laughed about the incident, and yet of all the times she’d eaten things that she could hardly bear to look at, this one occasion when she failed the test stood out for her.

Related Characters: Tracy Kidder (speaker), Doctor Paul Farmer , Ophelia Dahl
Page Number: 87
Explanation and Analysis:

In this passage, Ophelia Dahl describes an episode from her travels in Haiti when, accompanied by her lover, Farmer, she was offered a traditional Haitian dish. Ophelia politely refused the dish, not realizing that her politeness would be interpreted as rudeness. Farmer irritably corrected Ophelia, showing that he was far more familiar with Haitian culture than she. Ophelia continues to remember this episode for many years. In her mind, it proves that she'll never be an important part of Farmer's life; on the contrary, she'll always be less relevant than his patient care.

A further implication of the passage is that Ophelia feels like a outsider in Haiti because of her privileged life in the United States and England. Ophelia, the wealthy daughter of the famous author Roald Dahl, is occasionally uncomfortable in Haiti because she's reminded of how lucky she was to be born to wealthy, white, Western parents. Incidents like the one described in the passage push Ophelia further away from Farmer while also exacerbating her "white guilt."

Chapter 10 Quotes

Some people said that medicine addresses only the symptoms of poverty. This, they agreed, was true, and they’d make “common cause” with anyone sincerely trying to change the “political economies” of countries like Haiti. But it didn’t follow, as some self-styled radicals said, that good works without revolution only prolonged the status quo, that the only thing projects like Cange really accomplish is the creation of “dependency.”

Related Characters: Tracy Kidder (speaker), Doctor Paul Farmer , Jim Yong Kim
Page Number: 100
Explanation and Analysis:

Paul Farmer and his friend, Jim Yong Kim, are thoughtful people who think deeply about the merits of their own work. One question Kim and Farmer ask each other frequently concerns the long-term effects of their work—is it possible that by treating disease, they're only making the Haitians more dependent on American aid, thereby keeping Haiti subservient to a foreign power? In other words, why doesn't Farmer train Haitian doctors to treat their own people—in time, wouldn't this be a better use of his time than continuing to treat hundreds of patients a day?

For now, Kim and Farmer insist that their work does more than merely creating a cycle of dependency. Just because Farmer spends hours treating Haitians doesn't mean that Haitians will always look to the U.S. for help and medical care. Indeed, by treating Haitians' medical problems, Farmer is enabling the Haitians to spend more time building their own businesses, running for political office, reforming education systems, etc. Healthy people can accomplish more than sick people, after all. Nevertheless, the fact that Farmer and Kim are considering the big-picture, long-term effects of their actions in Haiti proves their devotion to nonprofit work and all its implications. 

Chapter 11 Quotes

He’d write about how the Centers for Disease Control, a federal U.S. agency, had gone so far as to identify Haitians as a “risk group,” along with several other groups whose names began with h—homosexuals, hemophiliacs, and heroin users—and about the incalculable harm all this had done to Haiti’s fragile economy and to Haitians wherever they lived. In his thesis, he’d marshal a host of epidemiological data to show that AIDS had almost certainly come from North America to Haiti.

Related Characters: Tracy Kidder (speaker), Doctor Paul Farmer
Page Number: 106
Explanation and Analysis:

Farmer is one of the world's foremost researchers on the subject of AIDS, the deadly virus that continues to kill millions around the world by weakening humans' immune systems. Farmer notices that American government officials have identified Haitians as a "risk group" for AIDS—in other words, Haitians are (supposedly) very likely to have AIDS, meaning that by associating with Haitians, other people are risking contracting AIDS themselves.

As Farmer argues, the U.S. government's treatment of Haiti is just an extension of racism. There is little convincing evidence that Haiti is any more of a risk group for AIDS than the U.S. itself—indeed, the evidence suggests that Americans are more at risk for carrying AIDS than Haitians! The reason that Haiti has been placed on the "risk list," Farmer suggests, is that Haitians have already been treated as dirty, animalistic, second-class, and, in general, subhuman. Like so much of America's medical policy toward Haiti, Farmer implies, the government's decision to place Haitians on the "risk list" is racism masquerading as prudence.

Chapter 12 Quotes

In early 1994, just before The Uses of Haiti came out, Farmer wrote an editorial for The Miami Herald. The gist of it was: “Should the U.S. military intervene in Haiti? We already have. Now we should do so in a new way, to restore democracy.”

Related Characters: Doctor Paul Farmer (speaker), Tracy Kidder (speaker)
Page Number: 117
Explanation and Analysis:

In his editorial for the Herald, Farmer clarifies his thoughts about the nature of America's involvement with the United States. In doing so, he distances himself both from establishment thinkers who believe that American foreign policy is an inherent good, and far-left thinkers who reject the concept of foreign aid altogether. As Farmer argues here, America has been intervening in Haiti for decades. America's goal has always been to suppress the Haitian economy and keep it dependent on America's power. In 1994, however, a new opportunity has presented itself: a large, democratic movement is coming into power. America, Farmer argues, can do some good for once: it can use its military power to foster a strong, stable society by ensuring that democratic elections are held in Haiti.

As Farmer acknowledges elsewhere, there are many who believe that American foreign intervention of any kind is harmful to the foreign country in question, because it increases the country's dependence on American generosity. Farmer has always rejected these facile arguments, because they're just an excuse to let the inhabitants of third-world countries suffer. Farmer believes that foreign intervention can be a force for good, provided that it's done well.

Chapter 15 Quotes

The motion of his mind toward root causes had always excited him. He loved the challenge of diagnosis and all its accoutrements—the stains on the microscopic slides, the beautiful morphologies of the creatures under the lens. But what he called “the eureka moment” had a bad aftertaste this time. Later he would tell me, “God, I’d hate to ever feel triumphant about something so rotten.”

Related Characters: Doctor Paul Farmer (speaker), Tracy Kidder (speaker)
Page Number: 140
Explanation and Analysis:

In this quotation, Farmer sheds some light on his own psychology: what motivates him to devote his entire life to medicine? And what goes through his mind when he works with a patient?

As Farmer explains, he feels a special thrill when he diagnoses a patient with a serious viral disease. But this thrill immediately causes Farmer guilt and shame—how could he possibly feel happy about a virus that causes human beings so much misery?

In general, the passage suggests that Farmer doesn't really think of his work as a doctor as pleasurable at all—what little pleasure he does feel on the job vanishes almost immediately, as Farmer takes in the gravity of the situation. Instead of practicing medicine for his own gratification, Farmer does it out of a more abstract sense of duty: his faith in liberation theology encourages him to devote himself to other people, whether he enjoys it or not, and he can never fully savor his more abstract, aesthetic appreciation of diagnoses without also considering the real-world, human cost of his work.

Farmer and Kim began collecting a number of official WHO statements. Some put the case more plainly: “In developing countries, people with multidrug-resistant tuberculosis usually die, because effective treatment is often impossible in poor countries.” For Farmer […] there was a larger principle involved. A TB epidemic, laced with MDR, had visited New York City in the late 1980s; it had been centered in prisons, homeless shelters, and public hospitals. When all the costs were totaled, various American agencies had spent about a billion dollars stanching the outbreak. Meanwhile, here in Peru, where the government made debt payments of more than a billion dollars every year to American banks and international lending institutions, experts in international TB control had deemed MDR too expensive to treat.

Related Characters: Tracy Kidder (speaker), Doctor Paul Farmer , Jim Yong Kim
Page Number: 141
Explanation and Analysis:

This long passage illustrates the hypocrisy in the way the Western world studies and treats diseases. As Kidder describes it, there was an outbreak of tuberculosis in Boston and Peru almost at the same time. The U.S government provided huge sums of money to ensure that the people of Boston wouldn't suffer any more than they absolutely had to. And yet when the time came to treat tuberculosis in Peru, American medical officials—including some of the same people who'd supported TB treatments in Boston—insisted that TB was too expensive to treat in Peru.

The hypocrisy of the medical establishment is clear here. If the sick are American citizens, who share a culture and a heritage with the medical officials, then no sum of money is too high to treat them. It's only when the patients are strangers—people who speak a different language, or have a different skin color than the medical officials—that cost becomes a factor at all. As Farmer argues, even to ask the question, "Is this treatment worth it?" is to treat a patient as a second-class human being, something to be measured in terms of economic value rather than basic human dignity.

Chapter 18 Quotes

Then Goldfarb spoke up again, his voice calm and acidic. “I want to share with you a simple reality. I have six million dollars. With three million dollars I can eemplement DOTS for five thousand Russian prison inmates. And assuming that ten percent have MDR-TB, forty-five hundred will be cured and five hundred will go down with MDR-TB and die. And there’s nothing much you can do. So. I have a choice. And my choice is to use another three million dollars to treat the five hundred with MDR-TB, or go to another region and treat another five thousand. I’m working with leemited resources. So my choice is not involved in the human rights of five hundred people, but five hundred people versus five thousand people.

Related Characters: Alex Goldfarb (speaker), Doctor Paul Farmer
Page Number: 162
Explanation and Analysis:

In this passage, Dr. Alex Goldfarb, a medical researcher who does important work with Russian prison inmates, makes a surprisingly eloquent argument for why—contrary to what Farmer has always maintained—the question, "is this worth it?" is sometimes a necessity for medical officials.

Goldfarb explains that he has a limited amount of money, with which he can either treat a small number of Russian prisoners who have a particularly deadly strain of TB, or treat a large number of different Russian prisoners who have a more manageable kind of TB. Goldfarb seems to believe that the best course of action is to treat the larger number of prisoners with the more common form of TB, even though doing so would mean letting the other Russian prisoners die of diseases that—technically—could be cured.

The scenario Goldfarb describes is very different from the ones Farmer has used to illustrate the hypocrisy of the medical community. Farmer is quick to criticize Western doctors for reducing the lives of "undesirable" people (prisoners, Haitians, Africans, etc.) to dollars and cents, effectively treating these people as second-class human beings. But Goldfarb doesn't fit into this critique at all. Rather, Goldfarb is sincerely interested in treating as many lives as possible—and for this reason, it's crucial to equate lives with dollars and cents. In the end, Goldfarb supports saving more lives, leaving other people to die. While his decision might seem harsh and inhuman, it's motivated by a sincere belief in the value of human life—not the cynical dismissal of human life, as Farmer would say.

Chapter 19 Quotes

As sometimes happened, Paul seemed to know what Jim was thinking. “What do you want to do now?” he asked. There was warmth in the question, Jim felt, a real invitation for him to come clean. “Political work is interesting to me, and it has to be done,” he said. “I prefer it to taking care of patients. It’s O for the P on an international scale.”

Related Characters: Doctor Paul Farmer (speaker), Jim Yong Kim (speaker)
Page Number: 174
Explanation and Analysis:

In this quotation, Farmer and Kim—two old, like-minded friends—part ways on the question of how they can best take care of the sick and impoverished. As Kim sees it, his talents would be put to the best use on a high-level, administrative level. Kim is a world-renowned expert on nonprofit policy: he's not necessarily the best one-on-one doctor, but he knows how to use resources efficiently, address the root causes of a problem, and put together a team of great doctors. Kim is, in short, an experienced, talented medical researcher who's ready to graduate to the next level.

Although Farmer respects Kim's ambitions of working in politics or high-level administration, he doesn't share these ambitions. Although Farmer is just as intelligent and far-thinking as Kim, he refuses to move on to administrative work, because his true passion (his calling, really) is patient care. It may seem strange that such a brilliant man would prefer working with individual patients (surely Farmer could accomplish more as a political leader than he could meeting with individual TB victims). But even if Farmer could accomplish more by pursuing a political career, he refuses to lose touch with his "roots" as a doctor. He's motivated by something entirely different than practicality, or even passion—he thinks it's his duty to continue practicing medicine.

Chapter 20 Quotes

Farmer was forty now, and he had the credentials to operate in the way Hiatt envisioned, on a purely executive level. In academic circles his reputation had grown. He was about to become a tenured Harvard professor. He was near the head of the line for the big prizes in medical anthropology; some of his peers were now saying that he’d “redefined” the field.

Related Characters: Tracy Kidder (speaker), Doctor Paul Farmer , Howard Hiatt
Page Number: 182
Explanation and Analysis:

In this passage, Kidder makes it clear that Farmer could retire or step into a cozy academic position—if he wanted to. Farmer has spent decades caring for patients, reorganizing the nonprofit world, and advising the next generation of charity workers. He has, in short, accomplished more in 20 years than most people could accomplish in a lifetime.

But in spite of his success as a humanitarian doctor, Farmer refuses to slow down the pace of his life. He continues to travel constantly in order to help as many patients and advise as many nonprofits as possible. Farmer's health and contentment are never a factor, and even when he's deliriously tired, he continues to work. By this point in Kidder's book, Farmer's drive is expected (if still not totally comprehensible)—if Farmer were seriously thinking about retiring at the age of 40, there's no way he would have been so productive in the previous 20 years.

Chapter 21 Quotes

He distrusted all ideologies, including his own, at least a little. “It’s an ology, after all,” he had written to me about liberation theology. “And all ologies fail us at some point. At a point, I suspect, not very far from where the Haitian poor live out their dangerous lives.” Where might it fail? He told me, “If one pushes this ology to its logical conclusion, then God is to be found in the struggle against injustice.

Related Characters: Doctor Paul Farmer (speaker), Tracy Kidder (speaker)
Page Number: 195
Explanation and Analysis:

Farmer takes a moment to clarify his thoughts on politics and philosophy. Although he's passionate about his belief in liberation theology—the Catholic belief in the importance of solving the concrete, real-world problems of human beings—Farmer acknowledges that any system of beliefs is always flawed in some way. In other words, he concludes, there's no system of thought that can tell us what to do in all cases—there will always come a point, particularly in an impoverished place like Haiti, where humans have to use their instincts to decide on the "right" thing to do.

Farmer's observations about the failure of "ologies" are important, because they help clarify why he's so devoted to helping the sick through individual consultations. In part, Farmer refuses to settle into a comfortable administrative position (chair of a major nonprofit, president of a medical society, etc.) because he doesn't want "ology" to guide his decision-making processes. By meeting with the sick one-on-one, Farmer reminds himself that no abstract belief system can fully solve humans' problems—only hard work and a strong sense of duty can make the world healthier.

It still seemed to me that he took a stance all too conveniently impregnable. He embodied a preferential option for the poor. Therefore, any criticism of him amounted to an assault on the already downtrodden people he served. But I knew by now he wasn’t simply posing. I felt something about him that I’d later frame to myself this way: He said patients came first, prisoners second, and students third, but this didn’t leave out much of humanity. Every sick person seemed to be a potential patient of Farmer’s and every healthy person a potential student. In his mind, he was fighting all poverty all the time, an endeavor full of difficulties and inevitable failures.

Related Characters: Tracy Kidder (speaker), Doctor Paul Farmer
Page Number: 210
Explanation and Analysis:

In this quotation, Kidder voices some of his frustration about Farmer and Farmer's attitude toward healthcare. Kidder can't help but suggest that Farmer is being a little disingenuous when he claims to be a kind of savior devoting his life to helping the poor and the sick. The problem with such a life, Kidder claims, is that it's immune from all criticism—Kidder can't disagree with Farmer without feeling that he's also somehow hurting the poor and sick people whom Farmer helps.

In part, Kidder's objections to Farmer sound like frustration with his own passivity—as Kidder himself acknowledges, he feels guilty whenever he's around Farmer, because Farmer could put any humanitarian to shame, let alone a wealthy writer like Kidder. At the same time, Kidder seems to have a valid point: Farmer isn't critical enough in his attitude toward patient care. By refusing to ever think of patient care as a matter of dollars and cents, Farmer is overly idealistic.

Chapter 26 Quotes

If you say, Well, I just think how much could have been done with twenty thousand dollars, you sound thoughtful, sensible, you know, reasonable, rational, someone you really want on your side. However, if you were to point out, But a young attending physician makes one hundred thousand dollars, not twenty, and that’s five times what it cost to try to save a boy’s life—that just makes you sound like an asshole. Same world, same numbers, same figures, same currency.

Related Characters: Doctor Paul Farmer (speaker)
Related Symbols: John’s Treatment
Page Number: 289
Explanation and Analysis:

Farmer offers Kidder one final explanation of why arguments for efficiency are immoral. There are some people (cynics, in Farmer's opinion) who would argue that John's treatment in Boston was a colossal waste of money, since it cost thousands and didn't save John's life. Kidder's point, however, is that these arguments place an unfair burden on the lives of third-world citizens. No first-world person would ever have to argue for why she "deserves" healthcare—the only relevant argument would be that doctors have a moral duty to help the sick. It's only when we bring up third-world people that the question of of cost-efficiency is brought up in the first place. Furthermore, Farmer argues, focusing on the cost-efficiency of treatment is the wrong issue. It would be better to focus on the ludicrous amounts of money spent on other, non-life-saving issues and professions, not the relatively small amounts of money that good doctors spend on sick patients in Haiti.

Get the entire Mountains LitChart as a printable PDF.
Mountains beyond mountains.pdf.medium

Doctor Paul Farmer Character Timeline in Mountains Beyond Mountains

The timeline below shows where the character Doctor Paul Farmer appears in Mountains Beyond Mountains. The colored dots and icons indicate which themes are associated with that appearance.
Chapter 1
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Tracy Kidder begins his book by noting that he first met Dr. Paul Edward Farmer in 1994, “because of a beheading.” Kidder, a journalist, was in Haiti at... (full context)
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...gets some visitors. A group of four Haitians tells the soldiers that a doctor named Paul Farmer has come to see Captain Carroll. Kidder notices immediately that Farmer is short, delicate,... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
A few weeks later, Kidder meets Farmer on board a flight to Miami. On the flight, Farmer gets to talking about the... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
A few weeks later, Kidder invites Farmer to dinner in Boston. Above all, Kidder is struck by Farmer’s easy-going attitude—he seems totally... (full context)
Chapter 2
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
...Hospital, and other legendary medical institutions. One such institution is the Brigham, a hospital where Farmer sometimes works. (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
The year is 1999. Farmer works in Brigham, and specializes in Infectious Diseases, or I.D. He’s a “big-shot” Boston doctor... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Farmer goes to talk to Joe, who’s very amiable, despite his condition. Farmer tells Joe that... (full context)
Saintliness Theme Icon
...with “warmth, our drugs, and a 6 pack of Bud.” Everybody can tell immediately that Farmer wrote this note. Farmer has found a homeless shelter for Joe. Although the shelter forbids... (full context)
Saintliness Theme Icon
In early 2000, Farmer leaves Brigham and travels back to Haiti. He emails Kidder, telling him to come back... (full context)
Chapter 3
Saintliness Theme Icon
In 2000, Kidder is in Haiti, having been invited there by Farmer. He’s driven through Haiti along the National Highway, a road surrounded on all sides by... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Kidder follows Farmer through a typical day. Farmer wakes early, dressing in jeans and a t-shirt. His co-workers... (full context)
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...They work in unsanitary conditions, and work long hours. When Zanmi Lasante was first established, Farmer and his colleagues arranged a system whereby patients only had to pay about 80 cents... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Kidder notes that the average hospital in Massachusetts serves about 175,000 people a year. Although Farmer’s facilities in Haiti serve about the same number, they do so with a tiny fraction... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Kidder gives more information about Farmer. He’s married to a Haitian woman named Didi Bertrand. They have a daughter, who lived... (full context)
Saintliness Theme Icon
Science, Magic, and Religion Theme Icon
Every morning in Haiti, Farmer goes to his offices in Zanmi Lasante. He usually has a couple dozen patients waiting... (full context)
Saintliness Theme Icon
Science, Magic, and Religion Theme Icon
...medical problems. One woman explains that her son has “sold” his brother to a sorcerer. Farmer is comfortable talking with patients in terms of magic and sorcery for long stretches of... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
In Haiti, Farmer uses new antiretroviral drugs to treat AIDS and HIV. These drugs are still cutting-edge, and... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Science, Magic, and Religion Theme Icon
Kidder describes how late one night Farmer rushes to the Zanmi Lasante facilities, where a young girl is suffering from meningitis. Farmer... (full context)
Chapter 4
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Kidder senses that Farmer is treating him like a student—someone to be trained in the importance of helping other... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
As a young man in Haiti, Farmer was trying to maximize the effectiveness of treatments for tuberculosis. He noticed that many Haitians... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Science, Magic, and Religion Theme Icon
Farmer spent long hours trying to understand the Haitians’ attitude toward magic. Once, he spoke with... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
...to the village of Morne Michel, a faraway community that still sends patients to see Farmer. One day, Kidder and Farmer go to visit Morne Michel to track down a patient... (full context)
America, Imperialism, and the First World Theme Icon
Science, Magic, and Religion Theme Icon
Farmer and Kidder walk out to Morne Michel. Kidder notes that Farmer has spent a lot... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
As they walk through Morne Michel, Farmer tells Kidder about the misery that Haitians endure. They don’t have enough food to feed... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
On their walk back to the hospital, Kidder and Farmer pass by a cockfighting pit. As Farmer walks past, Haitians produce chairs for him to... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
During their walk back, Kidder and Farmer stand on the top of a hill, looking down at Haiti. Kidder sees that much... (full context)
Chapter 5
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Kidder researches Farmer’s life. He was born in Massachusetts in 1959. His mother was a farmer’s daughter, and... (full context)
Saintliness Theme Icon
When Farmer was about 12, his father moved the family once again, to Tampa, Florida. Farmer’s mother... (full context)
Saintliness Theme Icon
Farmer’s father loved to go sailing. He had a boat, the Lady Gin, in which Farmer... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Farmer was an excellent student in high school. He was president of his class, and attended... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Farmer’s father died at the age of 49, very suddenly. He’d seemed to be a healthy... (full context)
Chapter 6
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Science, Magic, and Religion Theme Icon
Kidder interviews Farmer’s friends from college. They recall that Farmer was warm, charismatic, and extremely clever. He studied... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Science, Magic, and Religion Theme Icon
Farmer cites the 19th century doctor Rudolf Virchow as one of his biggest influences. Virchow is... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Farmer was intensely political at Duke. In 1980, he was struck by the murder of Archbishop... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
In 1983, Farmer won a prize of 1,000 dollars for an essay about Haitian art. He decided to... (full context)
Chapter 7
Saintliness Theme Icon
The chapter begins with a letter that Farmer received from a woman he wanted to marry. In the letter, a woman named Ophelia... (full context)
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Kidder explains that Farmer met Ophelia Dahl in 1983, when they were both working at Eye Care Haiti. Ophelia,... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
As Ophelia spent more time with Farmer, she came to see that he was charming, sensitive, and more than a little nerdy.... (full context)
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Within a few months, Farmer and Ophelia became lovers. Farmer wrote her a poem called “The Mango Lady,” about the... (full context)
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
...Haiti for the time being. She began preparing to begin her premed education. She and Farmer sent one another love letters, and recommended each other books. A few months after returning... (full context)
Chapter 8
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
In May 1983, Farmer came to Cange, Haiti for the first time. He was immediately struck by the crudeness... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Science, Magic, and Religion Theme Icon
Farmer left Cange shortly after visiting, as he had more work to attend to in Port-au-Prince.... (full context)
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Shortly after recovering from his dysentery, Farmer met a young American doctor. Once, when the young doctor was about to fly home,... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Science, Magic, and Religion Theme Icon
Inspired by his studies of liberation theology and his experience with the young doctor, Farmer set out establishing new hospital facilities in Haiti. Using his college connections in the U.S.,... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Farmer went to the Haitian town of Mirebalais to work for the priest Père Lafontant. Lafontant’s... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Science, Magic, and Religion Theme Icon
In early 1984, Farmer was treating a young woman in Cange who suffered from malaria. While the woman’s father... (full context)
Saintliness Theme Icon
Science, Magic, and Religion Theme Icon
Kidder loops back to discuss Farmer’s training in medicine. In 1984, the 24-year-old Farmer enrolled at Harvard Medical School. He spent... (full context)
Chapter 9
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Science, Magic, and Religion Theme Icon
During his years in Harvard Medical School, Farmer developed his own form of religious faith. Farmer struggled with Christianity and belief in God,... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Science, Magic, and Religion Theme Icon
In 1985, Ophelia flew back to Haiti to see Farmer. By this point, Farmer was comfortable with his role as an American doctor in Haiti:... (full context)
Saintliness Theme Icon
Science, Magic, and Religion Theme Icon
Ophelia loved spending the summer with Farmer. And yet she couldn’t help but notice the differences between her own personality and abilities,... (full context)
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
During his time with Ophelia, Farmer threw himself into the design of his new hospital. He conducted a new health census,... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Farmer admired Père Lafontant for his calm leadership. Under his supervision, engineers established a pipe system.... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Farmer’s ambitious plans for helping the Haitians would require huge sums of money. Farmer was able... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Science, Magic, and Religion Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
White contacted Farmer, and ended up flying out to meet Farmer in Haiti. The poverty in Haiti made... (full context)
Chapter 10
Saintliness Theme Icon
For the second half of the 80s, Ophelia visits Farmer in Haiti every summer. Although Ophelia treasures her time with Farmer, she finds herself trying... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...instead, power shifts to the military, and things remain more or less the same. Once, Farmer and Ophelia are in Port-au-Prince when shots break out: the army is breaking up a... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
In 1988, Ophelia comes to live with Farmer in Boston, where Farmer is busy with his clinical rotations. Although Farmer is forced to... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
At the end of his clinical rotations, Farmer is preparing to come to Haiti permanently. Then he is hit by a car in... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
In the early 90s, Farmer proposes to Ophelia, and she turns him down. Hurt, Farmer tells Ophelia that he can’t... (full context)
Chapter 11
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Science, Magic, and Religion Theme Icon
In December 1988, after recovering from his broken leg, Farmer returns to Cange, Haiti. Haiti is in shambles at the time—the departure of Baby Doc... (full context)
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
In 1990, Farmer receives his Ph.D. and his M.D., and wins prizes for his AIDS thesis. He’s now... (full context)
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
In 1990, it’s rumored that there will be elections in Haiti. To his great surprise, Farmer finds that he’s become a political target, and he receives threatening phone calls from the... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
In the summer of 1991, Farmer goes to work at Brigham, and uses the time to raise extra money for his... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
On September 29, 1991, Farmer travels back to Haiti to consult about the hospital construction plans. When he arrives, he’s... (full context)
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
On his next trip to Haiti, Farmer is pleased to find that he can enter the country without a problem. He resumes... (full context)
Chapter 12
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...of Haiti’s military junta. She’s terrified of being arrested or killed for being associated with Paul, who supported Aristide. She’s even more disturbed after she learns that Farmer has accepted 10,000... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
One day, a soldier comes to Farmer’s hospital, armed. Farmer rushes to the soldier and tells him to leave. The soldier points... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
In 1993, Farmer receives his MacArthur genius grant. At the awards ceremony in Chicago, Farmer notes ruefully that... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
For much of 1994, Farmer lectures across America about the situation in Haiti. He isn’t particularly popular, since he’s regarded... (full context)
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
When Farmer returns to Haiti, he finds a country torn apart by the junta. Thousands have been... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Farmer is now 35 years old. In the U.S. he’s a superstar in both medicine and... (full context)
Chapter 13
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
In Haiti, Farmer faces a serious problem: multidrug resistant tuberculosis bacilli. MDR-TB (i.e., multidrug resistant tuberculosis) was common... (full context)
Chapter 14
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
While studying at medical school, Kidder explains, Farmer visited a church run by the priest Jack Roussin, or Father Jack. The church is... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...a slum in Lima, Peru, where he’s to take on a new parish. He tells Farmer that PIH should start a project there. Farmer agrees, and convinces Tom White to raise... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Farmer is devastated by Father Jack’s sudden death. He investigates drug-resistant TB, wondering how deadly it’s... (full context)
Chapter 15
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Kidder comes to Carabayllo with Farmer. He’s struck by the traffic congestion in the area, and the gloom of the city... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Science, Magic, and Religion Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
In Carabayllo, Farmer and his assistants identify 10 cases of MDR-TB. He obtains samples of TB bacilli in... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Science, Magic, and Religion Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Farmer develops a hypothesis for the cause of the MDR-TB. The 10 patients must have had... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Farmer researches the history of TB treatments in Lima, and realizes that the World Health Organization... (full context)
Chapter 16
Cost-Efficiency vs. the Value of Life Theme Icon
In Peru, there is a “rigorous” anti-TB program, established in 1991. Farmer believes that at the present, faulty drug treatments have caused hundreds of drug-resistant strains of... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Jim Kim and Farmer plan to treat MDR-TB in South America. Jim cynically points out that first world countries... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...is unpopular in Peru, because it implies that the Peruvian government’s health measures are insufficient. Farmer and his team are derisively nicknamed Médicos adventureros: “adventuring doctors.” The government points out that... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Farmer tries to use his political influence to work around the Peruvian government. He makes a... (full context)
Chapter 17
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
In 1994, Farmer begins dating a new woman, Didi Bertrand. She’s the daughter of a schoolmaster in Cange,... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...MDR cases, representing approximately 10 percent of all cases in the slum. A friend of Farmer’s, Howard Hiatt—an influential professor at Harvard Medical School—advises PIH to find new methods of payment... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
...schedule, in which he travels to Cange and then Peru, sometimes in the same day. Farmer’s schedule is even tougher, and he barely sleeps at all anymore. He develops nausea, and... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Farmer resumes his work in Peru working with MDR patients. The Peruvian government has “softened” its... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Kidder backs up to explain Farmer’s experience treating Christian. Two years ago, Christian was severely ill with TB, and could barely... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
On the day that Kidder sees Farmer reunite with Christian, Farmer proceeds with his other cases. He examines a young girl with... (full context)
Chapter 18
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...1998, and a special meeting of tuberculosis specialists, organized by Howard Hiatt, gathers in Boston. Farmer’s hospital in Lima has treated 53 patients over the last 2 years, and more than... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...it’s a testament to a country’s bad medical practices. One doctor, Arata Kochi, argues that Farmer’s innovations in Lima have changed TB treatment forever: from now on, the emphasis will be... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...named Alex Goldfarb, talks about his experiences treating TB in Russian prison populations. Hiatt and Farmer explain how expensive it is to treat TB, but add that the costs of treatment... (full context)
Nonprofits, Politics, and Compromise Theme Icon
...that doctors should never underestimate the efforts of a small group of people, such as Farmer and his PIH team. (full context)
Chapter 19
Cost-Efficiency vs. the Value of Life Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...in the third world will fail, unless they’re accompanied by the MDR treatments pioneered by Farmer in Peru. Farmer’s research has begun to establish a new paradigm in the medical world.... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Science, Magic, and Religion Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Kidder stops to give some background information about Farmer’s partner, Jim Kim. Kim was born in South Korea and grew up in Iowa in... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...anthropology, doing most of the research in pharmaceutical companies in South Korea. When he met Farmer, he was struck by Farmer’s devotion to helping the people of Haiti. Inspired by Farmer,... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
In the late 90s, Jim Kim and Farmer are researching drugs for treating MDR. They know from experience that the cost of a... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...called the Green Light Committee promoted second-line meningococcal vaccines in the third world. Kim and Farmer plan to found a new committee for the circulation of second-line TB drugs. The committee... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
By the year 2000, the new Green Light Committee, headed by Farmer and Jim Kim, has driven down the costs of MDR drugs by about 95 percent.... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Jim Kim and Farmer meet in Austria to attend a conference on TB. They discuss the “O for P,”... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Kidder considers what Jim Kim and Farmer have accomplished in Peru. The medical world thinks in terms of cost-effectiveness, arguing that it’s... (full context)
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Jim Kim, Farmer, and Ophelia devise a bold new strategy. Using their success with treating MDR, PIH will... (full context)
Chapter 20
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
As the chapter begins, Howard Hiatt is explaining to Kidder that Farmer and Jim Kim have “mobilized the world to accept drug-resistance TB as a soluble problem.”... (full context)
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Science, Magic, and Religion Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Farmer is now 40 years old. He’s a tenured professor at Harvard, and renowned for “redefining... (full context)
Saintliness Theme Icon
To get a sense for how busy Farmer has become, Kidder “tags along” with him for a month in early 2000. He travels... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Science, Magic, and Religion Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...a system of conscripted labor that dates back to the time of slavery. Kidder and Farmer visit a Haitian prison to inspect the living conditions, and make a variety of other... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
The next day, Farmer and Kidder fly to Miami. At the Miami airport, Farmer “catches up” with his friends—he’s... (full context)
Chapter 21
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Kidder and Farmer land in Havana, and Farmer ecstatically notes the beautiful trees and green fields. Although Cuba... (full context)
Saintliness Theme Icon
Science, Magic, and Religion Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Farmer has a conflicted relationship with communism. He finds it perfectly obvious that society is locked... (full context)
America, Imperialism, and the First World Theme Icon
Farmer has flown to Cuba to attend a medical conference, visit a friend, Dr. Pérez, and... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
America, Imperialism, and the First World Theme Icon
At the medical conference, Farmer meets Luc Montagnier, the doctor usually credited with discovering AIDS. Farmer and Montagnier discuss the... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
America, Imperialism, and the First World Theme Icon
After the conference, Farmer gets to work on his latest book, which is about the history of inequality and... (full context)
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
The next day, Farmer and Kidder go on a tour of a Cuban sanatorium designed for AIDs patients. Farmer... (full context)
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Kidder notes that Farmer travels more than anyone he’s ever met, and yet he’s never seen the tourist destinations... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
As they’re preparing to leave Cuba, Kidder suggests to Farmer that the Cubans must love Farmer for his denunciations of U.S. foreign policy, as he... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Farmer and Kidder’s next trip is to Russia, by way of Miami and Paris. Kidder considers... (full context)
Chapter 22
Cost-Efficiency vs. the Value of Life Theme Icon
America, Imperialism, and the First World Theme Icon
Before flying to Russia, Farmer and Kidder visit Didi, who’s studying the history of colonialism. As they’re taking a taxi... (full context)
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
In Paris, Farmer joyfully reunites with Didi and his daughter, Catherine. Didi asks Farmer when he’s flying to... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Kidder has asked Farmer about Catherine before. Shortly after Catherine’s birth, a woman gave birth to a stillborn baby... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Farmer had come to Paris to celebrate Catherine’s second birthday. Guests at the birthday party include... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...de Gaulle Airport, Kidder points out that the city seems like another world from Haiti. Farmer points out that this is wrong: Paris’s prosperity is intimately tied to Haiti’s poverty, and... (full context)
Chapter 23
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...Russia by funding medical research in the country. On the flight from Paris to Russia, Farmer explains to Kidder that this project has been going on for some 2 years. George... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Farmer continues to explain the history of the TB project in Russia. Farmer told George Soros... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Kidder and Farmer arrive in Russia. Although they drive by Russia’s beautiful towers and churches, they don’t stop... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Farmer and Kidder dine with the chief of Russian doctors, along with some of the chief’s... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Kidder notes that Farmer and Jim Kim have demonstrated that MDR can be treated cost-effectively, meaning that they’re often... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
On the day of the World Bank conference, Farmer dresses in a surprisingly stylish suit, explaining to Kidder that politics is all about the... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Kidder watches Farmer and Goldfarb playfully arguing about prison populations. Farmer claims that the vast majority of people... (full context)
Chapter 24
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...overjoyed with this development, plans to eliminate at least 80 percent of cases of MDR. Farmer is also delighted, though he worries that news of the Gates Foundation’s generosity will result... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Although Farmer will be traveling to Peru to help out with the new Gates endowment, he continues... (full context)
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...in Russia. Soros decided to pull out of Russia for the foreseeable future, and asked Farmer and PIH to replace his organization. (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Shortly after the Soros Foundation appoints the PIH its successor, Jim Kim tells Farmer that he’s unable to come to a meeting in Russia, as he has another meeting... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
A few weeks after his argument with Farmer, Jim Kim flies to Siberia, and Kidder goes with him. They travel into the town... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
The next morning, Jim Kim leaves Russia and Farmer arrives. He spends his day examining MDR patients, and attends another banquet in the evening.... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Farmer travels more than ever, Kidder notes, and for a while Kidder communicates with him mostly... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Farmer now turns to the project of fighting AIDS around the world. There have been antiretroviral... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Kidder notes that Farmer has already made the acquaintance of the influential economist Jeffrey Sachs, who founded the Global... (full context)
Chapter 25
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Farmer has always found the flight from Haiti to Boston strange, Kidder reports. When he arrives... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...diagnosing John requires several trips to and from Haiti, over the course of several weeks. Farmer’s assistant, Serena Koenig, arranges an emergency medical visa for John, so that he can exit... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
While Farmer attends a Soros conference in Europe, Serena prepares to fly John out to Mass General... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
America, Imperialism, and the First World Theme Icon
...the pediatric wards of Mass General, and the team has John in bed very quickly. Farmer, who’s agreed to meet Serena in Boston, tells Serena that she did the right thing... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
...to see her son just before the end of his life. Shortly after John’s death, Farmer offers her a job at Zanmi Lasante, which she accepts. Months after the incident, the... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
...treatment. In a sense, he thinks of it as a lesson in the impossibility of Farmer’s project—a symbol of its futility. (full context)
Chapter 26
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
...after John’s transportation to Boston. Kidder is in Boston, preparing to travel to Cange with Farmer for one of the last times. In Cange, Kidder speaks with Ti Jean, Farmer’s “chief... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Science, Magic, and Religion Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
...Alcante, who came to Zanmi Lasante with a sever case of scrofula—an infectious disease. After Farmer treated Alcante for the disease, he made a full recovery. Afterwards, Alcante’s entire family journeyed... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Kidder describes the long walk that he and Farmer make to Casse, accompanied by Ti Jean. The hike is even longer than the one... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
After leaving the house, Kidder tries to ask Farmer a question he’s been formulating for a while—ever since John’s death. He points out that... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Farmer discusses John’s death with Kidder. It’s certainly possible to question Serena’s decision to move John... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
America, Imperialism, and the First World Theme Icon
Kidder and Farmer continue walking through Casse. After many hours, they arrive at Alcante’s home. Alcante and his... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Saintliness Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Kidder remembers a wealthy donor who abruptly stopped donating to Farmer and PIH, on the basis that while Farmer was a great doctor, his nonprofit model... (full context)
Cost-Efficiency vs. the Value of Life Theme Icon
Science, Magic, and Religion Theme Icon
Nonprofits, Politics, and Compromise Theme Icon
Farmer and Kidder return to Zanmi Lasante. There, Ti Jean has been supervising patient care in... (full context)