Mountains Beyond Mountains

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America, Imperialism, and the First World Theme Analysis

Themes and Colors
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
LitCharts assigns a color and icon to each theme in Mountains Beyond Mountains, which you can use to track the themes throughout the work.
America, Imperialism, and the First World Theme Icon

It’s almost impossible to understand Doctor Paul Farmer’s attitude toward healthcare and nonprofit work without first understanding his attitude toward American foreign policy. In general, it’s important to understand the way Farmer defines the uneasy relationship between the First World—countries with wealth and power—and the Third World—countries that lack these things.

In Farmer’s view, the United States has been a major imperialist aggressor for hundreds of years, with often-disastrous consequences for the Third World. Although the Caribbean nation of Haiti became an independent republic in the 1790s—only a few years after the U.S. itself—it would be decades before America recognized Haiti as such. Instead, America treated Haiti as a tribute state, establishing businesses in Haiti that were designed to send the country’s key natural resources back to the U.S. As the U.S. became the major military power in the Western hemisphere, and then the world, it pursued a strategy of funding military dictatorships in Haiti, believing that a repressive Haitian state would be advantageous for American business interests. Farmer contrasts Haiti—an impoverished country that’s been effectively controlled by the American military and economy for the last 200 years—with Cuba—a healthier, far more prosperous country that’s largely avoided American imperialism, and has been condemned in America for its Communist leadership.

Understanding Haiti’s fraught history with the U.S. is a vital part of Farmer’s work in the country. Many who live in America know nothing about their country’s relationship with Haiti, or assume that the relationship has always been friendly and supportive. As a result, there is a tendency in America to “blame the victims”—in other words, to conclude that the Haitians (or, for that matter, the people of any Third World country) are impoverished and unhealthy because of their culture or society. Farmer believes that the opposite is the case: if anything, the suffering in Haiti is indicative of a long, unfair relationship with the U.S. that has kept Haiti poor and disorganized, and was to some extent designed to do so.

Although Farmer often has to censor his own political views (his collaborators and donors don’t always share his beliefs), his view of the U.S. and of the First World is an important aspect of his work. The role of the doctor, he believes, isn’t simply to cure the sick, but rather to fight the structural inequalities that cause sickness throughout the Third World. An ordinary doctor might treat Haitian typhoid victims, but a politically-minded doctor like Farmer might try to rebuild the Haitian sewer system that was destroyed in wars sponsored in part by U.S. government officials. Perhaps Farmer’s most important political action is to broadcast his views of Haiti and the U.S. in books and interviews. In doing so, he educates people in the First World and makes it more difficult for them to blame the victims in the Third World.

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America, Imperialism, and the First World ThemeTracker

The ThemeTracker below shows where, and to what degree, the theme of America, Imperialism, and the First World appears in each chapter of Mountains Beyond Mountains. Click or tap on any chapter to read its Summary & Analysis.
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America, Imperialism, and the First World Quotes in Mountains Beyond Mountains

Below you will find the important quotes in Mountains Beyond Mountains related to the theme of America, Imperialism, and the First World.
Chapter 1 Quotes

The world is full of miserable places. One way of living comfortably is not to think about them or, when you do, to send money.

Related Characters: Tracy Kidder (speaker)
Page Number: 8
Explanation and Analysis:

At the beginning of the novel, Tracy Kidder (the author) offers some harsh truths about the state of the Western world. For most of the people who live in developed, first-world countries, the easiest course of action is to carry on with one's own personal problems and affairs, and ignore the millions of starving human beings around the world—people whose lives could be drastically changed for the better with just a fragment of the wealth or resources most Westerners enjoy daily.

In short, the rich countries of the world have to perform some complicated mental gymnastics to avoid becoming overcome with guilt at their own passivity: no moral, prosperous human being, Kidder insists, can think about the world's poverty and disease without guilt. Instead, most people either ignore the problem or do the bare minimum, and send some money now and then in the hopes that it will improve the problem slightly.

Against this backdrop of ignorance, passivity, and sheer laziness, Kidder introduces us to Doctor Paul Farmer—a man who refuses to play along with his peers in America. Instead of ignoring the world's problems, Farmer tries to use his intelligence and medical training to eliminate them altogether, one problem at a time.


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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 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 8 Quotes

A doctor who knew nothing about local beliefs might end up at war with Voodoo priests, but a doctor-anthropologist who understood those beliefs could find ways to make Voodoo houngans his allies. A doctor who didn’t understand local culture would probably mistake many patients’ complaints for bizarre superstitions.

Related Characters: Tracy Kidder (speaker)
Page Number: 83
Explanation and Analysis:

In addition to his training as a doctor, Farmer is also a kind of anthropologist, who has focused on the Voodoo customs of Haiti for many years. Farmer recognizes that many of the patients he visits in Haiti suffer from bizarre-sounding symptoms that, to many American doctors, sound like mere superstitions, reflecting the ubiquity of Voodoo in the country. As Farmer sees it, however, it's the job of a good doctor to take the Haitians' belief in Voodoo seriously. Farmer recognizes that some of the Haitians' complaints are legitimate, even if they're wrapped in the language of Voodoo. An untrained American doctor could easily ignore a legitimate medical problem, assuming that it was imagined.

In general, Farmer's thoughts suggest that the duty of a good doctor is to understand the culture of his patients, since the study of the human body is an important part of any culture. More importantly, Farmer suggests that American racism—the glib dismissal of Voodoo as primitive or superstitious, for example—is getting in the way of proper patient care.

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 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 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.