Mountains Beyond Mountains

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Nonprofits, Politics, and Compromise 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.
Nonprofits, Politics, and Compromise Theme Icon

Although Paul Farmer spends the vast majority of his time consulting with individual patients, he arguably accomplishes even more good by convincing others to donate their money and time to help him fight disease in the Third World. Farmer is a politician as well as a doctor: he makes speeches around the world, influencing powerful people to send their money to Haiti and Peru. Farmer’s nonprofit ventures require him to work with large government organizations, obey strict rules, and at times navigate through the complex world of bureaucracy. In order to understand Farmer’s success as a doctor, we need to understand how he goes about organizing, planning, and—at times—humbly begging.

Usually Farmer’s fundraising strategy is simple: communicate his passion and his personal convictions to the wealthiest people in the world, most of them American. One of his most important allies is Tom White, a Boston development millionaire who gives enormous sums of money to Farmer’s hospitals in Cange and Lima. As Kidder explains, White is sympathetic to Farmer’s political and ideological convictions: he respects liberation doctrine and, like Farmer, has deep misgivings about American foreign policy. It’s largely because of individuals like White that Farmer’s most important charity, Partners in Health, survives for so many years.

But at times, Farmer faces a more difficult task: soliciting money and resources from institutions that he doesn’t entirely respect. In these cases, he’s forced to “soften” some of his political and moral stances, at least rhetorically. When PIH is trying to fund TB treatments in South America, for instance, Farmer makes a series of speeches in which he implies that denying South America this treatment would be disastrous, for the reason that TB bacilli would eventually spread to the United States, causing massive death. While he privately believes that saving South American lives is a worthwhile end in itself, Farmer presents his plan to American investors in a more palatable way: measuring the “value” of the treatment program in American lives—the only currency his audience understands.

As with any politician, Farmer has to soften or compromise on some of his beliefs in order to accomplish tangible goals. But because of his strong overriding commitment to protecting individual lives, the outcomes of his dealings with donors and other nonprofits never feel like compromises. For all his political engagement, Farmer claims that he’s not dogmatic in his thinking—the only thing he’s really dogmatic about is healing the sick. In this sense, any money he raises from a wealthy donor is a victory for PIH, and any partnership he arranges with another nonprofit is a step forward for his patients.

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Nonprofits, Politics, and Compromise ThemeTracker

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

Below you will find the important quotes in Mountains Beyond Mountains related to the theme of Nonprofits, Politics, and Compromise.
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.


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Chapter 9 Quotes

One time when they were together in Boston, White said, “You know, Paul, sometimes I’d like to chuck it all and work as a missionary with you in Haiti.” Farmer thought for a while, then said, “In your particular case, that would be a sin.”

Related Characters: Tracy Kidder (speaker), Tom White (speaker)
Page Number: 95
Explanation and Analysis:

In this passage, one of Farmer's key allies, a man named Tom White, discusses the possibility of going to Haiti to be a one-on-one charity worker. White is a wealthy man who donates millions of dollars of his own money to ensure that Farmer can continue practicing medicine in Haiti. When Farmer says that White's decision to move to Haiti would be a sin, he's saying that White is far more valuable to the world as a donor to nonprofit work than he would be as a missionary on the ground.

Farmer's observation shows an awareness of the importance of strategy and resource allocation in nonprofit work: there are some people who work best as donors and some people who work best as one-on-one doctors. At the midpoint of his career, Farmer excels at the latter: while he thinks of the "big picture" as much as possible, he prefers the thrill of curing an individual patient's illness.

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

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.