Kidder senses that Farmer is treating him like a student—someone to be trained in the importance of helping other people. Farmer is fond of repeating a story about his first visit to Haiti in 1988. He was treating a woman for tuberculosis, but had to return to the U.S. to treat an injury of his own, a broken leg. When he returned, he found that the woman had died. Workers told Farmer that she would never have died had Farmer been present. Farmer took this episode as a mandate to work harder and devote himself to the lives of others.
Farmer tells the story of how he “let a woman die” again and again. In reality, this incident seems perfectly forgivable: Farmer is a good doctor, and in his (very reasonable) absence the quality of healthcare declines. But from Farmer’s perspective, the story is a mandate to ignore his own pain and concentrate only on saving others. One consequence of this seems to be that Farmer doesn’t spend much time with his own family: he’s too busy with patients, whose problems seem larger and more urgent.
As a young man in Haiti, Farmer was trying to maximize the effectiveness of treatments for tuberculosis. He noticed that many Haitians didn’t take the TB pills they’d been given, because they believed TB to be caused by magic. He devised a study in which two groups of patients were given free treatments. One treatment consisted entirely of being given TB pills. The other treatment involved receiving pills, but also cash for food, free transportation, etc. Farmer determined that the latter treatment was significantly more effective at eliminating TB. In other words, the common wisdom in the medical community—that Haitian superstition was getting in the way of medicine—was wrong. The real problem was that Americans weren’t fighting the root cause of Haitians’ suffering: namely, institutionalized poverty.
Farmer, like any good scientist, uses the scientific method to understand the root cause of a problem. Where his predecessors throw up their hands and conclude that healthcare in Haiti will always be subpar, Farmer tries to maximize the effectiveness of the TB treatments available. His conclusion is interesting because it suggests that the conventional Western wisdom is to blame the Haitians for their own sickness and poverty. In reality, Farmer seems to believe, the real cause of Haitian disease is outside Haitians’ control: it’s poverty (which is arguably caused by the United States).
Farmer spent long hours trying to understand the Haitians’ attitude toward magic. Once, he spoke with a woman who was suffering from tuberculosis. The woman explained that she was taking all of her pills, because—of course—germs caused TB. She also told Farmer that she knew her disease had been caused by her argument with an old friend. Farmer asked the woman how she could believe in magic and science at the same time, to which she replied, “Are you incapable of complexity?” Farmer has now come to believe that Haitians—just like Americans—believe in all manner of supernatural causes, while also embracing science.
With one question (“Are you incapable of complexity?”) the woman dismisses the narrow-mindedness of America’s attitude toward Haiti—and toward much of the Third World. In many of the canonical works of anthropology, English-language researchers criticize or even ridicule third-world people for their superstitions (James Frazer’s The Gold Bough may be the best example of this problem). Farmer’s point is that these researchers can’t see the superstitions and irrational beliefs in their own lives.
Kidder notes a common proverb in Haiti, “Beyond mountains there are mountains.” This proverb applies 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 who’s stopped coming in for his treatments. As they walk out to Morne Michel, Kidder thinks about the Haitian term for white people, blan, a term which sometimes refers more generally to all non-Haitian people. Farmer remembers a staffer who told him “All you blan look alike.”
The meaning of the Haitian proverb seems to be that challenges are never over: for every “mountain” that one succeeds in climbing, there’s another mountain ahead. This concept could apply to Farmer’s career, as Kidder clearly implies with the title of his book. Although Farmer works very hard, there are always new problems for him to attend to. Kidder’s question, then, is whether Farmer’s efforts are worth it if they will never solve all of Haiti’s problems.
Farmer and Kidder walk out to Morne Michel. Kidder notes that Farmer has spent a lot of time learning about the history of the region and talking to “old-timers,” who tell him stories about Haiti’s past, before hurricanes destroyed much of the country’s agriculture and industry. Farmer learned that in the 1980s, the United States led an effort to destroy most of the pigs living in Haiti, since it was believed that pigs were carrying a dangerous swine fever. As a result of the slaughter of these pigs, farmers lost their source of income, and Haiti fell deeper into poverty.
America’s treatment of Haitian pigs is an excellent example of the foolishness (disguised as foreign policy) that has kept Haiti impoverished for hundreds of years. Bad medical information (about the source of a swine fever) was just a blunder for the U.S., but its results led poor Haitians to fall into greater poverty. The suggestion is that Farmer is also working to correct American misinformation and imperialism.
As they walk through Morne Michel, Farmer tells Kidder about the misery that Haitians endure. They don’t have enough food to feed their families, and have to apologize to their children for leading them to starve. As Kidder listens, he’s unsure how to respond. They walk into the mountains, with Farmer noting the names of various plants and trees. When they arrive in the center of Morne Michel, Farmer finds the patient he was looking for, living in his hut. Farmer demands to know why the patient hasn’t been coming in to collect new medication. The patient explains that he’d been given false information, and hasn’t received his usual cash stipend. Farmer promises to fix the patient’s problem, and tells him to come in for more pills as soon as possible. As they walk away, Farmer tells Kidder, “Some people would argue this wasn’t worth a five-hour walk.”
Kidder devotes a lot of time to describing this house call. In doing so, he makes an important point: this is only one of the hundreds of house calls Farmer makes every week. We can’t help but pose the same question that Farmer himself brings up: “Was this worth it?” While it’s hard to deny that Farmer is doing good work in Haiti, and this good work involves his walking across mountains for hours every day, we wonder if his talents wouldn’t be better spent on medical research: developing a better TB treatment instead of personally treating dozens of TB patients. This is essentially the argument of cost-efficiency vs. the value of life, something that comes up again and again in the book and in Farmer’s work.
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 sit down—clearly, he’s respected throughout the area. Young women sit around him, smiling at him. Kidder recalls that Farmer was the first doctor to practice gynecology in Haiti, so he gave some of these women their first pelvic exams.
Even when he’s trudging across Haiti, Farmer is also training to become a better doctor: he’s familiarizing himself with the culture and geography of the country he cares about. As we’ve already seen, anthropology is a vital part of Farmer’s practice. He’s not just trying to cure his patients’ diseases, but also to improve their overall lives.
During their walk back, Kidder and Farmer stand on the top of a hill, looking down at Haiti. Kidder sees that much of the land is flooded, making agriculture impossible. As Kidder stares out, he thinks of the billions of people living in misery due to natural disasters. He doesn’t say anything, “for fear of disappointing” Farmer.
Kidder still can’t share Farmer’s optimism: even if Farmer’s good work in Haiti has concrete, measurable results, these results appear to pale in comparison with the bulk of human suffering in Haiti (let alone the world). The thought of such mass suffering seem paralyzing, but Farmer’s philosophy seems to be to take things “one case at a time,” and so he remains undaunted.