Mountains Beyond Mountains


Tracy Kidder

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Mountains Beyond Mountains Summary

In 1994, the journalist Tracy Kidder travels to Haiti to report on the country’s military coup. There, Kidder sees Paul Farmer, a highly respected doctor and humanitarian worker, negotiate with the American military on behalf of his Haitian patients. Shortly afterwards, Kidder flies back to the U.S. with Farmer, and is struck by Farmer’s calmness and selflessness. Five years later, Kidder sees Farmer again at Harvard Medical School, where Farmer is a renowned doctor. Several of Farmer’s patients call him a “saint” for the care and kindness he shows them.

Impressed with Farmer, Kidder flies back to Haiti in 2000 to observe Farmer’s work in the country. Using the nonprofit he founded, Partners in Health, Farmer has established a medical facility called Zanmi Lasante, which treats hundreds of thousands of patients every year, almost free of charge. Farmer is a gifted doctor who spends an unusually large amount of time consulting with individual patients and researching the Voodoo practices of the Haitians. Farmer, who studied anthropology in college, changed American thinking on Voodoo: before Farmer, it was believed that the Haitian belief in Voodoo precluded Haitians’ acceptance of antibiotics and vaccines. Farmer, however, showed that many Haitians believe in both Voodoo and the efficacy of Western medicine. Farmer also has strong opinions about American foreign policy: he claims that America has sponsored military dictatorships in Haiti for hundreds of years, ensuring that the country remains impoverished.

Kidder then flashes back to discuss Farmer’s early life. Farmer was born in Massachusetts to a lower-class family. His father was a salesman, and moved the family to Florida when Farmer was young. In Florida, Farmer first met Haitian immigrants while picking fruit—a task which, in the 1960s, was regarded as “negro work.” Farmer was a superb student, and studied at Duke, followed by Harvard Medical School. He had an unusual relationship with his father: although his father loved him and was very proud of his accomplishments, he never gave his son any praise.

As a young man, Farmer went to Haiti to do charity work. There, he met Ophelia Dahl, a beautiful young woman with whom he struck up a close friendship. During this period, Farmer embraced the doctrine of “liberation theology”—the idea that people should work hard to correct humanity’s concrete, real-world problems. With the help of Boston donors, along with his Harvard friend, Jim Yong Kim, Farmer built the medical facility of Zanmi Lasante, and founded a nonprofit group called Partners in Health. Farmer proposed to Ophelia when they were in their late twenties, but Ophelia turned him down for fear that his investment in charity work would limit their time together. Nevertheless, Ophelia continued to work closely with Partners in Health, eventually serving as its budget director.

In the early 90s, there was a military junta in Haiti, and Farmer—as an American and a left-wing thinker—was banned from the country for a brief time. Beginning in this period, Farmer leads PIH to become active in Lima, Peru. Outbreaks of drug-resistant tuberculosis inspire Farmer to research new treatments for the deadly disease. Although he and Jim Kim want to distribute their new TB treatments throughout South America, they find that such treatments are prohibitively expensive—an explanation that Farmer interprets to mean that South American lives just aren’t that valuable. By partnering with pharmaceutical companies, Jim Kim succeeds in lowering the cost of TB treatments by 95%, and PIH sends drug-resistant TB treatments throughout Peru.

By the late 90s, Farmer has an extremely busy schedule. He’s a renowned doctor, and also the recipient of a MacArthur genius grant. He travels around the world giving lectures, and works on multiple books and articles at once. He continues to work hands-on in Peru and Haiti, devoting hours every day to individual patients, nearly all of whom regard him as a hero. Kidder decides to follow Farmer around the world for a few months.

To Kidder’s surprise, Farmer is married to a woman named Didi Bertrand, who studies anthropology in Paris. Farmer met Didi in Haiti, and together, they have a small child, Catherine. Farmer visits Didi in Paris, but is unable to stay for more than a day—a fact that seems to irritate Didi. After Paris, Farmer (and Kidder) fly to Russia, where he’s scheduled to investigate conditions in Russian prisons, which are some of the dirtiest and most dangerous in the world. For this work Farmer has partnered with the Soros Foundation, run by the wealthy philanthropist George Soros. Speaking before the World Bank and the Soros Foundation, Farmer argues that tuberculosis treatments are immediately needed in Russian prisons. Soon afterwards, the World Bank agrees to allocate millions of dollars for TB treatment in Russia.

In the year 2000, the Gates Foundation—one of the largest charities in the world—gives PIH 45 million dollars to wipe out tuberculosis in South America. Although this is a huge victory, Farmer continues to work hands-on in Haiti in addition to his lectures and meetings around the world. While Farmer is in Europe, Kidder witnesses a crisis in Haiti: a young boy named John goes into critical condition due to his rare facial cancer. Farmer’s assistant, Serena Koenig, decides to fly John out to Boston for emergency treatment, even though the flight alone will cost 20,000 dollars. The drive from Zanmi Lasante to the airport is agonizing for John, and by the time he arrives in Boston, he can barely breathe. In Boston, John is given the best medical care, but he dies anyway.

Farmer is deeply saddened by John’s death, and Kidder wonders if John’s death might not be a symbol for the ultimately futility of Farmer’s work: no matter how hard he tries, people continue to live in miserable conditions and die in agony. Nevertheless, Farmer insists that there is value in trying to save individual lives, no matter what the cost of treatment might be. The usual arguments of cost-efficiency, he claims, are just a way for rich, powerful people to rationalize their own inaction. Farmer continues to practice medicine in Haiti and other Third-World countries, working long hours and sometimes walking miles just to make house calls. Kidder concludes that Farmer, while not a saint, is sincerely devoted to helping the poor and the downtrodden.