Review: Mountains Beyond Mountains

Author: Tracy Kidder

As biographies go, Mountains beyond mountains certainly doesn’t lack for material. Paul Farmer, a self-described “poor people’s doctor”, is a fascinating character, who has had an outsized impact on medicine and public health across the globe.

The core of the book is about Farmer’s relationship with Haiti, and in particular, one extremely poor town known as Cange. The reader gets to know Farmer’s fiery personality and philosophy by seeing what he sees – poverty as the direct result of oppression by the powerful. After finishing his undergraduate degree in anthropology at Duke University, he landed in Haiti in 1983 to work as a medical volunteer, and continued to spend as much time as he could there throughout his time at medical school and beyond. His approach as a doctor-anthropologist enabled him to truly understand that country in a way few others did.  The reader is given a vivid picture of his time as a young man working in rudimentary clinics, walking house-to-house and talking to locals for a health census in a place that had never had one before. He develops close friendships with like-minded farmers, priests and politicians.

Before he’d even graduated from medical school, he spearheaded the creation of the charity Partners in Health, together with 3 others: a fellow medical student (Jim Kim, who ended up being head of the World Bank), a wealthy Boston businessman and Ophelia Dahl, the daughter of author Roald Dahl, who worked alongside him also as a volunteer. Their development of Cange’s health clinic, and later a comprehensive public health system, as well as schools, a clean water system, and decent housing is an inspiring tale of optimism succeeding in the face of huge odds.

The other parts of the book could be novels in themselves. Farmer and his partners have a fierce battle with the WHO, governments, and the consensus of the entire global health community to provide what were at first eye-wateringly expensive treatments for multi-drug resistant TB and HIV. These projects, in the slums of Peru, prisons in Russia, and Cange itself, proved that effective treatment of difficult problems was possible in resource-constrained settings. This helped to open the door to massive expansion of these schemes and tumbling prices.

Farmer’s stature as a great hero relentlessly fighting for the poorest is, at times, difficult to stomach. He isn’t like normal people, and it’s poignant that his family seems to come below the world’s poor in his list of priorities. His astonishing levels of energy – hardly any sleep, food or rest and near-constant travel, clinical work and meetings – put his achievements beyond what any normal person could hope to emulate. His hatred of the mantra of cost-effectiveness, whilst often useful in challenging the status quo, seems damaging to his efforts on occasion. One particular passage involving an urgent medevac flight and tens of thousands of dollars is jaw-dropping in its wastefulness. He spends many days hiking across rural Haiti to visit one patient at a time. However, the author and Farmer do an excellent job of addressing this easy criticism, and the reader is left pondering their own biases. Farmer’s clear focus on the patient at all times, his refusal to accept injustice, and his insistence that the only true nation is humanity are inspiring. I would thoroughly recommend this book to anyone interested in global health, poverty, and development.

Toby Bonvoisin

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