Mountains Beyond Mountains by Tracy Kidder

The Quest of Dr. Paul Farmer, A Man Who Would Cure the World

Jun 18, 2009

The nonfiction book "Mountains Beyond Mountains" is the story of Paul Farmer's life and his mission to bring health care to the poorest of the poor in Haiti and Russia.

Tracy Kidder felt compelled to write about Paul Farmer after he met him in Haiti: "I was drawn to the man himself. He worked extraordinary hours. In fact, I don't think he sleeps more than an hour or two most nights. Here was a person who seemed to be practicing more than he preached, who seemed to be living, as nearly as any human being can, without hypocrisy." (Author Q&A, Random House)

Tracy Kidder Travels the World with Paul Farmer

To get to know Paul Farmer, Kidder traveled with him for a whole year from Haiti to Boston, from Haiti to Russia and from Haiti to Cuba. Zanmi Lasante in Haiti, a community-based health care center founded by Farmer, was his home base at the time. In Russia Farmer negotiated a loan from the World Bank to stop the epidemic of multi-drug resistant tuberculosis (MDR-TB) in Russian prisons. Tuberculosis was the leading cause of death for Russian prisoners in the 1990s.

Tracy Kidder usually does not bring himself into the narrative, but he felt strongly that describing his own relationship with Dr. Farmer would be helpful for readers. He also spent time with Farmer's mother and his siblings. Paul was the second of six children, and grew up in Florida, where the whole family lived on a houseboat. He won a scholarship to Duke University and went on to Harvard Medical School.

"Yes, We Can" Treat Disease in Resource-Poor Areas

"Mountains Beyond Mountains" chronicles Farmer's effort to diagnose and treat TB and HIV/AIDS in resource-poor areas. For the longest time the cost of treating MDR-TB (multi-drug-resistant TB) and HIV/AIDS in poor countries seemed prohibitive. Paul Farmer identifies the patients in gravest danger and gives them priority. He focuses on the individual patient and is not deterred by notions of efficiency and cost-effectiveness. Again and again he convinces health officials that this work can be done, and that it must be done. Farmer and his colleagues at Partners in Health (PIH) eventually changed minds and international health practices. At its heart the story is about the attempt of a small group of people who make a difference.

An Introduction to the Pandemics Tuberculosis and HIV/AIDS

The book is the study of a man who goes to extremes for his moral principles, but it is also a textbook on the major epidemics in the developing world. Deaths from tuberculosis (TB) are rare in rich countries. Yet TB kills 5,000 people every day, nearly two million people per year. In recent years, the TB epidemic has intensified alongside HIV/AIDS. People whose immune systems have been weakened by HIV are particularly vulnerable to catching TB. Partners in Health developed a unique treatment program for MDR-TB in resource-poor settings.

Why the Title "Mountains Beyond Mountains"?

The Haitian proverb "Dèyè mòn gen mòn" translates "Beyond mountains there are mountains", a fitting title for Farmer's life story. For Haitians it expresses the idea that opportunities are inexhaustible, literally it means when you surmount one obstacle you gain a clearer view of the next one. The title comes to mind in the last chapter, when Kidder describes how he can hardly keep up with Farmer making house calls in Haiti's steep mountains. Kneeling on a dirt floor in a tiny hut checking an old woman's blood pressure, Kidder remembers one of Farmer's famous quotes: "There is a profound difference between being bedridden in a nice house outside Boston and mat-ridden in a hut like this." (MBM, p.285)

Socioeconomic Conditions Need to Change

Partners in Health has grown from a small charity in 1987 into a household name in world health circles. The economist Jeffrey Sachs used Farmer's work as a key example when he worked with UN Secretary Kofi Annan to launch the Global Fund to Fight AIDS, Tuberculosis and Malaria (MBM, p.257).Throughout the story Tracy Kidder keeps the reader focused on the larger global context and the fact that socioeconomic conditions need to change in order to make an impact.

The copyright of the article Mountains Beyond Mountains by Tracy Kidder in Poverty/World Development is owned by Christine Welter. Permission to republish Mountains Beyond Mountains by Tracy Kidder in print or online must be granted by the author in writing.