‘Mountains Beyond Mountains’

Posted on | April 19, 2008 | Comments Off on ‘Mountains Beyond Mountains’

Tracy Kidder book helps explain motivations of doctors who practice international ‘relief’ medicine

With my busy schedule, I don’t have much time to sit down and read, so when I am able to do that, it is precious for me. I’ve just finished Tracy Kidder’s Mountains Beyond Mountains, subtitled "The Quest of Dr. Paul Farmer, A Man Who Would Cure the World."

For many of us in the field of wilderness medicine, and certainly for healthcare professionals involved with international medicine, travel to foreign (to the U.S.) countries is part of the profession. Furthermore, the situations in these countries is rarely like that in our highly privileged circumstances. As Dr. Paul Farmer discovered early in his career, there are enormous unmet needs everywhere, and particularly in "third world" countries, which suffer from combinations of poverty, civil disobedience, lawlessness, lack of food and shelter, endemic malnutrition, absence of access to healthcare, corrupt governments, and many other factors that contribute to the physical and emotional afflictions of mankind. It takes a special type of person to be dedicated to improving such situations. Indeed, it is usually all that a person can do to be a single provider caring for patients, let alone someone who takes on the responsibility to improve an entire healthcare delivery system.

In Mountains Beyond Mountains, Tracy Kidder follows Dr. Paul Farmer from his days as a medical student to his emergence as an internationally known figure in global health. It is written in a style that does not glorify Dr. Farmer or his calling in life. Rather, we are presented with some of the intricacies of his personality, not all of which are flattering. No human is perfect, and it is both instructive and refreshing to learn how a young man on a mission to bring modern healthcare to impoverished persons can transcend personal and professional difficulties to make a profound difference. One of my favorite expressions in life is, "If it were easy, everybody would be doing it." Dr. Paul Farmer aspired to tasks selected by few individuals, because they obligated him to sacrifice or postpone much of what we Westerners see as laudable social and financial outcomes. He realized at a tender age that one makes a difference by actually making a difference, not hypothesizing or pontificating about change.

Dr. Farmer has chosen to tackle difficult diseases, such as HIV and tuberculosis, because these are the scourges of the types of people to whom he has dedicated his efforts – the downtrodden, displaced, and incarcerated. In these populations reside reservoirs of potent, relentless infectious diseases that prey upon their weakened immune systems. In most countries, poor people do not have the resources to meet their daily nutritional requirements, let alone seek the guidance of professors in major medical centers. Having spent time as a volunteer in such countries, one becomes accustomed to both the nondemanding demeanor of the patients and their fatalism, born of reality, when faced with serious diseases and conditions. They understand that resources are limited, and are usually enormously grateful for whatever assistance they are given. It is always striking to travel from the U.S. to a place like Haiti or Guatemala and to witness the striking dichotomies in the lifestyles and resources for the "haves" and "have nots." I suspect that this will only grow worse as the world’s population increases and unwieldy numbers of humans are forced to life in proximity on a declining land mass.

Tracy Kidder does an excellent job of portraying Dr. Farmer for what he is – an exceedingly talented and intelligent human being with a moral compass that points in the direction of compassion and progress. None of his remarkable work in places like Haiti and Russia came without sacrifice. As for most of us, his emotional and cultural frameworks were installed by his parents and his upbringing. The rest derives from the motivations and emotional framework that are unique to this fascinating and highly accomplished individual.

Here is what is written about Dr. Paul Farmer by the Brigham and Women’s Hospital in Boston:

"Paul Farmer, M.D., Ph.D., Associate Chief of the Division of Social Medicine and Health Inequalities, is a physician-anthropologist who has worked in infectious disease control for nearly two decades. He is a co-founder of Partners In Health, an international charity organization that provides direct health care services and undertakes research and advocacy activities on behalf of those who are sick and living in poverty. Dr. Farmer is the Maude and Lillian Presley Professor of Medical Anthropology in the Department of Social Medicine at Harvard Medical School. He has been a visiting professor at institutions throughout the U.S. as well as in France, Canada, Peru, the Netherlands, Russia, and Central Asia.

Along with his colleagues at DSMHI and in the Program in Infectious Disease and Social Change at Harvard Medical School, Dr. Farmer has pioneered novel, community-based treatment strategies for infectious diseases (including HIV/AIDS and multidrug-resistant tuberculosis) in resource-poor settings. Author or co-author of over 100 scholarly publications, his research and writing stem in large part from work in Haiti, Peru, Russia, and Rwanda and from his clinical and teaching activities. He is the author of Pathologies of Power (University of California Press, 2003); Infections and Inequalities (University of California Press, 1998); The Uses of Haiti (Common Courage Press, 1994); and AIDS and Accusation (University of California Press, 1992). In addition, he is co-editor of Women, Poverty, and AIDS (Common Courage Press, 1996) and of The Global Impact of Drug-Resistant Tuberculosis (Harvard Medical School and Open Society Institute, 1999).

Among the numerous awards Dr. Farmer has received are the Jimmy and Rosalynn Carter Award for Humanitarian Contributions to the Health of Humankind from the National Foundation for Infectious Diseases, the Salk Institute Medal for Health and Humanity, the Duke University Humanitarian Award, the Margaret Mead Award from the American Anthropological Association, the American Medical Association’s International Physician (Nathan Davis) Award, and the Heinz Award for the Human Condition. In 1993, he was awarded a John D. and Catherine T. MacArthur Foundation ‘genius award’ in recognition of his work.

Dr. Farmer received his Bachelor’s degree in 1982 from Duke University, and his M.D. and Ph.D. (in Anthropology) simultaneously in 1990 from Harvard University."

I highly recommend Mountains Beyond Mountains for every medical student who intends to practice clinical medicine, and for persons who seek to understand what motivates persons like Dr. Paul Farmer to reach beyond the comforts of the U.S. to make the world a better place.

Preview the 25th Anniversary & Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 25-30, 2008.