Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World

Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World is a 2003 nonfiction book by Pulitzer Prize-winning author Tracy Kidder. It is an expansion of “The Good Doctor,” a 2000 article for The New Yorker and the winner of the 2004 Lettre Ulysses Award for the Art of Reportage. The book profiles Dr. Paul Edward Farmer, co-founder of Partners in Health, as he treats patients in Haiti and other developing countries while challenging medical inequality.

Plot Summary

While reporting on the United States’ 1993 military intervention in Haiti, author Tracy Kidder meets Dr. Paul Edward Farmer, who dedicates his life to treating the country’s poorest people in the refugee village of Cange. Kidder finds Farmer to be empathetic, brilliant, self-assured, and aware of Haiti’s struggles, but he is reluctant to write about his extreme altruism. Years later, he agrees to cover Farmer’s innovative work in tuberculosis care.

The second of six children, Farmer grew up in a nomadic family that moved from Massachusetts to the South on his father’s whim. His childhood included years of living in a retrofitted bus and boat in the Tampa Bay area as well as a brief period working on a farm with Haitian workers. Farmer was an exceptional student and got a taste of high society as an undergraduate at Duke University, but he refocused on helping the poor in Haiti after learning about liberation theology and the work of Rudolf Virchow, which advocate for equal access to medical care regardless of social class. He spent the next few years flying between Haiti and Harvard University, where he pursued both medical and anthropology doctorates.

Farmer builds his own hospital after witnessing the shabby, expensive facilities on the island. He creates a census of people in Cange, noting dreadful tuberculosis and maternal mortality rates, and establishes the nonprofit Partners in Health (PIH) and its Haitian facility Zanmi Lasante. Its initial staff includes Ophelia Dahl as financial manager, Tom White as its primary investor, and Jim Yong Kim as vice chairman. Farmer and Ophelia fall in love, but Farmer’s unyielding devotion to his mission creates a rift.

PIH’s efforts include medical treatment, with Farmer insisting on personal visits, as well as housing, food, and education programs that improve quality of life. Zanmi Lasante recruits Haitian staff members and is respectful of local customs, including the misunderstood Voodoo religion. Eventually, Cange performs better than some American cities in infant mortality, tuberculosis, and AIDS rates. Farmer wins a MacArthur genius grant and becomes an infectious disease expert at Brigham and Women’s Hospital in Boston. However, the military governments that rule Haiti exile Farmer twice for his connections to resistance leader and eventual President Jean-Bertrand Aristide. Steadfast and occasionally temperamental, Farmer refutes medical authorities’ self-proclaimed pragmatic approach to treating poor populations and criticizes the US history of enabling Haitian dictators and implementing self-serving aid projects.

While Farmer prefers that PIH remain a small organization, Kim convinces him to open a branch in Lima, Peru. There, they discover that a World Health Organization-approved anti-tuberculosis program is creating drug-resistant strains due to overtreatment. PIH overcomes political resistance and artificially high drug prices to allow a faster transition to second-line drugs. PIH also works with the Soros Foundation on a World Bank loan for a tuberculosis program in Russia’s overcrowded prisons.

Kidder accompanies Farmer and other PIH members on several globetrotting trips. Farmer accuses Kidder of using his pro-Cuba views to give readers an excuse to ignore the poor. When Farmer visits his family in France, he becomes upset that he only recognized the pain of losing a child after becoming a father and notes that the country is not in a “parallel universe” from Haiti where one isn’t responsible for the other’s suffering. After covering an expensive medevac flight for a young patient with an ultimately untreatable cancer, Kidder asks whether the costs are worth it. Farmer stresses that it is vital to do everything possible for every patient and that the way others deem certain groups to be expendable is the source of much of the world’s problems. While maintaining some doubts, Kidder learns to respect Farmer as a passionate doctor who treats everyone as a potential patient.