Mountains Beyond Mountains

LOFTY THOUGHTS—DR. PAUL FARMER MOVES MOUNTAINS

By Claudia J. Taller

Although lofty thoughts and contemplation will not solve the world’s problems, being reminded of world issues and possible solutions can spur us to make our own contribution. Paul Farmer, MD, speaks on “Global Health Equity” on February 7 at Cleveland's Palace Theater on Playhouse Square. I read reporter Tracy Kidder’s book on Farmer, entitled "Mountains Beyond Mountains, The Quest of Dr. Paul Farmer, a Man Who Would Cure the World" with my book discussion group this past year. Dr. Farmer is admirable and deserves to be heard.

The energetic and passionate Farmer insists on making a difference in the world. In doing so, he inspires us to be better people. Paul Farmer is the Presley Professor of Medical Anthropology at Harvard University and Co-founder of Partners in Health which is his project in Haiti begun when he was a young medical student at Harvard. He’s an advocate for and provider of free healthcare for the world’s poor and he oversees healthcare projects in such far flung places as Russia, Rwanda and Peru, in addition to Haiti.

Farmer came from humble beginnings. His salesman father uprooted the family from Birmingham to teach in Brooksville, a small town north of Tampa, where they lived in the Bluebird Inn, an old school bus, at a campground. Later the large family lived on a houseboat. To avoid onerous houseboat chores, the children in the family became busy in extracurricular activities, and Farmer was popular with the girls in school because, his mother said, “’He listened to them.” And one of his main priorities was maternal mortality because the deaths of mothers led to catastrophes in families. He escaped to Duke and then to Harvard, going to medical school while working in Haiti, the beginning of his double life in Boston and Haiti. He wrote his senior anthropology thesis on gender inequality and depression, and his mentor as Rudolf Virchow who was “’the principal architect of the foundations of scientific medicine,’ the first to propose that basic units of biological life were self-producing cells, and that the study of disease should focus on changes in the cell.”

Farmer grew up Catholic, but he had a problem with “the cult of resignation” in which people were to accept their lot patiently, waiting for the afterlife. His religion was that the world was wrong for screwing over the poor and God was keeping score. He was drawn back to Catholicism as an act of solidarity. And when Aristide won the election, nothing ever moved Farmer so deeply, because it was the first time the people could choose and “at last, after centuries of misery, of slavery and subsequent misrule and foreign interference, the people of Haiti had claimed their country.” Soon after, Farmer wrote “The Uses of Haiti” while in a Quebec hotel room for ten days. But Farmer never felt he’d done enough, and lived his whole life in what he called “the long defeat,” never quite making it all happen.

Farmer is the kind of guy who can write a book on a plane during a fit of an obsessive need to make a point. He has published more than 200 articles, chapters and books and supports a “preferential option for the poor.” He’s been tireless in his mission to change the way healthcare is delivered to the poor. After reading Kidder’s book about Farmer, the audience is left with the true feeling that we should all be doing more.

Kidder portrays Farmer as relentless and untiring in striving to cure the world of TB and AIDS and any other infectious disease that comes along and ruins entire communities of poor people. Kidder did a fantastic job detailing Farmer’s world—we had a real sense of urgency and driven energy in the combat against both disease and poverty, for Farmer believes there’s not a lot of point in curing someone from TB if he’s just going to go back to a hut with a roof that leaks. He believes he should replace the banana leaves with tile and the dirt floor with cement and get the kids into school and the mothers healthy. Whenever he’s forced to make a choice between taking action on one thing or taking action on another, he’s failed because he wasn’t able to attend to both. In the midst of economic limitations, he forges ahead, having faith it will turn out all right. For the number one thing on Dr. Farmer’s agenda is saving his patients.

Kidder’s a great writer, a champion for causes, and is to be admired because he followed Farmer to Haiti and on flights to Peru and Paris and back to Boston. Kidder trailed Farmer as he stopped at the bedsides of the sickest and poorest of humanity. He lived Farmer’s life with him. The writing in the 300-page book is excellent; it’s trim but multi-layered with meaning. It gives us a lot of detailed information about battling cells and what the administered medicines do to the cells, but it’s not so dense that the lay reader decides to put the book down with a big sigh.

Tracy Kidder first came upon Farmer when he was in Haiti writing a story about the soldiers in Haiti. Farmer uncomfortably confronted Kidder about his belief system. Later, Kidder took Farmer to dinner in Boston and was intriqued that Farmer, with all his education and talent, seemed to like living amongst peasants in Haiti and in a church rectory in Haiti.

If a patient doesn’t show up for treatment, “this was one of the rules—someone had to go and find him . . . Farmer said, ‘the only noncompliant people are physicians. If the patient doesn’t get better, it’s your own fault. Fix it.’” There you go—it was all on him. How many doctors take on that kind of responsibility? How many human beings? The proverb “Beyond mountains there are mountains” purely describes this searching out of patients; the title of the book reflects Farmer’s way of looking at life—you just do it. Paul Farmer said, “The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.”

When Farmer talked about medicine, he said he didn’t know why people don’t get excited about it, and then, Kidder said, “He smiled at me, and his face turned bright, not red so much as glowing a luminescent smile. It affected me quite strongly, like a welcome gladly given, one you didn’t have to earn.” And that’s who Farmer was, what he passed on to the peasants who loved him. If a patient didn’t show up for treatment, “So—this was one of the rules—someone had to go and find him . . . Farmer said, ‘the only noncompliant people are physicians. If the patient doesn’t get better, it’s your own fault. Fix it.’” There you go—it was all on him. How many doctors take on that kind of responsibility? How many human beings? The proverb “Beyond mountains there are mountains” purely describes this searching out of patients; the title of the book reflects Farmer’s way of looking at life—you just do it.

The United States, like the World Health Organization, attempts to help the poor in ways that sometimes does more harm than good, like building a dam in the name of improvement only to leave people without fertile farmland. “Families had hurried away, carrying whatever they could save of their former lives, turning back now and then to watch the water drown their gardens and rise up the trunks of their mango trees . . . For most, there was nothing to do but settle in the steep surrounding hills, where farming meant erosion and widespread malnutrition, tending nearer every year toward famine.” Farmer had problems with white liberals, WL’s, with their ‘they’re poor but they’re happy’ line. “’But WL’s think all the world’s problems can e fixed without any cost to themselves. We don’t believe that. There’s a lot to be said for sacrifice, remorse, even pity. It’s what separates us from roaches.’”

Kidder describes a walk with Farmer to find a noncompliant patient and they were surrounded by women who talked. “One woman was telling him that they needed an additional community health worker up here, but mostly they were just passing the time. Is there a more widespread notion than the one that rural people are laconic, and is there a rural place anywhere in the world whose people really are?” Then, later, “I felt as if I could fall asleep, and as if I already had, enfolded in femininity.” One thing I like about Tracy Kidder is that he’s in there, and we’re experiencing his subject matter with him. Kind of like my own “walks” pieces.

When I told a friend about Paul Farmer, his response was, “he sounds like a saint.” That’s exactly what my book group thought. Paul Farmer would say he’s just a guy doing what needs to be done. That selfless attitude is what makes him a saint.