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

by Tracy Kidder

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Part III, Chapter 17 Summary and Analysis

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Summary
Chapter 17 begins with a brief mention of Didi Bertrand, the new love of Paul's life. He courted her for two years before they married in 1996 in Cange, where 4,000 people attended.

The bulk of the chapter focuses on PIH's work in Peru. It cost $15,000 to $20,000 per patient to treat those sick with MDR, and the more PIH investigated, the more infected people they found. Farmer dealt with some of this expense creatively—talking individuals at Harvard Medical School into giving him the drugs he needed without paying the $92,000 at the time. They spent Tom White's money freely, and in general tried to do what they needed to do first and then figure out how to pay for it (or get permission to do it) later. Jim Kim and Farmer both traveled to Carabayllo often, usually without Farmer cutting anything out of his already crowded schedule. Sometimes he would drive (and run!) from Cange to the airport in Port-au-Prince, fly to Miami, then to Lima, then to Carabayllo where he treated patients all day, then back to the Lima airport, Miami, Port-au-Prince, and Cange, traveling 22 of 48 hours.

In early 1997, Farmer planned to spend a month in Boston, but when he got there, he felt sick. At first he thought he had come down with MDR, but test results revealed he had hepatitis A. Farmer's liver functions were impaired, and for a time Jim Kim and other doctors thought he might need a liver transplant. He recovered, and then took a two week vacation with Didi.

The remainder of Chapter 17 describes Farmer's actual treatment of two young patients. One, a little boy named Christian, had been suffering from TB so badly it had started to destroy his spine. Farmer improvised a new treatment using "second-line" TB drugs and cured him. In the other treatment, this one of a small girl, Farmer had to play through an elaborate "charade" of consultation: the child's father and doctors knew she had MDR, but the Peruvian doctors risked too much by diagnosing it, and so had to have Farmer do so.

Analysis
The limited space given to Farmer's courtship and marriage (half a page) and then to his illness (just over two pages) communicate volumes about the focus of Farmer's life and Kidder's narrative. Although Farmer was sick enough that he almost needed an organ transplant, this was no more than a stumbling block in his mission. Moreover, Farmer himself noted that his condition—and any illness he was likely to get—was only "nearly fatal" because of his access to Western medicine. Farmer's suffering was minimized and became a kind of object lesson on the existential differences one's economic position in the world made.

Likewise, finding joy in romantic love is treated with far less detail and, again, given far less space than his treatment of others. Fathering his first child receives literally one line; nursing someone else's child back from the brink of death receives several pages.

Throughout this space, Kidder's descriptions of Farmer working through the "charade" with the Peruvian doctors show a man who is learning how to adapt: he is capable of playing games if that is what he needs to do to save children. This is the political shadow of Farmer's adaptation of existing treatment regimes to save Christian: both show growth and ingenuity in order to serve others.

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Part III, Chapter 16 Summary and Analysis

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Part III, Chapter 18 Summary and Analysis

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