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

Tracy Kidder

Part I: Dokte Paul

Part I: Dokte Paul
This section introduces Paul Farmer and explains how Tracy Kidder came to write his story. It opens with a dramatic line: “We met because of a beheading, of all things.” Kidder then dramatically recounts a clash between Farmer and Jon Carroll, a captain in the American Special Forces. Both men were in Haiti to save the country, but each in different ways. Carroll was one of 20,000 American soldiers who had come to Haiti to oversee the reinstitution of democracy (Kidder was there to report on this mission). Farmer was in Haiti to implement an ambitious public health program. The two men argued over how to pursue the beheading of a local assistant mayor. Everyone knew who had killed the...

(The entire section is 592 words.)

Part II: The Tin Roofs of Cange

Part II: The Tin Roofs of Cange
Kidder begins the next section with another revealing sentence: “It was impossible to spend any time with Farmer and not wonder how he happened to choose this life.” He follows this claim with an extended review of Farmer’s life. His father, Paul Sr., was an athletic and strong-minded but idiosyncratic man who led his family on a life of self-chosen adventure. Paul Sr. left a good job in Massachusetts to move his family to Alabama. Once there, he bought a bus and the family lived on it, moving from campground to campground without running water. Later, they lived for a time on a boat. Farmer’s parents encouraged them all to pursue their own interests, but Paul Sr. was...

(The entire section is 1018 words.)

Part III: Medicos Aventureros

Part III: Medicos Aventureros
While in medical school, Farmer had lived at St. Mary of the Angels. The priest there, Father Jack Roussin, had left Boston in the early 1990s to go work in Lima, Peru. He urged Farmer to establish a branch of Partners in Health there, which they did. However, while the pharmacy they built was helping the poor, Father Jack died of multidrug resistant (MDR) TB. In the industrialized world, TB was relatively easy to treat for a serious disease, but if treatment was interrupted, there was a strong chance that the surviving TB bacillus would become resistant to the drugs first used to treat them. This made the disease harder and more expensive to cure and more likely to kill the patients. Farmer found that the normas (treatment norms) in Peru had led to many patients becoming infected with MDR TB. What’s worse, the standard policy for the World Health Organization (WHO) was to ration treatment—to treat only the cheaper patients, and to let the rest die.

This combination of infected poor and dysfunctional official policies led Farmer into a new arena: shaping international public health policy. He started by having to challenge national health policies in Peru, where Farmer’s anthropological training and stubbornness led him to expose problems with existing treatments. Some of these were both personal and poignant; Farmer, for example, treated one Peruvian doctor’s daughter who had TB, but the doctor could not challenge the normas because he would lose his job if he spoke up. In February 1997, Farmer spoke at a meeting of the International Union Against Tuberculosis and Lung Disease, publicly challenging current TB treatments. While he waited for policies to change, Farmer kept doing what he needed to do to treat MDR patients in Peru, even essentially stealing drugs from Boston to do so. The result was that he had results from an MDR treatment program to share with an international audience, which he did in Boston in 1998, at a session of the American Academy of Arts and Sciences. There Farmer entered into direct discussion with people like Arata Kochi, head of the WHO’s TB division, who had helped develop current TB treatment norms, and Alex Goldfarb, who was looking for help addressing Russia’s massive TB program with his limited funds. The Partners in Health Peru project started to be held up as a model and to have influence. Among other accomplishments, Jim Kim worked tirelessly to lower drug costs, in some cases getting prices dropped by 97 percent! During these professional challenges, Farmer’s personal life rolled on. He married Didi Bertrand in 1996—and came down with Hepatitis A the following year.

Part IV: A Light Month for Travel

Part IV: A Light Month for Travel
The next section of the book uses descriptions of Paul Farmer in the act of travel and on site as a way to show how his work was developing, how the developments were putting Farmer under ever-greater tensions, and how his actions showcase the complex ideological context in which medicine occurs. Chapter 20 focuses on Farmer’s travels between the United States and Haiti, describing how he takes responsibility for all Haitian challenges (including, for example, flying or using an escalator for the first time), adapts his personal dress to Haitian demands (somewhat), and maintains an almost continuous stream of email correspondence with friends and colleagues around the world. In chapter 21, Farmer visits Cuba, which he admires for its superior public health program. While Farmer is shown as distrusting all political theories, he does support Marxist social analyses, seeing them as fundamental in understanding the contemporary political situation—specifically, that human suffering does not just happen but is created by society. In chapter 22, Farmer goes to Paris for his daughter’s second birthday party. Farmer clearly loves his family and carries a picture of his daughter, Catherine, with him everywhere. However, he also carries a picture of a little Haitian girl about the same age, who has kwashiorkor (an illness caused by malnutrition), a pairing which for Kidder symbolizes Farmer’s dedication to his patients. Chapter 23 describes Farmer’s trip to Russia, where he toured Siberian prisons with Alex Goldfarb, working with him to improve the country’s treatment of TB. No matter where Farmer was, though, or how hard others pushed him toward stepping back into a more administrative role, he insisted on seeing patients and treating them firsthand. Without seeing patients, he said, “I wouldn’t be anything.”

Part V: O for the P

Part V: O for the P
The fifth section of Mountains Beyond Mountains brings the narrative up to the present. It shows what happens when Farmer and Partners in Health move from being struggling rebels to becoming models for others’ actions; it also shows how much has changed since Farmer began his quest—and how much has not. Chapter 24 begins with a measure of Partners in Health’s success: the Gates Foundation donated $45 million to eradicate MDR TB in Peru. It is an enormous project, with plans to last five years and treat thousands of patients, and it would be a tremendous victory, fundamentally changing conditions for the poor there, perhaps for decades. This very success, however, pushed...

(The entire section is 683 words.)