Book review: Tracy Kidder’s “Mountains Beyond Mountains”

A doctor helps the poorest of the poor in Haiti
Mon, 12/30/2013 - 3:00pm

Tracy Kidder is a “literary journalist” and through this genre takes the reader along trails of discovery in whatever subject he has chosen. Kidder’s first book was a flop. His second, “The Soul of a New Machine,” published in 1981, won a Pulitzer Prize.

Although Kidder’s “Mountains Beyond Mountains” has a copyright date of 2003, its main subject, healthcare in Haiti, is as timely as ever. I may have never, browsing in the library, chosen this particular book. But it appeared, strangely, on my bed one day about a year ago. It turned out that my daughter had left it there. She had been given it at her University of Rhode Island orientation, as “summer reading.”

And it turned out that both Kidder and his primary subject, Dr. Paul Farmer, were each slated to speak at URI’s 2012 Honors Colloquium. The Honors Colloquium is a series of free weekly lectures each fall on a selected subject. The subject for 2012 was: “Health Care Change? Health, Politics, and Money.”

Dr. Farmer is an interesting man, still in the midst of an ardent quest: delivering quality healthcare to the poorest of the poor, and helping others to do so as well. His undergraduate degree is in medical anthropology, which has given him an understanding of the relationship between culture, poverty and disease. His work in Haiti started in the early 1980s, before he started medical school at Harvard. Even while in school, he often “dipped out” to Haiti to continue doing volunteer work. His professors did not seem to mind, and even encouraged him.

If Farmer could have hand-picked an author to chronicle his career, he couldn’t have chosen a better one than Kidder. Kidder can craft a conversation so the reader feels he is there; a diner at the next table. He captures the unspoken tensions, the accents, and the humor. Farmer exudes warmth and frustrations, mischief and endless optimism.

And Kidder seems to be willing to follow Farmer and his cohorts anywhere. Farmer has chosen to “doctor” in the area of Cange, in the central plateau region of Haiti. It is a long journey from Port-au-Prince. Much of the road there is unpaved, narrow, rutted and rocky. Its sides are littered with debris and the hulking wrecks of vehicles that met their demise. On Kidder’s first journey there with Farmer, they come across a just-wrecked tim-tam, which has resulted in the death of one of its passengers.

In Cange, where Farmer slowly built up a healthcare system to try to meet the needs of the landless peasants who reside there — most often in small huts with dirt floors and roofs of banana leaves. One of the first things he did was to have public latrines built and fresh potable water brought in. He met not only the challenges of dealing with the terrible diseases of HIV and tuberculosis, but the societal belief that these diseases were brought about to the sufferers by a voodoo curse.

That journey to Cange was repeated by Farmer over and over again. He supported his work there by doing regular rotations at the Brigham Hospital in Boston, a teaching hospital. He sometimes brought lab samples there, saying at one point that Boston had the best facilities for diagnosing and treating multiple-drug-resistant tuberculosis, but not much of the disease to treat.

He did not do all this alone. He had partners, some willing and some, well, snookered into helping. Early on, Farmer had been joined in his mission by Ophelia Dahl, whom he met in Haiti, and Dr. Jim Yong Kim, whom he’d met at Harvard. Together the three formed Partners In Health, a not-for-profit in Cambridge, Mass., that supported the work in Haiti. Kidder tells the story of each, and also tells the story of Farmer through their eyes.

Kim wanted to try to replicate Farmer’s success in treating tuberculosis, especially the drug-resistant type, in the slums of Peru and he established a program there, with the help of Farmer. Their work was noted throughout the world and they were frequently consulted and asked for help.

And so Kidder quite literally follows them not only from Boston to Haiti and Peru, but to Paris, Moscow and Siberia, where there is a pandemic of tuberculosis in the penal system. But as they travel the world, Farmer’s heart remains in Haiti. He cannot give up ministering health to the poorest of the poor.

Kidder writes:

“Here’s an influential anthropologist, medical diplomat, public health administrator, epidemiologist, who has helped to bring new resolve and hope to some of the world’s most dreadful problems, and he’s just spent seven hours making house calls. How many desperate families live in Haiti? He’s made this trip to visit two.”

It should be said that those seven hours were on foot, sometimes along mountainous paths, and Kidder accompanied him all the way. Why does he do it?

“Farmer told Ophelia that he heard two sets of voices. At one ear he heard friends and allies saying he should concentrate on the big issues of world health and, at the other ear, the groans of his Haitian patients: the voice of the world saying, ‘This meeting’s important,’ and the voice of Haiti saying, ‘My child is dying.’”