Tracy Kidder: Mountains Beyond Mountains: The Quest Of Dr. Paul Farmer, A Man Who Would Cure The World

The fourth part of Tracy Kidder's Mountains Beyond Mountains, an absorbing biography about one man's tireless efforts to change the way the world's health community ministers to the poor, is wryly titled "A Light Month For Travel." In this section, Kidder witnesses Dr. Paul Farmer journey from a patient's bedside in remote Haiti to a tuberculosis clinic in Peru to lectures and fundraising appearances in the U.S. to a one-night visit with his wife and baby girl in Paris, all before whisking off to a Siberian prison. A classic micromanager, but with global ambitions, Farmer has the résumé (and schedule) of a dozen singularly dedicated men. He works 100-hour weeks that comprise both the smallest details of patient care and conferences that grapple with sweeping issues in world health-care policy. For someone who has spent his career battling the scourge of cost-benefit analyses, the two roles aren't mutually exclusive: The amount of time, attention, and financial resources dedicated to one patient applies to all patients. In Farmer's mind, there's no such thing as cutting losses, no matter how overextended a caregiver becomes. Writing in the first person, Kidder casts Farmer as a modern-day saint–"I'm not a saint," Farmer protests, with modesty that only makes him seem saintlier–but with a twinge of ambivalence that comes from being around such a peerless humanitarian. For his part, Farmer seems keenly aware that his very presence sends off shock waves of guilt in "WLs" (white liberals) and other privileged mortals, and he isn't above needling that soft spot to finance his many projects. The shining beacon to his achievements is Zanmi Lasante (Creole for "Partners In Health," the name of his Boston-based organization), a modern Haitian hospital that serves the poorest of the poor, with a catchment area of around one million people. Upon seeing this "lovely walled citadel" in the middle of a destitute region, Kidder recalls that he "wouldn't have thought it much less improbable if [he'd] been told it had been brought by spaceship." A Harvard-trained physician and tenured professor who specializes in infectious diseases, Farmer has been leading the charge in treating the seemingly uncontrollable outbreaks of TB (and its frequent partner, HIV) in the poorest areas of Haiti and Peru, as well as Siberian prisons and Boston slums. To the cost-benefit analysts, the resources Farmer devotes to one patient could come at the expense of many, which indicates a possible myopia on his part. But when he and partner Jim Yong Kim take on a small, potentially devastating rash of drug-resistant TB in Peru (at enormous cost per patient, due to the expense of "second-line" drugs), their success causes world health officials to rethink their models. At times, Mountains Beyond Mountains threatens to bury itself too deeply in international policy issues and lose track of the human stories at its core. Yet in this way, it still stays true to Farmer, who himself has to negotiate powerful governments and institutions in addition to making house calls as the "country doctor" in remote Haiti. Sharp, quick-witted, passionate, and empathetic, Farmer comes across as so heroic that Kidder catches himself looking for "chinks in the moral armor." He finds few of them, which does nothing to diminish the book's complexity and power.