Review Mountains Beyond Mountains by Tracy Kidder

Wow. I loved this book - it is engaging, educational and, above all, inspiring! Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World by Tracy Kidder tells the story of Dr. Paul Farmer, the founder of Partners in Health which is an organization that fights disease and poverty among the globe's poorest and sickest in countries such as Haiti, Rwanda and Peru. His personal quest to treat patients one by one, improve their lives and fight for global health equality is impressive.

A Preferential Option for the Poor
Paul Farmer's commitment to public service started while at Duke where he worked became interested in migrant labor camps near the University. He was struck by how wretched the conditions were for these mostly Haitian workers and wanted to learn more about the country they left behind to toil on these farmers as migrant workers. He went to Haiti to volunteer his time while he awaited responses from the medical schools to which he had applied. His life was never the same - from that point on, he traveled to and fro Haiti (even while completing medical school) providing care to the country's sick who were desperate for even the most basic treatment. He quickly realizes, however, that he will never staunch the spread of disease just by treating the patients as they present - the key is in prevention and the institution of some basic public health measures such as clean water and sanitation.

Farmer founded Partners in Health initially to fund a clinic he and others had opened and through which they provided free medical care in Cange, Haiti. He soon became interested in the treatment of TB since it plagued so many of the clinic's patients and he discovered that in addition to primary TB, many patients presented with MDR TB (multi-drug resistant). MDR threatened to cause a catastrophic health crisis and Farmer became impassioned about bucking the traditional public health and infectious disease paradigms for treating TB in impoverished communities. This work expanded PIH's efforts into Peru and Russia where MDR was flourishing and putting the poor population at risk.

"Pathology, social medicine, politics, anthropology. My Model."
Farmer is first and foremost a physician - although he becomes increasingly involved in public health policy and fundraising as his organization expands, he is happiest when he is treating patients in The Brigham in Boston or in any of the clinics throughout the world where he provides essential care to the world's poorest. He meets patients "where they are at" and tries to meet their basic needs as part of their medical treatment - this integration of social medicine and clinical medicine is Farmer's signature and what has made his work for the poorest patients so successful. There are many stories throughout the book of Farmer treating patients both in the first world of Mass General and in the third world of the people's roofless homes in the mountains of Haiti. Within each story, a few things are evident - Farmer has a passion for medicine and the deductive process of diagnosis and he cares deeply for each and every patient. In fact, this became a criticism levied against him and PIH - those in public health circles felt Farmer and PIH focused more on the patient in front of them than on developing sustainable health solutions. While I see the argument that sustainability is important in any public health endeavor and that you can do more harm by swooping in to help and then needing to abruptly leave because your methods were not sustainable, Farmer's brand of personalized medicine is appealing if only because it deals directly with the problem at hand.

My Thoughts
This book appealed to me on so many levels - I work in a scientific field so the parts of the book that dealt with patients and the treatment of disease were very interesting for me. In addition, I have a Masters in Public Health and took courses on healthcare inequities, issues in global health and the principles of public health policy and I feel as if this book could have been taught in any of those courses! Finally, I have always harbored a desire to work for an NGO focusing on healthcare in a underdeveloped country and this book has fueled that desire. My company offers a unique opportunity that would allow me to do this and I am now committed to pursuing it. This book truly affected me and I am happy to see their are unselfish, dedicated and inspiring people such as Dr. Paul Farmer in the world.



I was inspired to read this book by a post from Mel at lit chick following the earthquake in Haiti earlier this year - PIH has been doing work in Haiti for more than 20 years and was one of the charitable organizations able to do the most on the ground immediately following the quake. You can make a donation to PIH here to fund their work in Haiti or in a number of other needy communities.
I read this book for the Social Justice Challenge (AIDS crisis month); it also meets the criteria for the Bad Blogger category of the TwentyTen Challenge and the Non Fiction Five Challenge