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

Social Justice Challenge: "In The World of Water, We Are All Downstream"

The Social Justice Challenge asks participants to learn about a different theme of social justice each month by reading or participating in other forms of media that focus on that theme. This month's theme is Water. This month I took part in one of the other forms of media - the Water H2O=Life Online Resource. The online resource was developed from an exhibit that was at the American Museum of Natural History . It provides a very accessible review of the issues that impact a clean, reliable supply of water and emphasizes the role of water in all living things.

We were asked to reflect on the following questions:

1. What is the first thought that comes to your mind when you think of Water as a social justice issue?

When I think about water as a social justice issue, I think about the developing world where there is a lack of reliable drinking water and the tremendous impact that has on the health of the population. The lack of clean water has a disproportionate impact on the world's poor - potable water is needed to bring people out of poverty. For that reason, improving access to clean water and basic sanitation is one of the UN's Millennium Development Goals. Consider these facts from Water.com:

• 3.575 million people die each year from water-related disease
  
• 43% of water-related deaths are due to diarrhea
  
• 84% of water-related deaths are in children ages 0 – 14
  
• 98% of water-related deaths occur in the developing world
  
• The water and sanitation crisis claims more lives through disease than any war claims through guns.
  
• At any given time, half of the world’s hospital beds are occupied by patients suffering from a water-related disease.
  
• An American taking a five-minute shower uses more water than the typical person living in a developing country slum uses in a whole day
  
• About a third of people without access to an improved water source live on less than $1 a day. More than two thirds of people without an improved water source live on less than $2 a day
  
• Poor people living in the slums often pay 5-10 times more per liter of water than wealthy people living in the same city

2. What, if any, exposure have you personally had to a water shortage?

I have not personally been exposed to a water shortage but I have traveled in countries without reliable access to clean drinking water. While in India earlier this year, I relied completely on bottled water and realized I was fortunate enough to be able to ensure I always had bottled water while much of the population did not have that "luxury". It made me aware of how I take the availability of clean water straight from the tap for granted at home.

3. What potential action steps can you think of that relate to this month’s theme of Water?

• Continue to educate myself about this issue using a variety of resources such as Columbia's Earth Institute and Water.org
• Raise awareness of this issue among family, friends, colleagues and via my blog
• Water is a right but conservation is a responsibility - make changes in my daily life to reduce the amount of water I use including using a refillable water bottle in place of bottled water
  

Review: Nine Parts of Desire by Geraldine Brooks

Nine Parts of Desire: The Hidden World of Islamic Women by Geraldine Brooks is the story of the author's journey through the Middle East as a foreign correspondent for the Wall Street Journal and her examination of Middle Eastern women and the cultural, religious and political influences which shape their lives. In each Middle Eastern country, she befriends and interviews women who tell their stories and describe their experiences living under the laws of their countries and within the requirements of their religion (often one and the same).

Brooks tells the story of a variety of women - poor and uneducated, highly educated, western converts to Islam, royalty, political figures and from a variety of Middle Eastern countries. I found the story of Asya, a recent graduate of Gaza University particularly compelling. Asya, a 29 year old unmarried woman who worked as journalist's assistant and breadwinner for her family, also adhered strictly to the laws of her religion and maintained a life segregated from men and shrouded in hijab. She struggled to find a husband (ok - I can relate to that!) who she could dialogue with and who, while respecting the requirements of their Islamic religion, would also respect her intellect and education. As much as I support and believe in the power of education to overcome injustices and ignorance, it seems almost unfair to educate women in countries where they are often restricted from using that education and many times not respected for their intellect. The author provides an update on Asya (and some of the other women) in the afterword to the book which appears on her website.

I thought this book was very well done and it certainly educated me on the variety of practices within Muslim countries and their impact on its women. Brooks expertly weaved excerpts from te Koran throughout the book and tried to dispute how some fundamentalists had misused the holy text to justify severe restrictions on women. She explores the teaching of Mohammed in an effort to distinguish between his teachings, generally allowing much more equality for women, and those of the more conservative political powers within many Middle Eastern countries. I appreciated the references to the Koran as is helped to substantiate the author's position that many of the oppressive practices enforced in these countries are, in fact, not mandated by the Koran. In addition, it emphasizes that the religion of Islam itself is not to blame for the violation of women's rights and other extremist views but rather the politicization of Islamic religion which has fueled fundamentalist extremism.

This book was written in 1995, and while reading it, I wondered how relevant its explanations of cultural and political influences still were 15 years later. I came the conclusion that in many cases things have likely gotten worse for women in these countries with the move towards a more conservative states which required strict adherence to Islamic law. Brooks seems to have done an excellent job of predicting to spread of fundamentalism throughout the Middle East. The afterword that appears on her website is written in following the terrorist attacks on 2001 - after reading this book, I found her perspective on this event interesting.

If you are looking for an introduction to the Muslim religion as it is practiced throughout the Middle East and its impact on women and their rights within those countries, I would recommend this book. It reads like a memoir, not a textbook, and artfully weaves stories of women with explanations of the Koran and the political forces at play within the Middle East. Excellent!

This book was my selection for January's theme of religious freedom for the Social Justice Challenge ; it also applies for the World Religion Challenge and for the "win win" category of the TwentyTen Challenge