Mountains Beyond Mountains, by Tracy Kidder

This nonfiction account of the life and work of Paul Farmer raised a number of questions for me. Paul Farmer is a doctor who could have cashed in his degree from Harvard Medical School for a lucrative practice anywhere in the U.S. Instead he chose to start a clinic in a small town in Haiti, a poor area even for that impoverished country. He started out treating tuberculosis and AIDS but soon realised that he also had to deal with source causes such as poor housing and lack of education. Through the foundation he started, Partners in Health, Farmer and his close associates went on to start programs in countries like Peru and Russia, as well as addressing global health concerns in fora like the World Health Organization.

Tracy Kidder’s prose is as absorbing as any novel. I particularly appreciated the structure of the book. It starts with Kidder’s first meeting with Farmer and chronologically follows from there, with detours as appropriate. Kidder folded in background information on Farmer and his associates just when I as a reader wanted it.

One of the questions that Kidder raised was the inefficiency of Farmer’s methods. We discussed the book in my book club, and one member believed that Farmer’s intensive hands-on approach to health care—Kidder described Farmer taking a whole day hiking out to make a single house call—limited the scope of his achievements. Farmer could have used his growing renown to better purpose by devoting himself to global health concerns or by institutionalizing his work. Several people believed that Farmer’s work would not live on without him. But another person said that Farmer’s practice of dealing with the patient in front of him grounded him and enabled him to accomplish as much as he did.

Kidder described Farmer sacrificing his entire life to his work, which raised questions for me. Being married to a genius or a saint is no picnic. Farmer had a wife and child living in Paris, but we didn’t hear much about them and it sounded as though Farmer rarely saw them. He never seemed to relax either, spending all of his time seeing patients, traveling extensively, and raising funds. Do you have to give up everything else in order to do good work? I’ve tried to make Emerson’s motto “To think is to act” my own, but how far can you, should you take right action?

One member of my book club said that the book made her aware of the luxury and waste in her life. She thought she should sell everything she owned and give it where it might do some good. Of course, it would just be a miniscule drop of what was needed and might accomplish little. However, I did think that an unsung hero of the book was Tom White who devoted his entire fortune to financing Farmer’s ventures. Without White’s money, Farmer would not have gotten very far. And I most admired the way Farmer was undeterred by how the problems he addressed were huge and ultimately unsolvable.

On the other hand, self-sacrifice can be a trap. In The Birds of Paradise —a remarkable novel and one of my favorites—Paul Scott wrote about how seductive it could be to make a burnt offering of yourself. Not only can it feed the illusion of your own importance, but it becomes a way of avoiding other decisions and other responsibilities. However, if Kidder’s account was accurate, then Farmer was not concerned with his own glory, only with the health of the patient in front of him, a single person, not a theory or the public’s acclaim. My friend was right: that is the way to stay grounded.

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