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Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World
Tracy Kidder, 2003
Random House
336 pp.

In Brief
Tracy Kidder is a winner of the Pulitzer Prize and the author of the bestsellers The Soul of a New Machine, House, Among Schoolchildren, and Home Town. He has been described by the Baltimore Sun as the "master of the non-fiction narrative." This powerful and inspiring new book shows how one person can make a difference, as Kidder tells the true story of a gifted man who is in love with the world and has set out to do all he can to cure it.

At the center of Mountains Beyond Mountains stands Paul Farmer. Doctor, Harvard professor, renowned infectious-disease specialist, anthropologist, the recipient of a MacArthur "genius" grant, world-class Robin Hood, Farmer was brought up in a bus and on a boat, and in medical school found his life's calling: to diagnose and cure infectious diseases and to bring the lifesaving tools of modern medicine to those who need them most. This magnificent book shows how radical change can be fostered in situations that seem insurmountable, and it also shows how a meaningful life can be created, as Farmer--brilliant, charismatic, charming, both a leader in international health and a doctor who finds time to make house calls in Boston and the mountains of Haiti--blasts through convention to get results.

Mountains Beyond Mountains takes us from Harvard to Haiti, Peru, Cuba, and Russia as Farmer changes minds and practices through his dedication to the philosophy that "the only real nation is humanity" - a philosophy that is embodied in the small public charity he founded, Partners In Health. He enlists the help of the Gates Foundation, George Soros, the U.N.'s World Health Organization,and others in his quest to cure the world. At the heart of this book is the example of a life based on hope, and on an understanding of the truth of the Haitian proverb "Beyond mountains there are mountains": as you solve one problem, another problem presents itself, and so you go on and try to solve that one too.

"Mountains Beyond Mountains unfolds with the force of a gathering revelation," says Annie Dillard, and Jonathan Harr says, "[Farmer] wants to change the world. Certainly this luminous and powerful book will change the way you see it.

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About the Author

• Birth—November 12, 1945
• Where—New York, New York, USA
• Education—B.A., Harvard; M.A., University of Iowa, Writers'    Workshop
• Awards—Pulitizer Prize and American Book Award, 1992
• Currently—lives in Massachusettes and Maine


Tracy Kidder has won the Pulitzer Prize, the National Book Award, and the Robert F. Kennedy Award, among other literary prizes. The author of Strength in What Remains, The Soul of a New Machine, House, Among Schoolchildren, Old Friends, and Home Town, Kidder lives in Massachusetts and Maine.

More
Tracy Kidder is an American author and Vietnam War veteran. Kidder may be best known, especially within the computing community, for his Pulitzer Prize-winning The Soul of a New Machine, an account of the development of Data General's Eclipse/MV minicomputer. The book typifies his distinctive style of research. He began following the project at its inception and, in addition to interviews, spent considerable time observing the engineers at work and outside of it. Using this perspective he was able to produce a more textured portrait of the development process than a purely retrospective study might.

Kidder followed up with House, in which he chronicles the design and construction of the award-winning Souweine House in Amherst, Massachusetts. House reads like a novel, but it is based on many hours of research with the architect, builders, clients, in-laws, and other interested parties

In 2003, Kidder published Mountains Beyond Mountains: The Quest of Dr Paul Farmer, A Man Who Would Cure The World after a chance encounter with Paul Farmer. The book was held to wide critical acclaim and became a New York Times bestseller.

A number of colleges and universities have used Mountains Beyond Mountains as their common reading book: University of Florida; Gustavus Adolphus College in St. Peter, Minnesota;, Carleton College; Illinois Wesleyan University; Pellissippi State Technical Community College in Knoxville, Tennessee; and Case Western Reserve University.

Mr. Kidder published Strength in What Remains in 2009. (From Wikipedia.)

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Background
Below are excerpts from an interview Kidder had with his publisher:

How did you meet Paul Farmer, and what made you want to write about him?
A: I met him in Haiti in 1994. I was doing a story on American soldiers sent there to reinstate the country's democratically elected government. Farmer showed up one night at the barracks and got into an argument with the commander. I wasn't very interested in him then, but a few weeks later I ran into him on the plane to Miami and I began to learn some of the outlines of his life, which I found very interesting. Farmer was the second of six children, and spent most of his childhood in Florida, the whole family living on a bus and a houseboat that was moored in a bayou on the Gulf Coast. He went to Duke on a full scholarship, and then, while he was earning his M.D. and Ph.D at Harvard, he conceived and helped to build an amazing health care system in one of the poorest corners of Haiti. Around the time when I met him, he and his small band of colleagues were about to go to war against the dominant ideologies in international health — eventually they'd actually win some significant battles.
And I was drawn to the man himself. He worked extraordinary hours. In fact, I don't think he sleeps more than an hour or two most nights. Here was a person who seemed to be practicing more than he preached, who seemed to be living, as nearly as any human being can, without hypocrisy. A challenging person, the kind of person whose example can irritate you by making you feel you've never done anything as important, and yet, in his presence, those kinds of feelings tended to vanish. In the past, when I'd imagined a person withcredentials like his, I'd imagined someone dour and self-righteous, but he was very friendly and irreverent, and quite funny. He seemed like someone I'd like to know, and I thought that if I did my job well, a reader would feel that way, too.
My favorite teacher once used to talk about how writers often have their best stories bestowed upon them, seemingly by accident. I felt as though, in meeting Farmer, I'd been offered a rare opportunity.

Q: What was Farmer's initial response to your wanting to write a book about him and his work?
A: I think the idea made him uncomfortable. At any rate, it took him some months to make the decision. I can't speak for him, but I think he agreed mainly because he was persuaded by some of his closest friends that a book about his life and work might bring attention both to the issues that he cares most about and also to the little organization that he helped to create — Partners In Health.

Q: What does the title, MOUNTAINS BEYOND MOUNTAINS, mean?
A: The title comes from a Haitian proverb, which is usually translated as: “Beyond the mountains, more mountains.” According to Farmer, a better translation is: “Beyond mountains there are mountains.” I first heard the proverb from Farmer, and I remember that he told me, “The Haitians, of course, use it in a zillion different ways.” Sometimes it's used to express the idea that opportunities are inexhaustible, and sometimes as a way of saying that when you surmount one great obstacle you merely gain a clear view of the next one. Of course, those two meanings aren't inconsistent, and I meant to imply both in the title. To me, the phrase expresses something fundamental about the spirit and the scale and the difficulty of Farmer's work. The Haitian proverb, by the way, is also a pretty accurate description of the topography of a lot of Haiti, certainly as I experienced it in my hikes with Farmer through the mountains of the central plateau.

Q: Farmer didn't have a conventional upbringing. Tell us more about that. Do you think Farmer's childhood was influential in the path he's chosen?
A: Farmer's father was a great big man, a ferociously competitive athelete nicknamed Elbows by people who played basketball with him, a sometime salesman and school teacher, with a lot of unconventional ideas and an absolutely pig-headed determination to have his family live by them. He took his family to a town north of Tampa, Florida, where for about five years they all lived in a bus in a campground. Then he took them to a bayou on the Gulf Coast where all eight of them lived in a leaky old 50 foot-long boat. As a boy, Farmer thrived in these unusual circumstances. He was a tall, skinny kid and he disappointed his father by not being much of an athelete, but he excelled in every intellectual department. He seems to have been precocious spiritually as well. At 11 he was given a copy of Tolkien's Lord of the Rings, which he read and then immediately re-read in the space of a few days. Then he took it to the public library and said to the woman at the desk, “I want more books like this.” She gave him adventure and fantasy novels and he kept coming back and saying, “This isn't it.” Finally, she gave him Tolstoy's War and Peace, which he devoured, at the age of 11. It wasn't adventure or fantasy that interested him; it was the epic struggle between good and evil. He didn't have the words to say that then. Returning the library's copy of War and Peace, he simply told the librarian, “This is it! This is just like Lord of the Rings.”
It was a childhood full of family adventures and misadventures and completely unconventional. Farmer himself didn't like to make too much of the connections between his background and the life he chose. At the very least, though, that childhood was good preparation for a life of travel and doctoring in difficult places like Haiti. He emerged from living on a boat in a bayou with what he called a “very compliant GI system,” and from dinners of hot dog bean soup without much fussiness about food, and from years of cramped quarters with the ability to concentrate anywhere. He could sleep in a dentist's chair, as he did at night for most of one summer in a clinic in Haiti, and consider it an improvement over other places he had slept, and I imagine that his fondness for a fine hotel and a good bottle of wine had the same origins.

There were other advantages, Farmer insisted. The kind of father who thought it reasonable to house his family in a bus, then a boat, was also the kind who saw no reason his son shouldn't keep a large acquarium inside. Farmer insisted that he never really felt deprived throughout his childhood, though he did admit, “It was pretty strange.” After living through some of his father's very public misadventures, it was hard to feel embarrassed or shy in front of anyone. He allowed that growing up as he did also probably relieved him of a homing instinct. “I never had a sense of a home town. It was, ‘This is my campground.' Then I got to the bottom of the barrel, and it was ‘Oh, this is my hometown.'” He meant the central plateau of Haiti.

Q: In your travels with Farmer, what most surprised and interested you? Did you learn something from the experience?
A: The thing about travel with Farmer is that you don't visit the brochure sights. His itinerary is pretty much restricted to visiting hospitals, slums, and prisons. The dreadful places of the world. I hadn't imagined that there were so many of those, and I hadn't known just how dreadful they were. But the trips weren't dreary and depressing, because Farmer and his colleagues were doing something tangible, something meaningful, something that was actually improving those places. This was especially true in Haiti and Peru. I'd say that I learned two things above all. That medicine and public health are a powerful lens for looking at the world. And that a small group of determined people can actually alter some of the pictures seen through that lens. I think that as a very young man Farmer chose to work in one of the most impoverished parts of Haiti because he was moved by the suffering he saw there. But if he'd wanted to prove a point about what is possible in public health, he couldn't have chosen a better site. If you can do a good thing in central Haiti, it stands to reason that you can do it anywhere. And what he and his friends have done and are doing in Haiti."

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Critics Say. . .
If you've never read anything by Tracy Kidder, this is book a good place to start—but don't stop here. Kidder is one of the finest non-fiction authors today. Mountains Beyond Mountains is both disturbing—because of ... read more.
A LitLovers Litpick - April '07



Dr. Farmer does not have anywhere near the name recognition of, say, Albert Schweitzer or Mother Teresa. But if any one person can be given credit for transforming the medical establishment's thinking about health care for the destitute, it is Paul Farmer.
   So readers are lucky that Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World has been published, not only because the extraordinary Dr. Farmer deserves the attention, but also because a sensitive and graceful writer like Tracy Kidder has chosen to tell his story. The result is a tale that inspires, discomforts and provokes.
Patricia Cohen - The New York Times



Mountains Beyond Mountains is inspiring, disturbing, daring and completely absorbing. It will rattle our complacency; it will prick our conscience. One senses that Farmer's life and work has affected Kidder, and it is a measure of Kidder's honesty that he is willing to reveal this to the reader.
Abraham Verghese - The New York Times Book Review



Two other things I like about this book: First, it's full of suspense, in an odd way. On every page, I wondered whether Farmer was going to be meek and gentle, as he often is with his patients, or whether he was going to turn his wrath on me, the reader. To the very end, Farmer made me nervous...Second, it's a great Washington, D.C. public policy book. It's an elegant argument about why everything you learn at the Kennedy School of Government or World Bank is wrong.
Thomas Geoghegan - The Washintgon Post



Kidder, author of Among Schoolchildren, focuses on many aspects of Farmer's life. As a renowned journalist, he examines the dedication that pushes Farmer to success. He traveled with Farmer for six years, interviewing his friends and family and creating a compelling bond with the man. In this masterpiece, Kidder will take you so deep into their journeys that you can almost feel the oppressive Haitian heat.
Nicholas Thomas - USA Today



In this excellent work, Pulitzer Prize-winner Kidder (The Soul of a New Machine) immerses himself in and beautifully explores the rich drama that exists in the life of Dr. Paul Farmer. A Massachusetts native who has been working in Haiti since 1982, Farmer founded Zanmi Lasante (Creole for Partners in Health), a nongovernmental organization that is the only health-care provider for hundreds of thousands of peasant farmers in the Plateau Central. He did this while juggling work in Haiti and study at the Harvard Medical School. (Farmer received his M.D. and a Ph.D. in anthropology simultaneously in 1990.) During his work in Haiti, Farmer pioneered a community-based treatment method for patients with tuberculosis that, Kidder explains, has had better clinical outcomes than those in U.S. inner cities. For this work, Farmer was recognized in 1993 with a MacArthur Foundation "genius grant," all of which he donated to Zanmi Lasante. Using interviews with family members and various friends and associates, Kidder provides a sympathetic account of Farmer's early life, from his idiosyncratic family to his early days in Haiti. Kidder also recounts his time with Farmer as he travels to Moscow; Lima, Peru; Boston; and other cities where Farmer relentlessly seeks funding and educates people about the hard conditions in Haiti. Throughout, Kidder captures the almost saintly effect Farmer has on those whom he treats. (Sept.) Copyright 2003 Reed Business Information.
Publishers Weekly


In his latest work, Pulitzer Prize winner Kidder (Among Schoolchildren; The Soul of a New Machine) turns his documentarian gaze on the life and work of Paul Farmer, a medical anthropologist and physician who has spent much of the past 20 years transforming healthcare in the impoverished central plateau of Haiti. Part biography, part public health text, and part travelog, his book follows Farmer from his childhood in Florida and Harvard medical education to his establishment of the Haitian clinic Zanmi Lasante and current status as an international expert in treating communicable diseases, such as AIDS and tuberculosis. Farmer's work is fascinating-as is the author's compassionate portrayal of the lives of the Haitians with whom his subject lives and works; if the book has a flaw, it is that it attempts to cover too much territory. Instead of trying to cram three books into one, Kidder could have taken any one of the three approaches that he used and made a complete and captivating study. However, he does include an excellent annotated bibliography for readers who desire more information on any of the themes covered in the book. Recommended for public libraries and public health collections. Eris Weaver, Redwood Health Lib., Petaluma, CA Copyright 2003 Reed Business Information.
Library Journal


Full-immersion journalist Kidder (Home Town, 1999, etc.) tries valiantly to keep up with a front-line, muddy-and-bloody general in the war against infectious disease in Haiti and elsewhere. The author occasionally confesses to weariness in this gripping account—and why not? Paul Farmer, who has an M.D. and a Ph.D. from Harvard, appears to be almost preternaturally intelligent, productive, energetic, and devoted to his causes. So trotting alongside him up Haitian hills, through international airports and Siberian prisons and Cuban clinics, may be beyond the capacity of a mere mortal. Kidder begins with a swift account of his first meeting with Farmer in Haiti while working on a story about American soldiers, then describes his initial visit to the doctor’s clinic, where the journalist felt he’d "encountered a miracle." Employing guile, grit, grins, and gifts from generous donors (especially Boston contractor Tom White), Farmer has created an oasis in Haiti where TB and AIDS meet their Waterloos. The doctor has an astonishing rapport with his patients and often travels by foot for hours over difficult terrain to treat them in their dwellings ("houses" would be far too grand a word). Kidder pauses to fill in Farmer’s amazing biography: his childhood in an eccentric family sounds like something from The Mosquito Coast; a love affair with Roald Dahl’s daughter ended amicably; his marriage to a Haitian anthropologist produced a daughter whom he sees infrequently thanks to his frenetic schedule. While studying at Duke and Harvard, Kidder writes, Farmer became obsessed with public health issues; even before he’d finished his degrees he was spending much of his time in Haiti establishing theclinic that would give him both immense personal satisfaction and unsurpassed credibility in the medical worlds he hopes to influence. Skilled and graceful exploration of the soul of an astonishing human being.
Kirkus Review

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Book Club Discussion Questions

1. Paul Farmer finds ways of connecting with people whose backgrounds are vastly different from his own. How does he do this? Are his methods something to which we can all aspire?

2. Paul Farmer believes that "if you're making sacrifices...you're trying to lessen some psychic discomfort" (24). Do you agree with the way that Farmer makes personal sacrifices? For what kinds of things do you make sacrifices, and when do you expect others to make them?

3. Kidder points out that Farmer is dissatisfied with the current distribution of money and medicine in the world. What is your opinion of the distribution of these forms of wealth? What would you change, if you could?

4. Farmer designed a study to find out whether there was a correlation between his Haitian patients' belief in in sorcery as the cause of TB and their recovery from that disease through medical treatment. What did he discover about the relative importance of cultural beliefs among his impoverished patients and their material circumstances? Do you think that this discovery might have borad application -- for instance, to situations in the United States?

5. The title of the book comes from the Haitian proverb, "Beyond mountains there are mountains." What does the saying mean in the context of the culture it comes from, and what does it mean in relation to Farmer's work? Can you think of other situations--personal or societal--for which this proverb might be apt?

6. Paul Farmer had an eccentric childhood and his accomplishments have been unique. Do you see a correlation between the way Farmer was raised and how he's chosen to live his life? How has your own background influenced your life and your decisions?

7. Compare Zanmi Lasante to the Socios en Salud project in Carabayllo. Consider how the projects got started, the relationships between doctors and patients, and also the involvement of the international community.

8. Kidder explains that Farmer and his colleagues at PIH were asked by some academics, "Why do you call your patients poor people? They don't call themselves poor people." How do Farmer and Jim Kim confront the issue of how to speak honestly about the people they work to help? How do they learn to speak honestly with each other, and what is the importance of the code words and acronyms that they share (for example, AMC's, or Areas of Moral Clarity)?

9. Ophelia Dahl and Tom White both play critical roles in this book and in the story Partners in Health . How are their acts of compassion different from Farmer's?

10. Tracy Kidder has written elsewhere that the choice of point of view is the most important an author makes in constructing a work of narrative non-fiction. He has also written that finding a point of view that works is a matter of making a choice among tools, and that the choice should be determined, not by theory, but by an author's immersion in the materials of the story itself. Kidder has never before written a book in which he made himself a character. Can you think of some of the reasons he might have had for doing this in Mountains Beyond Mountains?
(Questions issued by publisher.)