Media Review: Mountains Beyond Mountains

By Ingrid Johnson


“God gives but doesn’t share.” – Haitian proverb

Mountains Beyond Mountains by Tracy Kidder (New York: Random House, 2003) tells the story of Dr. Paul Farmer, founder of Zanmi Lasante hospital in Haiti’s poorest province.  Farmer is also the instigator and champion of groundbreaking worldwide efforts to treat and prevent multiple-drug-resistant (MDR) tuberculosis.   Furthermore, with the help of several well-heeled and well-connected friends, Farmer founded and runs Partners in Health (PIH), an organization that works to bring nutrition, sanitation, and medicine to communities in need.

Kidder tells Farmer’s story with warmth, humor, and deep respect.  The journalist met the doctor in 1994 while covering a story in Haiti and the two men became fast friends.  Since then, Kidder has made several visits to Farmer’s hospital, travels with him elsewhere in the world, and helps out with the work of PIH.

Farmer’s life work is an example of dedication, ingenuity, and humble (but hardly timid) servanthood in the face of overwhelming odds.  His conversation, his projects, and his writing address injustices that influence the distribution of both health problems and medical care.  More than qualified to work at the Boston’s Brigham and Women’s Hospital (where he spends part of each year), Farmer prefers his island outpost and seems more at home in a pickup truck jostling down a rutted dirt road or hiking for hours to sit at the bedside of a Haitian peasant in a mountain hut.

Paul Farmer is a true character.  This man does not take ‘no’ or ‘impossible’ for an answer.  He doggedly pursues imaginative solutions because the problems are there and people are suffering; it would be contrary to his nature to do otherwise. Undaunted by social convention or political correctness, Farmer sticks his neck out and says unpopular things in the face of authority—including, on occasion, authority carrying a gun.  During a time of junta military rule in Haiti, an armed soldier entered the crowded Zanmi Lasante courtyard.  Farmer confronted him, “You can’t bring a gun in here.”  “Who the f*ck are you to tell me what I can do?”  “I’m the person who’s going to take care of you when you get sick.”  The soldier, muttering threats, backed down.     

Farmer takes hunger and sickness personally, sometimes spontaneously giving up his own paycheck so that someone more in need than him can eat dinner that week.  His race, nationality, and credentials do not alienate him from the Haitians working alongside him at Zanmi Lasante.  After a day-and-a-half absence on a fundraising trip to the U.S., Farmer received this e-mail from one of the hospital staff:

"Dear Polo, we are so glad we will see you in a mere matter of hours.  We miss you.  We miss you as the dry, cracked earth misses the rain."

The courage and daily embodied ethic of compassion driving Farmer’s work are deeply theological in origin if largely ‘unorthodox’ in expression.  One day while on the road with Farmer, Kidder recalled out loud some words from his religious education, “if you’ve done it unto the least of them, you’ve done it unto me.”  Farmer responded, “Matthew twenty-five,” and then went on to quote several verses from the passage, concluding with a smile, “Then it says, Inasmuch as you did it not, you’re screwed.”

Throughout the story, Kidder quotes Farmer’s always candid and often cheerfully irreverent commentary on situations that would stop lesser people in their tracks.  In an e-mail response to a question from a fellow doctor (Farmer answers his e-mail religiously), he wrote:

 ". . .even hydrocephalus is often due to inflammatory debris blocking the foramina. . . . it’s anatomy and pus, my friend. anatomy and pus. it’s always anatomy and pus."

On an airplane with Kidder, going over patient records, Farmer commented, “And there’s this preemie who worried me because she’s no bigger than a peanut.  But she looked fine . . . for a tadpole.”


Kidder also recounts anecdotes of Farmer’s interesting upbringing and the formative experiences that helped prepare him for his extraordinary career.  The second of six children, Farmer spent much of his youth living on a bus with no running water and in the bayou on a boat called the Lady Gin.  His mother (who had not been to college and worked as a Winn-Dixie cashier) read to her brood at night, a novel called Cry, the Beloved Country (a story of South African apartheid) among other things.  His father was known as the Warden.  One day when the family was short on funds, the Warden declared to Paul and his two brothers, “We’re going to pick citrus.”  Paul objected, “But, Dad, white people don’t pick citrus.”  “Yeah?  I’ll give you white people.”

The story of this colorful, remarkable man is both educational and inspiring.  I recommend Mountains Beyond Mountains to anyone who wants to better understand their place in the world with a view to using privilege to serve others, but especially those in the health care professions.