In my entire life I have read six books from start to finish in one sitting. In the cases of The Great Gatsby or Pale Fire, I read them straight through because I had enjoyed the work previously and had a desire to experience the books as wholes, without interruption, as Poe suggests we experience short-stories. In the cases of Infinite Jest and Anna Karenina, I embarked on a narcissistic challenge just to see if I could, in fact, consume such massive amounts in one sitting.
But my two greatest experiences of reading something in one sitting are Omnivores’ Dilemma and now, Mountains Beyond Mountains, the latter written by Tracy Kidder and recommended to me by my sister Markay. I started Mountains Beyond Mountains one evening at 11 pm and finished sometime before dawn. The need to read this book (as well as Omnivore’s Dilemma) straight through without interruption was not due to planning or experimentation but because it seemed unwise not to. Within the first few pages, I knew I would have to read each of these books straight through, because they were, at least to me, revolutionary.
Revolution is a word I often use in these reviews, but not without a specifically intended meaning. Too often it is understood as a word applying to a group of individuals claiming or reclaiming power for their own interests. Even when I use it in reference to capitalism, this is not how I mean it. When I talk of revolution, I mean a sudden massive shift in thought necessary to bring about change. Mountains Beyond Mountains, a biographical portrait of Dr. Paul Farmer, is revolutionary to me because it so acutely exposes, unlike anything I’ve ever read, the massive obstacles that are in place preventing modern first world societies from treating (or even curing!) the global health pandemics, even when the medicine and treatments are widely available. In addition, Mountains Beyond Mountains presents a way, practiced by Dr. Farmer, to eradicate curable diseases from our planet. Not only does Dr. Farmer provide a highly skilled method of entering poor (developing) countries, starting health centers and treating these individuals, but, perhaps more importantly, he gives us a reason why we should do it.
Dr. Paul Farmer is one of the few people in this world who straddle ‘the great epi [epidemiological:] divide (125).’ This dividing line on a map, as Kidder describes it, marked by the use of two colors to signify two separate societies. One color represents people who live to an average age of 65 – 75 and who die most often from diseases of sedentary post-industrial living, of overconsumption, or of the inevitable diseases of aging; the other color would signify people who on average die 10 -40 years sooner from violence and poverty and often due to curable disease that medical science knows how to prevent and cure. This is the line that divides many cities and many countries and which few of us ever cross. Dr. Paul Farmer, a Harvard trained doctor and anthropologist, spends eight months of every year in Haiti running a clinic that treats TB, and the remaining four months of the year in Boston working on books, raising money, and living with his family. His clinic in Haiti is renowned for not having a single TB related death within its area of service in over 12 years, an accomplishment virtually unheard of in other impoverished areas, including the ghetto’s of America’s own cities. (In the six months I worked in San Quentin, over 15 people died of TB.) Not only is Dr. Paul Farmer able to effectively treat TB in Haiti, he is able to do it for several hundred dollars a patient, while in an American Hospital that treatment might cost up to $30,000.
Beyond his clinic in Haiti, Dr. Farmer has made significant achievements in advocacy across the globe, from Peru to Russia, by presenting plausible ideas of treatment and wealth distribution in order to foster this treatment. The narration of Dr. Farmer’s life offers an exhausting account of his achievements in the face of Western Institutions that not only prevent medical care from spreading across the globe but also often contribute to the spread of the disease itself. His insights into these issues range from his understanding and acknowledgement of local beliefs (he works within Voodoo beliefs in order to get his patients in Haiti to take TB meds) to his understanding of the most productive ways to use money to achieve a goal (i.e. cost-effectiveness). He’s the type of guy you’d want drawing up the country’s budget, analyzing how each expenditure contributes to achieving a goal, which for him, is curing human beings and saving lives.
Some of the revolutionary feeling inspired by this book comes from witnessing Dr. Farmer’s endless energy, devotion, and his brilliance in treating health issues across the globe. However, the true revolution, the true shift in thought, is instigated in me by the answer he gives to the question of ‘why?’ It’s not a direct answer, not argued systematically in one paragraph or chapter, but can be found interwoven through the entirety of the book. It ‘s based in liberation theology’s fundamental goal – to provide a preferential option for the poor. Dr. Farmer embodies this practice in Boston as much as he does in Haiti. When he encounters a homeless drug addict with AIDS in Boston, he helps the man into a home, where he can at least be among people, sit in a chair and drink a six-pack every day. This might not be a cure, but Dr. Farmer draws a clear logical list of the progress this creates – beer versus heroine, roof versus streets, warm versus cold.
While liberation theology is another tool in Dr. Farmer’s toolbox of treating global health pandemics, it also serves as a compelling reason for why the Western World should partake in the eradication of disease among underprivileged nations. At one point in the book Dr. Farmer is railing against the American elite whom he is often critical of. While he is thankful for their money and their willingness to contribute to his causes, he feels they “think all the world’s problems can be fixed without any cost to themselves. We don’t believe that. There’s a lot to be said for sacrifice, remorse, even pity. It’s what separates us from the roaches (39).” While many contribute by shedding some of there excess needs, only a few, like Dr. Farmer, actually sacrifice. The author tries to emphasize this point by featuring some of Farmer’s eccentricities and focusing on his loves of high-class dining, good wine, and the wife and child in Boston he spends eight months of every year apart from. In this way we don’t see Dr. Farmer merely as a renegade healer obsessed with curing people, but a more fully realized and complicated being who chooses to sacrifice on a daily basis.
To understand Paul Farmer’s answer to why we ought to devote ourselves to the eradication of global poverty and disease we must return to liberation theology and to the belief that every human has a right to the fair pursuit of a fully realized life, and that not contributing to ensuring this right is unjust. By combating this injustice and throwing his entire life into doing so Dr. Famer must be seen, and is depicted throughout this book, as embodying a virtue seldom valued. In this sense he is a hero, but his heroism is not singular or fated to him alone. His feats are not something only he could have achieved, a fact he himself points out. Instead, he leads and calls others to follow his path as he provides the knowledge of how to do so.
This book is a revolution because it makes other things that seemed important suddenly seem not nearly as significant. Global Justice with regard to the distribution of medicine and the application of cures is not as valued as things like Politics, or March Madness, or stock prices. The amount of time and energy we devote to these things makes them de facto Virtues in our society, held up as high as if they were eternal values. Currently though, crossing ‘the epi divide’ is seen as strange or foreign or something interesting to do in your twenties as an “interesting, enriching experience,” or to spice up a CV, and it is certainly something the current health care environment deters by failing to reward this commitment to the eradication of poverty and social justice by permitting excessive predatory lending to health care students, which in medicine incentivizes sub-specialization and healing the rich.
We might also think that Farmer’s crusade is appealing and nice in theory, but only feasible for a few zealous physicians, or something we agree with in principle and long for quietly but can only afford to join in with once we have more time or more money, individually or as a society. These are just excuses to disguise the truth that we just don’t really care enough unless we are instructed to by a book, media or a politician. If we can dump billions of dollars on Tsunami victims one Christmas morning or spend billions invading a country, we can cure TB – if we want to. And the possibility always remains that – following Dr. Farmer and others’ examples – we can realign our virtues and move forward with different values in mind so that we will feel when looking at untreated TB patients and AIDS victims the same outraged sense of injustice we currently feel when we read of the victims of bank defaults or ‘ponzi’ schemes. Without a revolution, however, there will be no change. This is a book that can cause that revolution. You just have to read it.