This article is an excerpt from the Shortform book guide to "Mountains Beyond Mountains" by Tracy Kidder. Shortform has the world's best summaries and analyses of books you should be reading.
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Who is Dr. Paul Farmer in Mountains Beyond Mountains? What was his mission? What were his views on health care?
Dr. Paul Farmer is a medical physician and anthropologist who devoted his life to providing health care to those in need. He believed that medical care should be available to everyone, and he went to great lengths to deliver that care: literally traversing mountains to treat his patients.
Keep reading for more about Dr. Paul Farmer, his approach to health care, and his unyielding commitment to serving the poor.
Dr. Paul Farmer: Anthropologist, Physician, or Saint?
Paul Farmer has worked for decades to provide health care to patients in Haiti and around the world. A doctor and anthropologist by training, Farmer saw the health of a nation’s people as a product of its culture and political history.
In 1983 Farmer arrived in Haiti and began his anthropological work: interviewing Haitian people to understand their life circumstances and politics.
However, Farmer soon realized that he had a fundamental conflict with observing people without any attempt to help them. From Farmer’s perspective, this made little sense when there were practical health services that could greatly improve people’s quality of life. So, he decided to go to medical school at Harvard University to earn a dual degree in medicine and anthropology.
During his years at Harvard, Paul Farmer set up a hospital in the Haitian city of Cange. He envisioned a multi-level health system for Cange and the villages surrounding it:
- Preventative services: clean drinking water, sanitation, vaccines, and women’s health services
- A network of locals who could teach people about health practices and identify illnesses, particularly severe ones like tuberculosis.
For any ailments not addressed at these levels, people could seek treatment at his clinic in Cange.
Farmer was very compassionate in his approach to treating patients. For example, he treated a patient who was homeless, Joe, he asked him what kind of shelter or additional treatment he wanted. Joe wanted a shelter where he could be treated for his HIV but wouldn’t get penalized for drinking alcohol, which is often forbidden at shelters.
Farmer found Joe a shelter, but it still forbade drinking alcohol. But for Farmer, sheltering a patient and allowing them some vices was still preferable to them being out on the street. On Christmas, he visited his patients in the community, including Joe, and brought them presents. For Joe, it was a six-pack of beer, which he gladly received, calling Farmer a saint.
Farmer didn’t think he deserved to be called a saint. He liked the idea, but he thought he’d need to work considerably harder to merit the title.
Traversing Mountains Beyond Mountains to Treat Patients
During his work in Haiti, Farmer often slept no more than 4 hours a night because he was thinking about patients who needed treatment but weren’t getting it. More broadly, he felt ambivalent about charging for his medical care knowing that many couldn’t afford it. For him, it spoke to a greater need to improve the distribution of medicine and wealth.
In Haiti, there is an expression that says, “beyond mountains, there are mountains.” Though Farmer faced immense obstacles to bring care to those in need, he felt a sustained and urgent drive to deliver the best care possible.
Paul Farmer would literally traverse mountains beyond mountains to treat his patients. One time, a TB patient missed his monthly appointment, and someone needed to go check on him to ensure he was still taking his medicine. Farmer decided to do it himself. He had to hike 3 hours on mountain trails to get to the patient’s home. It demonstrated the lengths Paul Farmer would go to serve his patients—traversing mountains beyond mountains.
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Here's what you'll find in our full Mountains Beyond Mountains summary:
- How Dr. Paul Farmer came to operate a hospital in Haiti
- What the connection is between sorcery and tuberculosis
- How Dr. Farmer's organization is a model for treating patients in poor countries