Mountains Beyond Mountains a biography by Tracy Kidder: Why anti-poverty crusader Paul Farmer irritated me
Written: Mar 27 '06 (Updated Oct 11 '06)
Product Rating:
Pros: Engrossing writing. Powerful sustained argumentation. Intriguing insight into an important crusade.
Cons: None. Farmer is someone that may irritate you, but that's part of Kidder's point.
The Bottom Line: Kidder's the most engrossing non-fiction writer I know. His biography about Farmer details one of today's great medical heroes. Too bad Farmer irritates me, (and occasionally Kidder too apparently).
benho's Full Review: Tracy Kidder - Mountains Beyond Mountains Books
Paul Farmer is a Harvard medical school professor who spends most of his time in Haiti fighting tuberculosis, AIDS and more generally poverty, both in Haiti and around the world. As someone who has dedicated his life to providing medical care for the truly impoverished, Farmer is a hero for my girlfriend, a med student, but somehow I always found him to be unsettling.
Tracy Kidder is the author of Soul of a New Machine, a Pulitzer Prize winning ethnographic analysis about the motivations of geeky computer engineers. It was the most compelling non-fiction book I have ever read and a crucial part of my education as an economist. As soon as I saw that Kidder had written a new biography, Mountains Beyond Mountains, subtitled "The Quest of Paul Farmer, A Man Who Would Cure the World" it was a book I bought at once for the both of us.
Kidder somehow accurately articulates exactly what always unsettled me about Farmer. It is some combination of his holier-than-thou crusade for the poor, his purposeful inspiration of guilt into all around him, his Communist ideology, and his utter disregard for efficiency. However, through personal narrative, Mountains Beyond Mountains leads the reader through Kidder's budding appreciation of Farmer as they travel together in the course of Kidder's research. Kidder helps the reader understand Farmer by showing how the medical crusader overcame Kidder's own misgivings, partly through his important academic contributions to the understanding of epidemics, partly through his immense personal dedication toward the eradication of poverty, but primarily through the inherent goodness of Farmer's morality which Kidder comes to appreciate.
But I should be more precise.
While Farmer was a young medical student working in Haiti, his girlfriend Ophelia mailed him a collection of contemporary novels to which he replied with a "book report of sorts" 'The entire novel is more fun if you've read Dante's Inferno, Joyce's Ulysses (the chapter in which Bloom brings Molly breakfast in bed), Homer, Proust (a la Recherche du Temps Perdu), and The Maids, a play by Genet.'" At least Farmer and I have something in common. After reading Kidder's biography, my reply to my girlfriend began "Kidder's biography is more fun if you've read Kant, Marx, Rand, Nietsche..."
I should also make clear that if I met Farmer in person, I would probably like him quite a bit. He is clearly a phenomenally smart guy. Farmer grew up living in boats and trailers in the rural south, on occasion picking fruit with Haitian immigrants, received a full scholarship to Duke, and while attending Harvard Medical School, started a public health program in Haiti that has since become the model for such systems around the world. Though I find much of his morality and ideology wrong-headed and repellent, Kidder makes it clear that Farmer is smart enough to recognize the paradoxes and contradictions of his thinking. For me, if someone truly understands all sides and angles, I can agree to disagree.
Farmer has done a phenomenal amount of good in the world. His medical anthropological analysis of how politics and poverty interact with medical epidemiology is a significant contribution in the fight against future epidemics. Even better, beyond theory, Farmer has affected and effected global policy in handling tuberculosis and AIDS, saving countless lives. Most important to Farmer is that he has done all that while spending most of his time interacting one-on-one with his own impoverished Haitian patients.
That being said, Farmer still somewhat irritates me. I should preface the following by echoing Kidder who at some point has to stop himself from holding Farmer to higher standards than everyone else. Despite my complaints Farmer undoubtedly has been a force for good in this world.
That being said, early on, Kidder nails dead on one of my prime irritations: "for me the problem often was that I couldn't muster a sufficient response internally. I'd feel sorry that so many Haitian children still died of measles; but I'd also feel that I could never be sorry enough to satisfy him. I'd end up annoyed at Farmer for a time, in the way one gets annoyed at others when one has done them a disservice" (emphasis added).
That summed up my feelings perfectly. Like, I get it, I feel bad, and I know I should feel guilty, but Farmer makes me feel like he is judging me by his righteousness.
"[Farmer is an inspiration]... Not as a comforting example but as its opposite"
He is not a supportive positive inspiration supporting all things good, but an angry negative inspiration fighting against all things bad. That really is the crux of things. Both methods could work; I guess I just prefer the positive way to do things.
The review in the Economist magazine pulls a similar quote: "As Mr Kidder observes, 'Farmer wasn't put on earth to make anyone feel comfortable, except those lucky enough to be his patients.' Or those unlucky enough to need him."
And Farmer admits that is exactly his intention: to make what he calls WL's-White Liberals-feel guilty enough to give up some of their luxuries to help the poor. He uses WL like I use the term, "NPR-liberal," a term that well describes myself to some extent and most of my friends to a much larger extent. It is a shame that to Farmer, WL is synonymous with "a**hole."
Farmer is disdainful of the bourgeois capitalist society that gave him an education, funds his lifestyle, and pays for his charitable works. The irony is that Farmer is a product of Harvard though he claims (perhaps ironically) that Harvard is evil. He spends enormous amounts of money jetting around the world on a whim (which Farmer admits is a luxury) with fancy toys like satellite phones and laptops in nice hotels, for a good cause for sure, but Farmer lives a lifestyle supported by the system that he derides. Though Farmer stands at the forefront to receive the heroic adulation that he richly deserves, the businessmen and capitalists whose money he is using are left in the shadows.
Kidder paints Farmer and his closest friends, Ophelia and Jim, as modern day Marx and Engels, philosophizing in cafes for hours about the plight of the poor. Like Marx, despite their proletariat leanings, both Marx and Farmer have a similar taste for good food and wine.
Farmer embraces Communism. He idealizes Fidel Castro. While Kidder and Farmer visit Cuba, Farmer wishes the rest of the developing world could be run the same way. Farmer was only seeing the parts of Cuba that fit his preconceived ideology. As Kidder's recount of Farmer's visit led me to have these qualms, Kidder makes the same observation, "I felt that Farmer was suspending his usually sharp critical judgment. I thought he was looking only for things to praise."
Ophelia eventually rejects Farmer's proposal for marriage because for Farmer, the world revolves around him and his patients. She couldn't deal with Farmer's single-mindedness and absoluteness of conviction, "'You are so sure about some things,' she remembered...the frustrating thing was, he usually was right," usually but not always. Their friend Jim helped run parts of their project, but Farmer acted "as if everything on his agenda mattered more than anything Jim might have to do himself. For years, Jim used to pick him up at the airport, but Paul never did that for him, not once."
Farmer's single minded devotion to his patients perhaps irks the economist in me the most. Kidder struggles to come to grips with this attribute as well. Like Kant, Farmer sees people as an ends rather than a means, in that he values the life of every patient of his as infinitely valuable, and never as a statistic or part of some larger goal. Thus he rejects cost-benefit analyses that try to maximize the number of lives saved; for Farmer, every life deserves his complete attention. For an economist, this leads to very frustrating inefficiencies.
While most doctors consider their own time so valuable, they limit each patient to five minutes, Farmer happily spends seven hours walking over "mountains beyond mountains" to check to make sure just one patient is keeping up with his TB medications. He ignores all the other patients he could be seeing during this seven hour trek, because at that moment, that particular patient's life is paramount. At another instance, Farmer's cash strapped organization spends $120,000 to fly a dying Haitian boy with cancer to a hospital at Harvard, for the small chance that it might save his life; the boy died shortly after arriving in Boston. The money could have been spent on enough TB medication to save dozens of other lives (by Farmer's own calculation), instead of just one. Kidder wondered if Farmer's actions had "more to do with proving the heroics of the organizations than saving [lives];" they willfully ignored the most cost effective way to save as many lives as possible in order to save the person right in front of them.
Farmer justifies his actions by rejecting the premise of the situation, that economic necessity requires choices to be made. He believes all should be saved. He acts as a Nietzschean ubermensch, exerting will over rationality. His academic contribution is not just that economics and politics play important roles in shaping epidemics, but also that the constraints imposed by economics and politics can be defied.
When a dying boy is sitting in front of you, with a name and a face, it of course becomes perfectly reasonable to want to spend every dollar and make every effort possible to save his life. Though that boy was flown to Boston at the expense of so many others, bringing him there changed the perceptions of the other Harvard doctors; one made the comment "Poverty in a place like Haiti is difficult to personalize. If it's in front of you it has a reality." Airlifting the boy to Boston changed the doctors' reality and led them to donate even more money to Farmer's efforts than the $120,000 spent on the boy's treatment.
For me, that is the key. Kidder gives the sense that Farmer understands well the inefficiencies and paradoxes of his methods and morality. Farmer knows and appreciates the privileges he has been given by living in America, but insists on fighting for a better way. Thus I respect the choices he has made though I may personally disagree. Kidder, Farmer, and Farmer's colleagues all acknowledge that Farmer is not a good role model. Not everybody has the power to exert their will over the realities of others. Paul Farmer is thus exceptional.
The genius of Kidder's first person narrative of his travels with Farmer is that it allows the reader to relive Kidder's gradual enlightenment as if it were our own. Kidder starts with my own initial point of rational skepticism, but brings us to a point of shared understanding.
For while Farmer is an exception, he is also an archetype to which many doctors aspire: a paragon of unflinching devotion to his patients. This single minded devotion at the expense of rationality is why the medical profession will forever be at odds with those who write the checks, though both are essential to the well being of those being cared for. Perhaps, however, Kidder's biography of Paul Farmer's life can help serve as a bridge that brings mutual understanding.
(Full disclosure: I used to have a friend at MIT who used to work for Paul Farmer. I think he irritated a lot of people for the same reasons Paul Farmer does.)
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