Mountains Beyond Mountains

Traces the efforts of Dr. Paul Farmer to transform healthcare on a global scale, documenting his visits to some of the world’s most impoverished regions and the unconventional methods that enabled him to improve and save lives.

One thought on “Mountains Beyond Mountains

  1. Gail Pritchard & Deborah Dimmett says:

    Deborah and I spent last year co-organizing a medical mission trip to Haiti. Deborah led the mission and was accompanied by 4 University of Arizona medical students, a nurse, and two student volunteers. For Deborah, this was the first medical mission, but the 10th year spent traveling and working in Haiti; for Gail, it was an introduction to an island and her people and a year of soul searching. As we prepared the students for this trip, we gathered up many different readings; some, Deborah had read with her middle school students, others were those newly discovered. We decided to share some of those with you this month and hope they will reveal both the myths and truths of Haiti.
    Deborah’s Take
    Mountains Beyond Mountains is a biography about Dr. Paul Farmer, who developed a deep interest in Haiti as a young man and developed a medical practice not only in Haiti but also in Cuba, Peru, Mexico, Russia, and Boston where his organization, Partners in Health, is located. The story begins with Farmer’s unusual upbringing and humble beginnings as a child and young adult. Much of his life was spent living in cramped living conditions with his parents and siblings. His father, a teacher who Paul affectionately refers to as the Warden, leaves teaching to pursue a different life for his family. They head to Florida in a Blue Bird bus, which becomes their home. It is there he first encounters Haitians working in the fields. After talking with some of them, he studies Haitian Creole and reads about their history, culture, arts, literature, vodou, and the living conditions of the Haitian people.
    In spite of Farmer’s economic disadvantage, he is able to attend Duke University and the Harvard School of Medicine to earn an M.D. and a Ph.D. in Anthropology. While working on his advanced degrees, Farmer makes frequent trips to Haiti beginning in 1983. During these trips, he provides medical care for those in the rural areas of Cange, where he opens a small clinic, Zanmi Lasante. Later, he builds and opens a highly acclaimed teaching hospital near Cange in Mirebalais. Half way into the book, the emphasis turns to Farmer’s interest in treating those who have developed multi-drug-resistant (MDR) tuberculosis. Farmer collaborates with other doctors from Cuba, Peru, and Russia to acquire an approved treatment with the drugs needed to fight MDR. He faces not only epidemiological challenges, but also financial difficulties and run-ins with the World Health Organization whose treatment of MDR is ineffective.
    Mountains Beyond Mountains also explores the philosophy and psychology of Farmer, who adopted the liberation theology position on preferential option for the poor—O for the P—which was also former president Jean-Bertrand Aristide’s manifest. His concern for the poor was particularly elevated because disease affected the poor in disproportionately high numbers. Believing that health care is a human right and not a privilege, he continues to work extensively around the world to treat people who are too poor and weak to seek health care on their own.
    The adaptation of this Pulitzer Prize winning book is expertly adapted by Michael French—an author of 20 published books including a number of adaptations of acclaimed works for young adults. Having read the original version of Mountains Beyond Mountains twice—once with middle school students—French’s adaptation superbly re-presents the biographical narrative and events with the tension and excitement in the original text. Furthermore, he has expertly re-presented Kidder’s voice as well as the voice of Farmer and others presented in the book. There was no disconnect between the voice and events presented in the original reading with those presented in the adaptation.
    Michael French’s adaptation cleverly includes geographical, historical, political, cultural, and medical information that a young adult would find helpful in understanding the biography and the relevance of some of the steps that Farmer had to take to realize his goals and initiatives of serving the poor. For example, when Farmer first begins to visit Haiti, Jean-Claude Duvalier reigned over Haiti with a corrupt and cruel governance. The original text assumes the reader has some knowledge of Haiti’s history prior to reading the book. French, on the other hand, knows young adults will need to have this information provided so the reading of Mountains Beyond Mountains will be a more meaningful experience.
    I have been traveling to Haiti for 10 years to work primarily in the areas of literacy, teacher education, and human rights. Last summer I co-organized and oversaw a two-week medical mission in Gressier, Haiti. Reading Mountains Beyond Mountains reminds me there is more I can do to further the effectiveness and sustainability of projects like that one. Although the reader might feel defeated, I feel reinvigorated with each reading. In French’s adaption, Tracy Kidder quotes his editor, who remarks on the perseverance of Farmer to make a difference:
    His life looks hard, but it also looks enviable. When he wakes up in the morning, he doesn’t have all sorts of conflicting feelings about his life. He knows what he’s going to do and he believes it’s what he ought to do, what he was put on earth to do.
    In the adaptation’s foreword, Kidder comments on his editor’s remark:

      If there is a lesson to this book, that may be it—not that everyone should go out and try to cure the world, but that all our lives are richer for having purpose, for pursuing something larger than ourselves.
      French’s adaptation of Mountains Beyond Mountains is a gift to young adults
      who are looking for meaning and motivation in their life. It gives them an opportunity to understand much more about the world they live in and to realize that there are whole communities, if not countries, of people who wake up each day and don’t know if they will have the means to eat or the sustenance to overcome opportunistic illnesses that strike the poorest people.

    Gail’s Take
    Prior to meeting Deborah, I knew practically nothing about Haiti and it turns out much of what I thought I knew was based in misconceptions. It has now been 6 months since the very successful medical mission trip and I find myself still devouring anything and everything I can find to read about Haiti. So it is with much pleasure that I begin this series of book talk exchanges with Deborah and you—the readers of My Take/Your Take…
    In my first day of reading Mountains Beyond Mountains, I sent Deborah several text messages:

      “I think my favorite quote is on pp 37-38 about treating TB and not giving food, too.”
      “My new motto might be mountains beyond mountains….”
      “Paul Farmer makes me want to be a better person.”

    I’ve read a lot of books over the year and I can’t think of another book that motivated me to text someone what I was thinking as I read!
    I knew a little bit about Paul Farmer before reading this book. It is impossible to read about health issues in Haiti without coming across Farmer’s name and his work in Haiti, particularly his new hospital in Mirebalais. I was surprised by how much the students knew about him. During this past summer while Deborah and the medical students were in Haiti, I took a global health course, and Farmer’s name came up many times in discussions about infectious disease and poverty. He is something of a rock star in the medical field. From the minute I began this read, I was deeply immersed in the story of a man who “had built a modern facility that provided health care for people who were living and dying in abject poverty” (p. 2). It is clear from the beginning of this book that Farmer is unique—from his tireless procurement of health care for the poor to his philosophical ponderings—he is remarkable; as the saying he goes, he walks the talk. He describes his intent as not to make others feel guilty, but to “help a new generation to get a sense of the extent of global poverty and the challenges and opportunities it presents to those who want to help improve the world” (p.5).
    As part of his story, I learned more about Haiti’s history, particularly in regard to U.S. involvement and the Central Plateau Region, the site of Farmer’s clinics. During the 1950’s, the U.S. “gave” Haiti a dam on the Artibonite River. The Army Corps of Engineers designed the Péligre Dam and it was financed by the Export-Import Bank of the United States. This dam flooded some of the most fertile farmland in the area and forced the residents to flee up the mountain—all with no warning from the government. While an elite group of business men in Port-au-Prince benefited from the electricity provided by the dam, the “water refugees” were left homeless with no way to support themselves. It was this area of extreme poverty that called to Paul Farmer.
    On his first trip to Haiti, just prior to beginning medical school, Farmer volunteered for a group called Eye Care Haiti. While doing outreach work in Mirebalais, he met Ophelia Dahl, daughter of Roald Dahl and Patricia Neal. “Her well-known father…had sent her to Haiti for a taste of adventure and perhaps to find a useful life serving others” (p.71). That was the beginning of a life-long relationship between the two and she still serves as executive director of Partners in Health (PIH), the organization established by Paul, Ophelia, Jim Kim, Todd McCormack and Tom White to provide healthcare to Haiti’s poor in the Central Plateau Region. PIH became the vehicle for Paul to act upon his convictions.
    One of those convictions centered on the relationship between poverty and effective medical treatment. “Farmer believed, without serving a patient’s other needs: basic education, habitable housing, clean water, food security, and hope for a better future,” proper medical treatment could not be effective (p. 17). It was in Cange, where the poorest of the poor and the sickest of the sick lived, that Farmer put his conviction to the test and built his first clinic, Zanmi Lasante. For Farmer, “giving people medicine for TB and not giving them food is like washing your hands and drying them in the dirt…” (pp. 37-38). In Cange, the school constructed by Father Lafontant would be further developed, a kitchen feeding over 2000 each day would be built, and a women’s clinic and a TB clinic would be established. Farmer would address the Haitians basic needs as he cared for their physical ailments.
    Throughout his decades of work in Haiti, Farmer has encountered mountains beyond mountains—a Haitian proverb that Kidder describes as meaning “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.” As I read Mountains Beyond Mountains, I was constantly reminded that rather than being discouraged at “Haiti’s problems [that are] impossibly deep and tangled,” Farmer saw them as a thousand open doors.
    And as I completed the book, I realized, as Kidder points out, “Farmer is so gifted, so self-sacrificing, and so passionate about his cause that it is sometimes hard to believe he’s for real…. At first Paul Farmer made me feel inadequate and even a little guilty. …. But he didn’t mean to make me feel that way, and I came to realize that he did not expect everyone to follow his path” (pp. 4-5). Farmer does not expect others to be like him, but he does expect them to do what they can, to have purpose, to pursue “something larger than ourselves” (p. 5). Having read Mountains Beyond Mountains, Tracy Kidder, Michael French, and Paul Farmer make me want to be a better person.

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