Tracy Kidder met Paul Farmer in 1994 when the former was writing an article about Haiti. They next met again in 1999 but it was only when Kidder expressed an interest in Farmer and his oeuvre that Farmer emailed him back, writing "To see my oeuvre you have to come to Haiti" (17). Kidder did just that, following the peripatetic workaholic Farmer to Peru, Russia, Boston, and wherever Farmer flew, which is anywhere there is poverty and disease, especially infectious disease.

In Mountains Beyond Mountains (MBM), Kidder chronicles Farmer’s childhood, medical school years (almost a correspondence course with Farmer’s frequent trips to Haiti), his founding of Partners in Health (PIH) and the construction of the medical center in Cange, Haiti, where "Partners in Health" becomes Zanmi Lasante in Creole.

The story of Farmer’s crusade for a more rational anti-tuberculosis regimen for resistant TB; his political struggles to wrestle with drug manufacturers to lower the price of these and medicines for HIV; his charismatic establishment of a larger and larger cadre, then foundation of co-workers; the story of Jim Kim, a fellow Harvard infectious disease specialist; Farmer’s marathon house calls on foot in Haiti; endless global trips punctuated by massive email consultations from all over the world; and gift-buying in airports for family, friends and patients--these are fascinating reading. In the end one is as amazed and puzzled by the whirlwind that is Paul Farmer--surely a future Nobel Peace Prize laureate like Mother Teresa--as Tracy Kidder was and grateful to have the opportunity to read about it by such an intelligent writer.


Paul Farmer is a phenomenon, a genius of many fabrics. He is of the same ilk as Joan of Arc, Martin Luther, and Albert Schweitzer, although it would most certainly pain him to hear this, judging from MBM. If one were to construct a Venn diagram of the seven overlapping circles of compassion, intelligence, drive, moral commitment, maturity, judgment, and charisma, with the extreme values of each overlapping, then very, very few people would fall in the 7-set of confluent penumbras. Paul Farmer is a 7-set human being with these virtues and abilities. He happens to be a physician, although my guess is that he would also object to this fact as a happenstance.

Tracy Kidder is almost as rare a combination of journalistic experience, writing skill, judge of human character, the ability to assess persons worthy of book length studies, and the wisdom to know that "honesty is the best policy" is also true for writing. Kidder clearly felt ambivalent about Farmer for most of the book and explicates the reasons why he and certainly many readers occasionally find Farmer hard to take. There is a hint of smugness, a smidgeon of self-righteousness, a moral superiority and impatience with many types of people [fools, those who disagree, do-nothing white liberals--what Teddy Roosevelt referred to as the "timid good man" (reference 1)--bureaucrats, curmudgeons who would be physicians (252)--surprising since he himself is such a curmudgeon; but one suspects he means in their dealing with patients].

Yet, as Kidder and the reader come to appreciate, Farmer is the real deal, warts (minor, in the big picture) and all: a true historical prodigy who single-handedly, and then with his army of recruits, ranging from millionaires to world leaders to nameless and faceless (to the reader at least) acolytes, has successfully changed how the entire world treats tuberculosis, views care of the third world poor, funds "orphan" medications for the many sick Haitians and Peruvians of the book and approaches "unsolvable" institutional problems.

The best parts of the book, aside from the careful and meticulously researched development of Farmer and his colleague, Jim Kim, are the long dialogues--almost Socratic in quality--between Kidder and Farmer. The final conversations betray a highly skilled interviewer and wise man who fervently believes in his vision, but one who is far from naïve about the realpolitik of health care economics. Farmer finally comes across as the religious crusader he is [{"’I’m not truly humble. I’m trying to be humble.’" (289)] on a mission he knows is, at best, a long shot: ". . . How about if I say, I have fought for MY WHOLE LIFE a long defeat. How about that? How about if I said, That’s all it adds up to is defeat? "A long defeat. [Kidder]

"I have fought the long defeat and brought other people on to fight the long defeat, and I’m not going to stop because we keep losing. Now I actually think sometimes we may win. I don’t dislike victory. . . . You know, people from our background--like you, like most PIH-ers [Partners in Health-ers], like me--we’re used to being on a victory team, and actually what we’re really trying to do in PIH is to make common cause with the LOSERS. Those are two very different things. We want to be on the winning team, but at the RISK of turning our backs on the losers, no, it’s not worth it. So you fight the long defeat" [words in caps are originally italics] (288).

[reference 1]: Accessed May 19, 2005


First published: 2003


Random House

Place Published

New York



Page Count