“Bondye konn bay, men li pa konn separe.” This Haitian saying, literally, “God gives, but doesn’t share” encapsulates one of the world’s largest problems. The sharing is left in our hands, and humanity’s seeming lack of skill for distribution could be called the driving force behind Dr. Paul Farmer’s mission. The vast inequalities regarding the world’s wealth distribution leave Third World citizens powerless, both politically and as regards their own well being. Dr. Farmer’s mission is simple enough. That mission is to bring healthcare to the people of the world, and specifically, the people of the world who can’t afford it. While many may advocate this aim, Farmer himself has carved a place in medical and philanthropic history as a man who is dedicating his life to this lofty ambition’s pragmatic achievement. In the best selling book, Mountains Beyond Mountains, Pulitzer Prize winning author Tracy Kidder delivers the thoroughly absorbing story of a man who dedicated his life to saving lives undervalued by society, while spreading the principle that all lives share equal worth.
It was Farmer’s college mentor, German polymath Rudolf Virchow, who would introduce Farmer to many of the philosophies that became the foundation of his works. Virchow acknowledged that sickness equated to an individual life under unfavorable living conditions, therefore an epidemic signaled a mass disturbance. The cure? According to Virchow, “full and unlimited democracy”, a claim that Dr. Farmer took to heart. His pull to Haiti was natural and immediate. His admission to Harvard Medical School coincided with a fierce dedication to making medical progress in this abused region. Here was a doctor determined to provide the poor with services that their governments would not, and so the blueprint for Zanmi Lasante was born. Zanmi Lasante, Farmer’s masterpiece a citadel surrounded by one of the most impoverished villages on the face of the planet, Cange. Dr. Farmer arrived in Cange to hordes of desperate Haitians, pleading with him for care for their untreated tuberculosis, worsening cases of AIDS, and starving infants. He knew he’d found the place to set up shop. While maintaining some of the highest grades in his class at Harvard, Farmer began his project and soon found himself living a life of non-stop travel and tribulation, not that he would have it any other way. One day Kidder asked Farmer why he pushed himself to such extremes, and Farmer, making clear that he hoped the comment didn’t sound meglomaniacal, stated simply that if he wasn’t working, someone died.
Paul Farmer Junior seems to possess more than the average person’s tolerance for unpleasant habituations, perhaps a tolerance that stemmed from his own unique circumstances in childhood. Living first in a house in Alabama, Paul Farmer Senior would soon relocate his young family to a trailer park in Florida where Paul, his parents, and two brothers and two sisters, would live in a huge blue bus they deemed The Blue Bird. Farmer would make first contact with people from Haiti, the nation he would later dedicate his life to, when his father made the family pick citrus fruit as a means of temporary income. The Farmers were the only white people amongst the Haitian workers. The stunt was short lived, but the experience was one more from his childhood which would instill principles of equality and sympathy for the poor. As a fourth grader, Farmer, dressed in a bathrobe that loosely resembled a lab jacket and with stick in hand serving as pointer would teach the family about various forms of reptilian life, jabbing at the incredibly accurate drawings he had created.
His early understanding would bloom into the genius that found him placed in the elite Brigham Hospital Residency program in Boston, Massachusetts. It was at Brigham that Farmer would engage in Robin Hood antics, filling backpacks with medical drugs and transporting them to Haiti. Many mentors would shape the course of Farmer’s life, one of the most influential being Father Jack, a priest who provided Farmer with church housing for much of his time at medical school. Father Jack’s personal philosophy? “It’s better to ask forgiveness than permission.” Paul and his colleagues would put this quote to use tenfold in their Robin Hood antics during the program’s development stages. It was benefactor Tom White, a billionaire determined to do something of worth with his fortune, who made much of the construction in Haiti, ranging from schools to multiple medical centers, a reality. White would also eventually reimburse Brigham for the “borrowed” aid. It was Farmer’s unalterable focus on individual patients that set him apart from the promoters of mass health care. It was this specialized attention that inspired the title of Kidder’s book. “Mountains beyond mountains” is a Haitian saying which Tom used on one occasion when the two would hike for an entire day to reach Morne Michel, the farthest settlement in Zanme Lisante’s catchment area, to ask one patient why he hadn’t attended the follow up appointment for his tuberculosis treatment. As it turned out, there’d been date confusion.
Paul’s mentor had taught him during his undergraduate studies that medicine and politics were intricately connected if not one in the same, “The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.” Paul’s expulsion from Haiti amongst growing political unrest would only solidify this ideology. The services that he was providing had not gone unnoticed by the mayor of Port-au-Prince, a corrupt leader who would have many of Farmer’s dearest friends evading assassination attempts when he fire bombed their churches. Farmer would lose four friends during this period. One powerful friend, Aristide, would be elected to office, only to be deposed almost immediately when it became clear that his intentions were democratic. Farmer regained entry to Haiti near the time of Aristide’s reinstatement three years later, and soon thereafter, would witness one of the most grizzly cases he had ever seen. Poor Chouchou, a Haitian who supported Aristide, was fatally brutalized by The Junta, the Haitian soldier’s who enforced the mayor’s policies. Farmer would later take his journey to save the world to Peru and Russia, where while the governments were more compliant, the rampant cases of tuberculosis and AIDS still gave Farmer opportunity to have substantial effect.
When parting from a trip to Cuba, Farmer and Kidder, now close companions, catch sight of an airplane hanger boasting the words “Partia es Humanidad”: The only nation is humanity. Tracy Kidder presents a detailed and impassioned account of one man’s belief in this idea. Paul Farmer Jr. didn’t consider himself an American, nor a “blan” as the people of Haiti initially called him, referring to his light skin. Just as a citizen of humanity, and a citizen who believes that while there are people in the world who can’t pay for his services, it would be “ambivalent” of him to charge for them. “I feel ambivalent about selling my services in a world where some can’t buy them. You can feel ambivalent about that, because you should feel ambivalent. Comma.” (Paul often ended sentences with the word comma, signifying the word asshole which was implied to follow). A life led in an extraordinarily successful evasion of ambivalence will hopefully inspire the rest of us to consider the fact that justice can’t prevail without personal sacrifice. Farmer and his dedicated team prove that it truly is a small group of people with a goal as vast as the planet who end up changing it. Hopefully Mountains Beyond Mountains will motivate the rest of us to avoid falling on the right side of that comma.