56 pages • 1 hour read
Tracy KidderMountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World
Nonfiction | Biography | Adult | Published in 2003A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Background
Geographical Context
Paul Farmer’s globetrotting travels constitute much of Mountains Beyond Mountains, and Farmer joins him on several trips. In fact, as Kidder recounts, Farmer lived a nomadic lifestyle even before his medical career. He was born in Massachusetts, but his family moved to the American South: first to Birmingham, Alabama, during the height of the civil rights movement, and then to a bus and boat on Florida’s west coast. Farmer then attended Duke University in North Carolina.
Haiti shares the island of Hispaniola with the Dominican Republic, one of the most-developed countries in the Caribbean. The island neighbors Cuba, whose medical capabilities and standard of living Farmer praises, and the US territory of Puerto Rico. The Haitian capital, Port-au-Prince, lies on the west coast, and reaching Zanmi Lasante in the central town of Cange requires several hours of driving on Highway 3’s rugged terrain. Traveling from Boston to Haiti requires an exchange in Miami, Florida.
Partners in Health expands into Lima, Peru, on the west coast of South America. While Lima appears to be a modern city on the surface, PIH focuses on the Carabayllo neighborhood, where many residents are rural refuges. Farmer also treats MDR-TB outbreaks in Russian prisons and notes the challenges of moving patients without infecting others in the vast province of Siberia.
Historical Context
Haiti has endured a long history of poverty and political instability from its days as a French colony and centerpiece of the Atlantic slave trade. When Farmer first arrives in 1984, Haiti is a dictatorship under Jean-Claude “Baby Doc” Duvalier, son of previous ruler François “Papa Doc” Duvalier. During both Duvalier’s reign and the military juntas that follow him, Farmer must clear several checkpoints along Highway 3, deal with soldiers and civilian militiamen, and at times choose alternative routes after treating victims in case of ambush. Jean-Bertrand Aristide became the first democratically elected ruler in 1990 following UN-observed elections but faced a coup d'état the following year. Exiled from the country at this time, Farmer advocates for US intervention, though he is suspicious of the country’s motives. Tracy Kidder meets Farmer for the first time during this mission in 1994. Aristide was reinstated, lost the following election, and won the presidency in 2000, though the United States had begun sanctioning his government at the time of the book’s publishing.
PIH begins its activities in Peru during the rule of Alberto Fujimori, a Peruvian president of Japanese descent who installed a harsh austerity program and orchestrated a coup against his own government. At one point, Shining Path guerrillas attack a PIH pharmacy, believe that they are offering dulling “crumbs for the poor” (131). PIH struggles to change the DOTS system at first because Peruvian medical authorities are reluctant to adjust one of the few success stories in the country. Meanwhile, Russia is in a lull between the fall of the Soviet Union and the rise of President Vladimir Putin in which government and oligarchic corruption is rampant. Farmer feels like only a few prisoners deserve to be in the jails, and his collaborator Alex Goldfarb flees the country after he helps a KGB agent flee the country.
Cultural Context
Partners in Health is an early advocate for social justice that addresses global inequalities, but Farmer and several other members also deride identity politics. While the phrase is a loaded term in a modern context, the 2003 book treats it with some nuance. Identity politics here largely refers to word choice by donors that tones down other people’s suffering, such as objections to using the term “poor” or equating their problems to people who have no clean water. Meanwhile, Jim Yong Kim, the son of Korean immigrants, recalls exploring his racial identity during college in response to the prejudice he faced as a child in Iowa, only to become disillusioned after visiting South Korea. He sees PIH as a place where he can commit real change rather than wallow in “self-hatred.”
Farmer’s pitch that Kim can be more than “the first Asian to do some stupid thing like walk on the moon” may be galling to some readers (169), and they may focus on how Farmer’s race enabled his success. Stealing microscopes and violating medical protocols would doom most doctors, but Farmer receives protection. Kidder and others condone his outbursts and treat his lack of consideration for colleagues as the price of extreme empathy. However, Farmer may be more aware of his white privilege than most. Farmer quit his fraternity over racist policies and references the triangular slave trade when getting a soft aid commitment from a French ambassador. His comments about guilt and Matthew 25 reflect his own need to serve others, and he questions why other Americans act as if they can leave Haiti at any time. It is possible for someone to be both a pioneer for social change and representative of ongoing issues.
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