Mountains beyond mountains

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JOUR 498 Tutorial

Book Review

Mountains Beyond Mountains By Tracy Kidder

A View From a Third World Lens

            Award winning literary journalist Tracy Kidder tells an inspiring true story about a doctor who significantly impacts the lives of many in his 2003 book, Mountains Beyond Mountains. <a href="http://www.tracykidder.com/about.php">Kidder has written many literary pieces such as Home Town, Strength in What Remains, Among Schoolchildren and The Soul of a New Machine. A Harvard graduate, Kidder has also won a Pulitzer Prize</a>. Kidder’s biographical piece on Dr. Paul Farmer in Mountains Beyond Mountains allows the readers to journey through some of the world’s poorest places that consists of the worst health conditions. Kidder plays a notable role as he chronicles Farmer’s expedition in the first person, permitting the readers to observe and understand how this one-of-a-kind doctor makes an essential change in the world. Farmer’s background on medical anthropology and internal medicine allows him to dedicate his life to cure infectious diseases in pursuit of bringing social justice for all.

            As a college educated woman who grew up in a third world country (the Philippines) and witnessed extreme poverty, this book has magnified my understanding about scarcity and the need for accessible healthcare across the globe. The descriptions about other countries like Haiti and Peru’s harsh conditions are an awakening revelation for most individuals. Despite the fact that the intended public for this piece maybe an American individual not educated about social medicine, poverty and social justice – people from many other Third World countries would find Mountains Beyond Mountains as an educational book as well because it enhances their understanding of the conditions in which countries those people live in. For that reason, those individuals with a background in a Third World nation will truly benefit from reading this book. There is a constant misconception between citizens of affluent countries and their views on the third world – their privilege and favorable positions are almost always taken for granted.

            Mountains Beyond Mountains not only opens many readers eyes to the harsh reality of the vast global issues surrounding poor health conditions but also the deeper political circumstances third world countries face. Kidder states, “the world is full of miserable places. One way of living comfortably is not to think about them or, when you do, to send money.” But is it enough to send money? Perhaps not for Paul Farmer. This book brings its readers the story about how this brilliant and selfless “saint” goes above and beyond to change the world one city at a time, truly dedicating his life to making that definite, significant transformation.  

            While there are many philanthropists across the world today, the story of Farmer is unlike many. Having been exposed to severe poverty and the many harsh conditions of a third world country, it’s always heart warming to know people from affluent nations and backgrounds actually care to do something about the poor health circumstances in these countries. The story of Farmer touches close to home. Farmer’s upbringing was nothing extravagant, just like my own experiences. He lived in a cramped bus and boat most of his life with his parents and five siblings. Unlike many kids, he excelled in school and has been a brilliant man since his youth years. He was used to a very simple living situation – he could sleep in a dentist chair and he would still find it comfortable. Farmer encountered his first Haitian migrant workers while picking fruits at a young age. He later discovered that would not be the first and last meeting with Haitians. Coincidentally, this would later prepare him for the remarkable relationship he has with the citizens of Haiti, and train for his future calling in Peru, Cuba, Russia and many other nations.

            There are many misunderstandings about people from wealthy countries and their views about the third world. “She’s crying, ‘It hurts, I’m hungry.’ Can you believe it? Only in Haiti would a child cry out that she’s hungry during a spinal tap.” A Haitian child can tolerate the pain from lumbar puncture because she suffers from extreme starvation. The position and privilege of an individual from an affluent country like the United States would probably never be in the same place as that Haitian child. Coming from a country where the poverty has always been the norm, who also grew up a block away from a squatter settlement, it’s uncomplicated and effortless for someone like me to appreciate the smallest things that affluent nations like the United States offer. Without the experiences and position I have witnessed growing up, the gratitude over the tiniest things like drinking clean water, for example, is something that many may be taken for granted.

            Being exposed to many hardships growing up allowed me to be open minded and retain the grasp about poverty not just about my home country but across the globe as well. However, even with the knowledge I hold regarding the underprivileged circumstances in the Philippines, reading about specific situations in Haiti, Peru, and other countries like Cuba and Russia enhanced my awareness even more about the need for accessible health care across the world. Tuberculosis and HIV is a global epidemic that needs attention immediately.

            Nothing is more eye opening than experiencing poverty on your own terms, like I did back in the Philippines. Seeing children starve, abandoned by their parents, left on the street to survive and beg for food on their own, dying of diseases that could easily be treated if affordable and accessible healthcare were ever provided were the usual scene one would witnessed in the streets of any poor city. The head of pediatrics from Mass General, Dr. Alan Ezekowitz (from Mountains Beyond Mountains) says, “poverty in a place like Haiti is difficult to personalize. If it’s in front of you, it has a reality.” Many privilege individuals who come from a prosperous background and comfortable living condition probably would never step foot in a country where known critical diseases spread rapidly, but without encountering these things first hand a person would never see what its really like to be on the other side of the fence. Residents of the First World do not ever have to worry about drinking dirty water and the spread of multiple diseases that can go untreated – living in a wealthy nation provides safety options for the poor.

            A simple incident that takes place in the book recalls Farmer telling Kidder to be prepared to witness something horrible. Something as simple as riding an escalator properly probably isn’t something an average individual worries about on his or her daily life. Because to us, this is something we see everyday and are exposed to. This is something that has become a part of our social norm. “Every fourth or fifth Haitian would come to a stop at the head of the escalator and look down at the moving stairs. They’d pause as if at the edge of deep water, and then start to run, trying to match the speed of their legs with the apparent speed of the stairs,” says Kidder. Simple things like riding an escalator, wearing shoes, having the opportunity to go to school or read a book is a privilege some of us possess. This is also a reminder that not everyone is as fortunate to hold this position – some do not even come close.

            In the Medicine and Social Justice article, Dr. Paul Farmer best explains how he addresses this global predicament, <a href="http://www.americamagazine.org/content/article.cfm?article_id=12080">“There is much to be learned from reflecting upon the lives and struggles of poor or otherwise oppressed people. How is suffering, including that due to sickness, best explained? How is it to be addressed? These questions are as old as humankind. We have had millennia in which to address-societally, in an organized fashion-the suffering that surrounds us. In looking at approaches to this problem, one can easily discern three main trends: charity, development and social justice”.</a>

            In the book, Kidder makes it clear that he was at first skeptical about Farmer. Of course readers would probably wonder the same thing if they were in Kidder’s position and question what Farmer’s moral drive genuinely is. Towards the progression of the book, readers are reminded that Farmer is a real person, not a made up character, personified in a true being that many refers to as a “saint”. What Farmer does is beneficial to each and every individual. Morality is his main motivation. “How does one person with great talents come to exert a force on the world? I think in Farmer’s case the answer lies somewhere in the apparent craziness, the sheer impracticality, of half of everything he does,” says Kidder. Farmer is the epitome of a man who can and will cure the world, without expecting anything in return.

            Mountains Beyond Mountains is an awe-inspiring read overall. Kidder does a simple yet brilliant way of generating Farmer’s story to the reader’s imagination. The audience must be prepared for doing some research and keeping a dictionary handy during the read. There will always be some misunderstandings about the views on Third World countries and their current situations, but perhaps reading this piece will help open some eyes to the idea that not everybody is as fortunate as others are. Somebody with a background in a Third World nation will still surely benefit from reading this book because it expands one’s knowledge about the conditions in other awfully poor countries like Haiti and Peru, including diseases such as tuberculosis and HIV. Additionally, it gives people hope that many other poor nations have a chance to overcome these circumstances – thanks to individuals like Farmer. Lastly, Mountains Beyond Mountains inspires an average individual who has a background regarding a poor nation to help and make a difference, especially when one has been subjected to such situations. It’s easy for anyone living in the United States or a different prosperous nation, to be caught up living a comfortable, perhaps even a lavish lifestyle – but reading this book opens and brings every reader back to a place that reminds everyone that there are bigger pandemic issues that should be addressed. One should be thankful for the countless possibilities, situations, positions and privilege that many take for granted on a daily basis.             

Alfredo Madrid

Professor Benavides

Jour 494

July 6, 2012

Selfless Bravery and Honor

     In the formidable process of enveloping the reader in a morose and engaging account of modern day disease and poverty stricken Haiti, Tracy Kidder astutely follows the path of one Dokte (Doctor) Paul Farmer and his courageously determined vision to change a nation one patient at a time.  As Cange, Haiti is plagued by uncontrollable strains of tuberculosis and AIDS, Farmer displays immense discipline and maintains an almost supernatural composure.  The author impressively follows Farmer to shanty towns and grim prisons ranging from Cuba to Russia and even internationally renowned press conferences.  By revealing the various intricate layers of Farmer’s personality, Kidder paints a vivid picture of his subject’s world throughout the entire piece with a discerning eye for human emotion and compassion.

    The book is quite engaging insofar as it leaves little room for the reader’s imagination to wander too far off the set path due to the severity of the situations that are presented.  Farmer’s world is depicted as it is: a decrepit, dilapidated and cold level of human existence.  There is a chilling factor throughout the piece, one that forces the reader to thank everyday trivialities and in turn look at them as novelties, such as running water, heat and even air conditioning.  Yet Farmer chooses to reside with the down trodden, to survive with them, accept their various gestures of kindness, and more importantly, to show himself as a true medic, where the idea of a hopeless patient holds a marvelous spell over him.  Never once does Famer complain about his living situation, or even physical state for that matter.  Kidder is prompt to present such information in a manner that is highly effective and laudable.  Farmer is not one to concern himself with matters that would affect his own existence and personal well being.  To a certain extent, he does not even exist to work.  One can almost surmise that Farmer feels it is his mission, his purpose in life to aid the poor.  The fashion in which the book can be interpreted allows the reader to believe, when Farmer is referred to as a “saint” on more than one occasion in Haiti, “that he felt like the thief in Hawthorne’s novel The Marble Faun, who steals something from a Catholic church, and before making his escape, dips his hand in holy water…this was seemingly, I thought, resisting beatification…I felt a small inner disturbance. It wasn’t that the words seemed immodest.  I felt I was in the presence of a different person from the one I’d been chatting with a moment ago, someone whose ambitions I hadn’t yet begun to fathom.”  Farmer’s humble demeanor makes him all that much more endearing to his patients, readers and almost any one he comes into contact with due to the fact that he does in fact present several qualities that could be deemed “divine” or even “God-like.”  Kidder makes an earnest effort, and gives a serious indication of this idea various times throughout the book.  As an interested and intrigued reader, one is left to truly wonder how such a genuinely good person, and to several extents, a beautiful human, could have been created amidst the mass destruction and intense times of the 21^st century.

       The underlying description of Farmer’s humanity and seemingly endless compassion are emphasized in a marked and distinct fashion throughout the book.  Kidder never allows an opportunity to fade and not display Farmer’s philanthropic qualities.  Quite the contrary, Kidder is almost constantly taking advantage of any chance to glorify Farmer, and rightly so, as there are a profuse amount of situations available to reveal Farmer’s inherent caring nature.  In response to Farmer’s unfaltering dedication to his vocation, Ophelia Dahl (with whom, it could quite possibly be argued, he shared his first serious adult courtship), Kidder writes, in reference to Dahl’s point of view, “they would patch up their quarrel, but inwardly she knew something had ended…she hated the separation from Paul.  More than ever he seemed to her like an important person to believe in.  Not as a figure to watch from a distance, thinking, Oh, look, there is good in the world.  Not as a comforting example, but the opposite.  As proof that it was possible to put up a fight…she knew he had a great weakness for forgiving people.  It was, she thought, the most salient of his priestly qualities.”  It is not by a mere whim that I have chosen to highlight two terms, “saint” and in the aforementioned sentence, “priest,” as the cornerstone of what I believe to be Farmer’s most resonating and humane attributes.  Here is a man who does not recoil at the idea of giving himself up, almost fully, in every context of the idea, in the hopes of aiding another human.  Kidder uses a masterful and motley colored method to embody and bring this point home.  Farmer is not at peace with himself if he knows someone is suffering—which is almost constant throughout the book.  Kidder excellently portrays a man living just as much in the well being of other creatures, and quite possibly more than even the care attended to oneself.  Farmer’s compassion is held within his self service to those in need, perfectly embodied in the fact that he does not expect anything in return.  Farmer uses his talents and high intelligence, both emotional and cerebral to make a marked difference in run down locales.

     After doing some basic research via what could possibly be humanity’s most versatile and extensive digital library, the Internet, I came across Tracy Kidder’s personal website, at .  According to the site, he won the Pulitzer Prize in General Non-Fiction for his non-fiction account, The Soul of a New Machine, in 1981.  The book’s plot centers on following the innovative designers of modern day computers and contemporary electronically driven devices.  Much like in Mountains Beyond Mountains, Kidder displays an uncanny vision of clearly and shrewdly depicting his subject’s plights.  Kidder is renowned for his ability as a writer of extreme versatility and this statement can be justified with the various awards and prizes he has received over his tenure, for example, The Christopher Award, 1990, for “Among School Children,” a detailed narrative regarding an impassioned school grade teacher’s dedication to her pupils.  In the process of analyzing such feats and taking into account his natural talent as a story teller, it is not difficult to understand the technical and stylistic approach that Kidder has employed throughout his lengthy, decorative and praiseworthy career.

     In my opinion, the manner in which Kidder chooses to depict Farmer is in a very philanthropic manner where love is the supreme force that goads his seemingly endless efforts to aid humanity.  Kidder goes into some detail concerning this fact when he writes, “…at some point—I’m not exactly sure when—I realized that I’d become inclined to hold Farmer to a higher standard than I did most people, including myself.”  Farmer displays, throughout various stages of his life, and in a myriad amount of forms throughout the book, that he is not only living for himself, but to a certain extent in other humans.  At times this caring outreach even touches other living creatures such as the fish he thoroughly enjoyed to collect in his mini aquarium.  Farmer places such a high value on all living life forms that he becomes almost a supernatural phantasm, a true angel, of sorts.  It is with this powerful idea, the one centering on nurturing and unconditional care, that Kidder is successfully able to exploit in bringing Farmer’s true, natural, awe inspiring and incredible nature to light.  Farmer constantly put others before himself, particularly his patients, and even going so far as to at times, let “his emotional side lay close to the surface, and, as Ophelia said, his emotions were usually sympathetic.  He cried openly over patients, and the memories of patients. He greeted everyone in his wide circle with blushing elation.  I was no less immune than most people to his warmth.”  Farmer stands out prominently as an individual who has surpassed mundane, day to day activities and has surrendered himself completely and selflessly to the well being of other humans.

     In conclusion, it is worthy to take not of Kidder’s exemplary depiction of Farmer, a man undaunted by disease and poverty, yet passionately stricken to improve living conditions for others.  Kidder stands out as an author determined to present his subject in an original manner, and in this case a man, Farmer, notable in his very noble and unselfish manner of being.  If others could adhere to such pristine and pure self-possession, the world would most likely be a more tranquil and peaceful environment in which to reside.  Throughout the piece, Kidder pulls of an extraordinary feat in depicting a nearly flawless man as a type of celestial being.  To emphasize one more time, I believe that Kidder’s aim with his style of writing was to present the idea of  human compassion and ultimately love in an individual who has done away with self interest and whom lives wholly in the spirit and wellbeing of others.  Farmer is a rare and very special individual, and Kidder knew just how and in which manner to present to the interested and clever reader the ultimate beauty in life: selfless dedication to other beings.

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Poverty’s struggle against medicine and holistic approach to health care

 “The poorest parts of the world are by and large the places in which one can best view the worst of medicine and not because doctors in these countries have different ideas about what constitutes modern medicine,” said <a href="http://ghsm.hms.harvard.edu/people/faculty/farmer">Dr. Paul Farmer</a>. “It's the system and its limitations that are to blame.” In <a href="http://www.tracykidder.com/books/mountains">Mountains Beyond Mountains</a> journalist <a href="http://www.tracykidder.com/">Tracy Kidder</a> documents the mission of Dr. Paul Farmer who devotes his life to treating the poor and brings radical change in a world that seems impossible. Kidder accomplishes this by telling Farmers story in first person.  By doing this Kidder allows the readers to fully experience, interpret and most importantly believe that Farmer, this “less ordinary” man, is real. Kidders book opens the eyes of the young and educated to the extreme poverty in third world countries and how this poverty affects access to medicine and a holistic approach to health care. <a href="http://www.tracykidder.com/books/mountains">Mountains Beyond Mountains</a> educates readers on difficulties in third world countries between medicine and poverty and gives faith that one man can make a difference.

Mountains Beyond Mountains reminds and educates readers of the extreme poverty in third world countries. “The world is full of miserable places,” Kidder writes. “One way of living comfortably is not to think about them or, when you do, to send money.” This memorable quote from the book speaks loud in other words saying the fortunate of the world turns a blind eye to the poor. But through Kidder’s <a href="http://www.the-writer-craft.com/first-person-point-of-view.html">first person point of view</a>, this book gives a believable lyrical voice in which the readers personally experience and can’t ignore the reality of poverty in third world countries. Kidder writes about his travels with Farmer to Haiti, and gives the readers a sense of what everyday life is like in these poor countries and how it compares to everyday life in countries like the United States. Mountains Beyond Mountains uncovers to readers the misunderstandings of third world countries and how ones interpretation of countries can be skewed from the actual reality. Through Farmers interactions and relationships with people in Haiti and Peru, the book opens reader’s eyes to the luxuries we don’t even consider like electricity, clean water, paved roads and most importantly the theme of the book medicine and health care.

In telling Dr. Paul Farmers story, Kidder teaches readers of the difficulties of <a href="http://www.americanmagazine.org/content/article.cfm?article_id=12080">health and social justice of the poor</a>. The poor suffer because they don’t have access to the necessary care or treatment, which leads to more death among poverty because diseases go untreated. Kidder writes of many different instances where a disease that would be considered simple and treatable in the United States is deadly in a third world country like Haiti. One instance Kidder wrote about was a pregnant woman, who was a mother of five children, died of malaria because there was no money to buy blood. “This is terrible,” the woman’s sister said. “You can’t even get a blood transfusion if you’re poor.” And she said, “We’re all human beings.” This moment along with many other situations in the book shows readers that the poor is dying and suffering because they cant afford treatment that is available, because of their social status. “It would make sense to provide medicine in the places that needed it most,” Kidder wrote. “…But clearly the doctrine implied making choices among degrees of poverty.”

Yet Farmers approach to health doesn’t stop at just medicine, he teaches readers of a more broad approach to health. That it’s not just the poor’s difficulties in access to medicine; it’s also the struggle of resources that affect a holistic approach on health care. “Many things affect a public’s health,” writes Kidder. ”Of course-nutrition and transportation, crime and housing, pest control and sanitation, as well as medicine.”  Mountain beyond Mountains teaches the readers that it’s not just the access to medicine but also the access to resources. Farmer’s approach to thinking of health in the “broadest possible sense” teaches readers how poverty affects the holistic approach to health care. While working in Haiti, Farmer did his best to not only bring treatment but also provide a “first line of defense” to the communities that included vaccination programs, protected water supplies and sanitation and health education. “Clean water and health care and school and food and tin roofs and cement floors, all of these things should constitute a set of basics that people must have as birthrights,” Farmer would say.

Along with teaching readers a holistic approach to health care, Mountains Beyond Mountains unveils the challenges in medicine. This is particularly illustrated in Farmers fight to treat <a href="http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001141/">Tuberculosis</a> among the poor. The book educates readers that if TB goes untreated it’s deadly but also teaches readers that fortunately there are good drugs that can treat and cure this disease. “Thanks in part to those antibiotics, tuberculosis had all but vanished from the rich parts of the world. But the disease still plaque the poor parts to a degree most Americans and many western Europeans would find hard to credit,” Kidder wrote. Kidder teaches readers that tubeculosis was the most common proximate cause of death of death among people in poor countries. Not because there is no treatment, but because since tuberculosis mainly affects the poor, “the industrial nations and pharmaceutical companies had all but abandoned the search for new technologies to fight it.”

Farmers fight for treatment of tuberculosis allows readers to see what he is fighting for across the world, that treating a disease that is preventable shouldn’t depend on ones social status.

The market for treating the disease is big but since most people who are infected are poor the actual demand is small. Readers learn about this in the book when Jim informs us of “price gouging”. This teaches readers that the medicine needed for treatment is available but the price is very high for the drugs because only one company makes it---“price gouging”.  While Jim explains this process to The World Health Organization to encourage drug companies to produce more second line drugs he is introduced to the <a href="http://www.idafoundation.org">International Dispensary Association</a>. Through this association they concentrate in reducing the prices of essential drugs which poor countries need the most. One way of doing this is through generic manufactures, and from this <a href="http://www.who.int/tb/challenges/mdr/greenlightcommittee/en/">The Green Light Committee</a> was created. With the committing serving as the ultimate distributor for second line drugs and <a href="http://www.who.int/en/">The World Health Organization</a> putting the second line antibiotics in its annex to its drug list the price reductions slowly came. Through all this readers learn the importance of cost-effective analysis. Readers learn the politics of medicine and the difficulties that must be overcome to simply serve to poor.

Readers also learn of the politics with medicine when Farmer and Goldfarb fight for more money from a loan with the <a href="http://www.worldbank.org/">World Bank</a> to treat patients in Russia’s prisons. Kidder explains that prisoners contract tuberculosis at higher rates than civilians because of the living conditions. Tuberculosis had become the leading cause of death in the prisons but many inmates were surviving long enough to spread the disease back into civilian society once they were realized. “In Russia just now, a young man could get thrown in jail for stealing a loaf of bread or a bottle of vodka and because the criminal justice system was clogged, languish in a detention center for a year or even four years before his case came to trial,” wrote Kidder. “While waiting or serving his sentence, he’d probably get infected with TB.” This informs readers that too many people are being put into prison for minor crimes, which ultimately adds to spreading TB over the country. Farmer stresses the best way to clean society is to “purify the prisons”. As much as this is fought with the World Bank, they only offered 20 percent of the loan. Farmer must convince them that they need 50 percent of the loan not only for medicine but also for more food and better conditions in order for the plan to be effective. The World Bank team insisted that extra food was not cost-effective, but then one of the negotiators secretly told Farmer to try and sneak the food in the budget by calling it vitamins. By doing this Farmer got the World Bank to agreed on giving prisons 50 percent of the loan. This teaches readers that Farmer will act as a beurocrat when it comes to the political system and the fight for medicine and holistic health care.

Through opening the eyes of the young and educated to a holistic approach to health care and how poverty affects access to medicine and the difficulties of the political system there is another important theme to take away from the book. And that is radical change can happen even in a world that seems impossible. It is important to take away the incredible accomplishments that have been made from a man with much persistence and perseverance. Farmer and the people who work around him continue to be determined as ever. Farmer sacrifices his family and at times his health to do his job, treat people in need. “The problem is, if I don’t work this hard, someone will die who doesn’t have to,” said Farmer. No matter what is accomplished they will never stop trying to win. Kidder teaches readers that no one can imitate Farmer but if people would just try think about how much better the world would be. The book approaches topics that are very troubling but Farmer bring so much light and optimism that inspires faith in readers that a difference can be made in world that seems nearly impossible. We just have to keep trying and as Farmer would say accept the “long defeat”. 

In Mountains Beyond Mountains (<a href="http://www.tracykidder.com/books/mountains/">http://www.tracykidder.com/books/mountains/</a><a href="http://www.tracykidder.com/books/mountains/">), </a>Tracy Kidder chronicles the journey of Dr. Paul Farmer, a man who “would cure the world.” Farmer's quest to change lives for the better, through the implementation of medicine in impoverished places, is mirrored by Kidder's own quest to understand the enigma that is Farmer. With a multidimensional character, Farmer eludes and captivates in his own humble way, and Kidder captures that in an epic profile of a man intent on serving justice to the world.

Kidder met Farmer by accident, at a beheading in Haiti in 1994. Kidder was there to report on American soldiers and their political endeavors in the country, and witnessed an exchange between Farmer and an American captain – one that left him viewing Farmer as a cocky self-assumed champion of human rights. Five years later, in Boston, they met again – at Kidder's request – and soon Kidder was jetting off to Haiti to witness the life and journey of Dr. Paul Farmer.

As Kidder follows Farmer around the globe, from Haiti – Farmer's beloved hub – to Cuba to Peru to Russia, he learns bit by bit what makes Farmer tick. Intelligent and skilled enough to make a wealthy living as a doctor in a renowned hospital, young Farmer instead chose to reside in the underbelly of poverty, curing the homely and sick. This is curious enough to peak the interest of both Kidder and the reader: and while Kidder embarked on a long journey to finally understand why, he reports back with a full account for the reader.

The primary theme in this novel is injustice. As a moral crusader against any injustice, Farmer utilizes his Harvard medical degree to materialize his idea of how the world should turn. He is stubborn, brash, and tireless, a constantly-moving powerhouse who sweeps in, drops rays of hope into dark and dismal hearts, and moves on again.

Though passionate about his vision to bring much-needed medical aid to places such as Haiti, Farmer is no stranger to the bureacracy of the global healthcare economics. He tirelessly campaigns against the hypocrisy of the World Health Organization (<a href="http://www.who.int/en/">http://www.who.int/en/</a> ), is consistently annoyed by the bloated disparities in healthcare fund allocations, and never takes a back seat where he can stand up front: a realistic idealist.

In all his accounts of personal encounters, lengthy dialogues, and Farmer's commentary to him on his own doings, Kidder slowly paints a picture of Farmer that materializes increasingly with each chapter. While he understands Farmer's passion for helping, he doesn't understand the various contradictions Farmer exhibits about himself: he purposely makes his life's direction to help others, but seems to believe that his life is not his own. He sees himself as merely a tool – moving not unwillingly, but perhaps involuntarily, as a beacon of medical assistance, comfort, and hope in the impoverished nations of the world, maintaining that he essentially has no choice; rather, it is his duty.

“If you do the right thing well, you avoid futility,” he says. (p. 295)

With his go-getter, do-good mantra, one could easily argue that Farmer is a modern, rough-around-the-edges Jesus Christ.

“I'm not truly humble. I'm trying to be humble.” (p. 288)

And yet he is not Jesus. He is not perfect, not sinless, and certainly not without his faults. In his quest to change the world, he neglects his own wife and child...and even himself. The key is that he understands that himself: “All the great religious traditions of the world say, love thy neighbor as thyself. My answer is, I'm sorry, I can't, but I'm going to keep on trying...” (p. 213)

Embedded in his idea of charity is the value of the individual – another underlying theme that permeates the novel. Farmer often travels long distances simply to see a single patient, embodying his idea that it is not enough to help the masses – one must start with the individual first. One saved soul is worth thousands in hindsight, a perspective reflected in Christian roots – and yet completely ignored in cost-benefits analysis (<a href="http://www.significancemagazine.org/details/webexclusive/1100611/Healthcare-research-the-end-of-cost-benefit-analysis.html">http://www.significancemagazine.org/details/webexclusive/1100611/Healthcare-research-the-end-of-cost-benefit-analysis.html</a> ), on which the major healthcare conglomerates all operate.

This is perhaps Farmer's biggest crusade: with a help-every-man attitude, he resents the politics of cost-benefits analysis. Large companies see impoverished countries and high rates of disease, infections, and inflictions. They see numbers, and pit them against the cost of curing each number...which often add up to an outrageous and unprofitable sum. Farmer, on the other hand, scowls at their logic, insisting that there is no other way to alleviate the suffering without taking a blow to the resources we do have. Illness and disease will not disappear, and it will take setbacks – often in funds – to cure them at first, but in the long run it will balance out.

“If you're making sacrifices...you're trying to lessen some psychic discomfort,” he says. (pg. 24)

And Farmer runs with that notion. In addition to his own towering mountain of undertakings, he supplements them with educational crusades, informing people and organizations everywhere he goes of the conditions in Haiti. Education is power, and power is fuel to “walk the walk.”

Such is the basis of Farmer's Partners In Health, (<a href="http://www.pih.org/">http://www.pih.org/</a> ), an organization he founded with his friend Ophelia Dahl, which campaigns on behalf of the ill and utilizes all available resources to provide healthcare for them as passionately as if the individual were one's own sibling.

This is but one of the complex dyads Kidder brings to light about Farmer: he talks the talk and walks the walk. And so deep is Farmer's character, that Kidder takes up to the last page to comprehend it fully. While he accompanies Farmer on his medical missions, converses with his girlfriend, partner, wife, mother, and those whom he aids, they are all just as flummoxed by his personality as Kidder is – at first. Farmer is not someone who is definable in one word, one sentence, or even by spending one day with him. He is a mystery, a deeply intriguing spirit that breaks the mold of normality so fiercely, even an observant and intuitive journalist must dig to get to his core.

Yet, this is what Kidder does purposely. As with any journalist, he selects the passages to tell. He had the freedom to portray Farmer as a saint, as Jesus. He had the freedom to portray him as a crazy, unstable man with an unrealistic goal. Yet he writes both sides, the truth, the reality, and the events, so the reader can observe and mold the two halves together to create one hybrid.

Perhaps this is reflected in the title of the book, which itself is the main underlying theme, the crux of all Farmer tries to do and how he does it. Though an old Haitian saying, which could suggest a practical use of theology since Farmer works extensively in Haiti, “mountains beyond mountains” embodies various viewpoints: obstacles lie beyond obstacles, or opportunity lies beyond more opportunity, and massive understanding at once is followed by a valley of confusion, followed by another bout of understanding. Kidder says himself on his Web site (<a href="http://www.tracykidder.com/books/mountains/behind.php">http://www.tracykidder.com/books/mountains/behind.php</a> ), “Those two meanings aren't inconsistent, and I meant to imply both in the title.” The title leaves much to the imagination, another clever integration of Kidder's profile.

Having spent months on end with Farmer, Kidder journeyed through the path of discovery blindly, not knowing what he would learn next, where he would fly next, or what would come out of Farmer's mouth next. His experience was much like reading a book – and thus, he recreated that in his book so the reader would journey the same way.

Writing in first person, Kidder provides an “everyman” perspective to a deeply complex character, allowing the reader a crutch on which to establish footing and understanding. He reflects the reader's curiosity, confusion, and even times of overwhelmed emotion, while still serving as a springboard for further insight. In writing his novel, Kidder undoubtedly rediscovered some functions of Farmer's character, and it is quite possible he even discovered new dynamics he never witnessed or understood before – a phenomenon reflected in the reader's experience.

Kidder writes on his Web site that he learned “two things above all” in his time with Farmer. One can see the world through new eyes, perhaps magnifying the injustice and cruelty usually hidden in the shadows, when looking at medicine and healthcare. And then when a “small group of determined people” storms in and addresses those concerns, we can see an ever-changing landscape of injustice turned to help, and despair turned to optimism. Farmer resembles that notion, spearheading a movement to transform a black-inked canvas to a vividly watercolored landscape.

We don't understand Farmer at all in the first chapters: we merely see a man who loves to help, wants to transform the world, and who goes to extraordinary lengths to do so. He is a fascinating curiosity, a confusing and perplexing contradiction of himself, and a sometimes frustrating enigma. But by and large, with exposure to his various adventures in various countries; his encounters with health “experts” and organizations; his own words revealing his thoughts about healthcare, the politics surrounding it, and the human spirit itself; and the reflections of his loved ones, Kidder presents a finished portrait of a man who, in the end, stands humbly in front of the reader. It's up to the reader to open his or her eyes to see it.

For a compelling journey through the underbelly of poverty, the war on health, and an extraordinary man's dynamic approach to both, pick up a copy of Tracy Kidder's Mountains Beyond Mountains.