This past weekend I read, from start to finish, the book "Mountains Beyond Mountains" by Tracy Kidder about the physician Dr. Paul Farmer. The book chronicles the story of Dr. Farmer from his childhood, to his work as a volunteer and student of anthropology in Haiti, to his days as a medical student, resident, and fellow in Infectious Disease in Boston, and to his numerous pursuits to rid the world of suffering, particularly in the poor. I had first heard about Farmer from an article in the New Yorker many years ago. It was one of those classic articles in the magazine that goes on forever, but which is entirely compelling. I had the good fortune to meet Dr. Farmer and to go on rounds with him at the Brigham and Women's Hospital in Boston when I was a visiting Chief Resident there in 2002. Unfortunately, I joined the team near the end of rounds, but I found Dr. Farmer to be both incredibly personable and captivating. His belief in the primacy and divine right of health care is enunciated best in this piece from NPR's "This I Believe" series.
Farmer's work with the poor in Haiti is the focal point of this book, and much of the focus is on the hospital Dr. Farmer helped build in Haiti called Zanmi Lasante, Creole for Partners in Health, which is the name of Farmer's global health non-profit organization. In the book, Farmer quotes from Virchow to summarize what motivates him, "Physicians are the natural attorneys of the poor…and social problems should largely be solved by them." This book and this quote reminded me of the patients I served during the course of my early medical training, which took place in county hospitals in Houston and Dallas. In both cases, these hospitals were the only place the poor in these communities could get quality medical care. Particularly in Dallas, however, I still feel as though the level of emergent or inpatient care these patients received was among the best in the world due to the drive and passion of the physician residents and attendings who worked in Parkland Hospital. What we lacked, however, was easy access to outpatient care and services and a system of community outreach to help patients improve their lots in life (educational services, social services, job training). Without the latter, can a patient or a population truly thrive? The answer, in my experience, as I saw the same patients present with the same problems over and over (congestive heart failure exacerbation due to the fact that salty canned foods were more affordable than fresh vegetables, asthma exacerbation because steroid inhalers were too costly or because of the poor air quality of the inner city, etc, etc) was clearly no.
I read a review of "Mountains Beyond Mountains" by Abraham Verghese after I finished the book, and in it he describes Kidder's book the following way:
''Mountains Beyond Mountains'' is inspiring, disturbing, daring and completely absorbing. It will rattle our complacency; it will prick our conscience. One senses that Farmer's life and work has affected Kidder, and it is a measure of Kidder's honesty that he is willing to reveal this to the reader. In 1987, a book called ''And the Band Played On'' changed the direction of my career and that of many physicians of my era who decided to devote themselves to the care of persons with AIDS; I had the same feeling after reading ''Mountains Beyond Mountains'': that after I'd read the book something had changed in me and it was impossible not to become involved."
I had the same sense after I turned the last page of Kidder's book, and I find it quite impossible to sit on the sidelines and to not work, in some small way, to ease the vast suffering which plagues our world. The mountains out there may be high and the troubles that the world faces may be vast, but is there a more worthy endeavor than helping those who are less fortunate? I leave you with a quote from my hero Albert Camus, which summarizes Paul Farmer's life and his life's work:
"I leave Sisyphus at the foot of the mountain! One always finds one's burden again. But Sisyphus teaches the higher fidelity that negates the gods and raises rocks. He too concludes that all is well. This universe henceforth without a master seems to him neither sterile nor futile. Each atom of that stone, each mineral flake of that night filled mountain, in itself forms a world. The struggle itself toward the heights is enough to fill a man's heart. One must imagine Sisyphus happy."
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