16735: Wharram: NYTimes.com Article: 'Mountains Beyond Mountains': A Credible Hero in Haiti (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: bryanwharram@brybiz.com

'Mountains Beyond Mountains': A Credible Hero in Haiti

September 14, 2003
 By ABRAHAM VERGHESE

"The world is full of miserable places,'' Tracy Kidder
writes. ''One way of living comfortably is not to think
about them or, when you do, to send money.'' ''Mountains
Beyond Mountains'' is about one physician's quest to
relieve suffering in just the kind of places we do not like
to think about. In a stylistic departure from most of
Kidder's previous books, he writes in the first person,
offering himself as a character and even as a foil, so that
his own reactions of admiration, skepticism, exasperation
and awe provide a second lens by which to see Dr. Paul
Farmer.

A latter-day Schweitzer, Paul Farmer divides his time
between the Harvard medical complex -- a ''Wall Street of
medicine,'' as Kidder describes it -- and Haiti. ''Out
there in the little village of Cange . . . in one of the
most impoverished, diseased, eroded and famished regions of
Haiti, there was this lovely walled citadel, Zanmi Lasante.
I wouldn't have thought it much less improbable if I'd been
told it had been brought by spaceship.'' The Zanmi Lasante
hospital serves about a million people and represents years
of single-minded effort by Paul Farmer.

Farmer's eccentric father was a wanderer whose children
christened him ''the Warden.'' Home for the Warden, his
uncomplaining wife and six children had included an old
bus, trailer parks and even a boat. Farmer says of his
childhood: ''I'd like to be able to say that when I was
young I lived in a trailer park, picked fruit with
Haitians, got interested in migrant farmworkers and went to
Latin America. All true, but not the truth. We're asked to
have tidy biographies that are coherent. Everyone does
that. But the fact is, a perfectly discrepant version has
the same ending.'' Paul was the scholastically gifted
child, and he won a scholarship and studied anthropology at
Duke University.

Farmer visited Haiti after graduation. He was appalled by
the health conditions and by the health care offered; even
the most caring doctors from abroad would ultimately return
home, turning their back on suffering that would not abate.
Farmer could not turn his back. He performed a preliminary
health census in Cange and found that mortality among
infants and juveniles was ''horrific.'' Maternal mortality
was of central importance because it often led to skeins of
catastrophes in the squatter settlements: hunger,
prostitution, disease and death. What was needed was a
healthy marriage of doctoring and public health; his field
of anthropology could be the perfect marriage counselor. It
is telling that Farmer found his life's work not by
theoretical explorations but through experiencing Haiti.
''I would read stuff from scholarly texts and know they
were wrong. Living in Haiti, I realized that a minor error
in one setting of power and privilege could have an
enormous impact on the poor in another.''

Farmer's efforts at Zanmi Lasante continued through his
training at Harvard, where he pursued a combined M.D./Ph.D.
degree in medicine and anthropology. His fellow students
knew him as Paul Foreigner, who was always off in his
beloved Haiti, showing up just in time for exams. The
combination of Harvard and Haiti had begun to enforce a new
kind of belief on Farmer. ''The fact that any sort of
religious faith was so disdained at Harvard and so
important to the poor -- not just in Haiti but elsewhere,
too -- made me even more convinced that faith must be
something good,'' he says. ''Surely someone is witnessing
this horror show? . . . I know it sounds shallow, the
opiate thing, needing to believe, palliating pain, but it
didn't feel shallow. . . . I was taken with the idea that
in an ostensibly godless world that worshiped money and
power or, more seductively, a sense of personal efficacy
and advancement, like at Duke and Harvard, there was still
a place to look for God, and that was in the suffering of
the poor. You want to talk crucifixion? I'll show you
crucifixion, you bastards.'' Farmer recounts a Haitian
proverb that says, essentially: ''God gives us humans
everything we need to flourish, but he's not the one who's
supposed to divvy up the loot. That charge was laid on
us.''

Kidder shadowed Farmer as he toiled at his hospital in
Haiti from dawn to dusk, as he hiked vast distances to
follow up on patients and then burned the midnight oil
writing grant applications and preparing speeches. Kidder
tagged along on Farmer's many trips to Cuba, Latin America
and Russia. The sense of Farmer as a driven, dedicated,
self-sacrificing physician emerges clearly. When Farmer won
the MacArthur ''genius'' award, he promptly turned that
money over to Partners in Health, the parent organization
he founded in Boston that oversees his efforts in Haiti and
elsewhere. His Harvard salary also goes straight to
Partners in Health. What, Kidder wonders, could drive a man
to such superhuman effort? ''The problem is, if I don't
work this hard, someone will die who doesn't have to,''
Farmer says. ''That sounds megalomaniacal. I wouldn't have
said that to you before I'd taken you to Haiti and you had
seen that it was manifestly true.'' And as for psychic
motivation, Farmer says: ''If you're making sacrifices,
unless you're automatically following some rule, it stands
to reason that you're trying to lessen some psychic
discomfort. So, for example, if I took steps to be a doctor
for those who don't have medical care, it could be regarded
as a sacrifice, but it could also be regarded as a way to
deal with ambivalence. . . . 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.''

''Mountains Beyond Mountains'' is less compelling when the
focus shifts away from Farmer, because Farmer is so
articulate about his own work. Kidder collects Farmer's
precise and pithy aphorisms: ''Medicine is a social
science, and politics is nothing but medicine on a large
scale.'' ''It is the curse of humanity that it learns to
tolerate even the most horrible situations by
habituation.'' ''Medical education does not exist to
provide students with a way of making a living, but to
ensure the health of the community.'' ''The physicians are
the natural attorneys of the poor, and the social problems
should largely be solved by them.''

Farmer anticipates what Kidder might have to say about him:
''When others write about people who live on the edge, who
challenge their comfortable lives -- and it has happened to
me -- they usually do it in a way that allows a reader a
way out. You could render generosity into pathology,
commitment into obsession. That's all in the repertory of
someone who wants to put the reader at ease rather than
conveying the truth in a compelling matter.''

But Kidder's conclusion after his time with Farmer is not
quite what Farmer predicted: ''It still seemed to me that
he took a stance all too conveniently impregnable. . . .
Any criticism of him amounted to an assault on the already
downtrodden people he served. But I knew by now he wasn't
simply posing. I felt something about him that I'd later
frame to myself this way: He said patients came first,
prisoners second and students third, but this didn't leave
out much of humanity. Every sick person seemed to be a
potential patient of Farmer's and every healthy person a
potential student. In his mind, he was fighting all poverty
all the time, an endeavor full of difficulties and
inevitable failures. For him, the reward was inward
clarity, and the price perpetual anger or, at best,
discomfort with the world, not always on the surface but
always there. Sensing this, I'd begun to be relieved of the
shallower discomforts I sometimes felt in his company. . .
. Farmer wasn't put on earth to make anyone feel
comfortable, except for those lucky enough to be his
patients, and for the moment, I had become one of those.''

''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.



Abraham Verghese is the Marvin Forland distinguished
professor at the University of Texas Health Science Center,
San Antonio. His most recent book is ''The Tennis
Partner.''

http://www.nytimes.com/2003/09/14/books/review/14VERGHET.html?ex=1064632425&ei=1&en=6b21000532cbf264


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