16946: Lemieux; Boston Globe re Paul Farmer (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: JD Lemieux <lxhaiti@yahoo.com>


Chronicling a doctor who aches for the world's poor
By David Mehegan, Globe Staff, 10/14/2003

CAMBRIDGE -- In a packed auditorium at Harvard's Longfellow
Hall, Tracy Kidder reads from his new book, "Mountains
Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who
Would Cure the World." It's a long section describing the
quirks, character, and mission of the 43-year-old cofounder
of Partners in Health, a Boston-based organization battling
infectious diseases in Haiti and other poor countries.

Farmer sits beside Kidder, listening. While Kidder is tall
and broad-shouldered, Farmer is lean, pale, and ascetic-
looking in his black suit and wire-rimmed glasses. He
fidgets, makes left-handed notes with long articulate
fingers, continually looks about, smiling and waving at
people. He winces when Kidder reads the phrase "a
world-class Robin Hood."

When his turn comes, Farmer fires off an uptempo,
five-minute comic roast of Tracy Kidder as a traveling
companion. But just when the room seems as loose as a
comedy club, he turns sharply to the wretched of the earth,
and the failure of wealthy societies to come to their aid.
He condemns the Bush administration's moratorium on aid to
Haiti: "Why are we blocking assistance to the poorest
country?" he demands to know. "It's bizarre, unfair, and
doesn't reflect the American people's will." The raw
injustice that must be addressed, he says, "is the
inequality of outcomes in health care. We have the tools
but not the equity plan."

That sudden shift from jollity to jeremiad seems to be
vintage Farmer, and it's part of the intricate mix of
traits that made him an irresistible subject for a book. We
learn much from "Mountains Beyond Mountains" about Haiti,
Partners in Health, the politics of world health policy,
and the infectious diseases devastating poor countries. But
at its heart, this book is about one multilayered man: his
sparkling personality, lofty vision, dedication, deep
anger, and effect on the world -- and on those around him.

Born in North Adams, the second-oldest of six children,
Paul Edward Farmer spent much of his childhood in a mobile
home made out of an old school bus, in a trailer park in
Birmingham, Ala. Later, his strong-willed father moved the
family onto a rebuilt hulk of a boat, moored in a bayou on
the Florida Gulf Coast.

Despite his strange home settings, Farmer was a brilliant
student who won a full scholarship to Duke University. He
studied anthropology and became interested in Haiti, the
poorest country in the Western Hemisphere. During a 1983
study trip there, he was so disturbed by the misery and
sickness that he committed himself to doing something about
it. He went to Harvard Medical School in 1984, and while
there in 1987 cofounded Partners in Health to treat the
destitute sick and train health workers in the poorest part
of central Haiti. The Haitian partner hospital, Zanmi
Lasante, has had remarkable success and draws visits from
public health specialists worldwide.

Farmer received doctorates in medicine and medical
anthropology at Harvard, and he became a professor of
social medicine and chairman of the division of social
medicine at Brigham and Women's Hospital. He learned
French, Haitian Creole, and Spanish. In 1993 he won a
$250,000 MacArthur Foundation "genius grant," gave it to
Partners, and last year did the same with a $250,000 Heinz
Foundation award. With original support from Boston
construction magnate Tom White (and more recently from the
World Health Organization, the Soros Foundation, and the
Gates Foundation), Farmer, cofounder Jim Yong Kim, and
executive director Ophelia Dahl have extended Partners'
reach to Peru, Mexico, Guatemala, and Siberia. Partners
also has an HIV-prevention program in Boston.

"I was put off by Farmer but became fascinated by him once
I began to get the outlines of his life," Kidder recalls in
an interview after the reading. Farmer had a way of
approaching Haiti "that would be hard to share because it
implies such an extreme definition of doing one's best. I
was afraid he would disturb my universe, as in fact he
did."

He met Farmer in Haiti in 1994 while researching a magazine
piece about the US military action that restored Haitian
president Jean-Bertrand Aristide to power. In Kidder's
presence, Farmer had complained to a US Special Forces
captain who had released a local thug, accused of a grisly
murder, for lack of evidence. The soldier insisted he
couldn't hold the man, but Farmer groused about legal
niceties in a country without a functioning criminal
justice system.

"I had bought into the pessimism of the soldiers," Kidder
says, "which was, `Why do we bother? Things aren't going to
get any better than they were before we came.' You'd just
as soon believe that these problems are insolvable. That's
how I felt about Haiti when I watched TV or read the
papers: I'd just turn away and say, `What are you going to
do?' But I knew that Farmer had a different view. I spent
the next six years with him on my mind."

Educated at Harvard and in a one-year Vietnam tour, Kidder,
57, had published five successful books: about a computer
("The Soul of a New Machine," which won the Pulitzer
Prize), a house ("House"), public education ("Among
Schoolchildren"), senior citizens ("Old Friends"), and the
town of Northampton ("Home Town"), which is near where he
lives in Williamsburg. All were centered on his adopted
state (he was born in New York).

Going the distance In 1999, Kidder was casting about for a
book subject when his friend Jonathan Harr, author of "A
Civil Action," suggested Paul Farmer. Kidder reluctantly
called Farmer, who invited him to spend January 2000 with
him in Haiti. The trip yielded a New Yorker magazine piece,
but Kidder knew it couldn't end there. He was so affected
by Haiti and by Farmer's work and philosophy that he knew
he'd found his book. Over the next couple of years, he
spent thousands of hours with Farmer, his associates, and
his family, absorbing his words and ways like a sponge,
playing Plato to Farmer's Socrates, pouring it into the
book. The Paul Farmer in "Mountains Beyond Mountains" is
energetic, witty, voluble, intense, and always optimistic.
He is married to a Haitian woman and has a young daughter.
He never writes anybody off and never seems to let up or
give up. He will trek for 11 hours over the Haitian
mountains to visit a sick patient in a remote village (it
happens in the book), while staying in touch with patients
in Boston and Partners programs around the world.

Kidder says, "Here is a person who has proved, along with a
lot of friends, that you can prevent people from dying
stupid deaths. They've done it in Haiti and Peru and
Russia. You take this world that says these pandemics like
AIDS, TB, and malaria are too big and expensive for us to
deal with, and here come these people who say no, it's not
impossible, it's not too expensive, and here is the proof.
Their view is, `We can do these things, therefore we have
to.' "

A hagiography would make dull reading, but "Mountains
Beyond Mountains" is more than that. A pervasive subtext is
the sometimes-unsettling effect that Paul Farmer's extreme
dedication has on other people. One of Farmer's colleagues
tells Kidder, "Paul has a gift for making people feel
guilty." On the wall of one Partners staffer's office is
the motto, "If Paul is the model, we're golden," but the
word "golden" is on a separate strip of paper loosely taped
over a common Anglo-Saxon vulgarism. Kidder was told it's a
warning to young staffers against the idea that "the right
thing to do with their lives is imitate Paul."

Kidder also had to learn to handle Farmer's example. He
concluded that few people could do or live as Farmer does,
and that he doesn't expect them to. "There are all sorts of
ways to look at this guy," Kidder says. "He is so friendly.
He is in love with the world and is offended in proportion
to his love for it. To look at him whole, you have to get
rid of this idea that you are to measure yourself against
him. If you do that, you will inevitably feel diminished."

Emotional responses In the book, Farmer describes to Kidder
an incident in Haiti when a sick young woman in the clinic
gave birth to a stillborn baby. Farmer said he unexpectedly
burst into tears when it happened, realizing he had
pictured his own little girl in the place of the dead
child, and immediately reproached himself: "So you love
your own child more than these kids." Kidder says he asked,
"Some people would say, `Where do you get off thinking
you're different from everyone and can love the children of
others as much as your own?' His answer was interesting. He
didn't get angry. He said, `All the great religions say,
`love thy neighbor as thyself.' I'm sorry, I can't. But I'm
going to keep on trying."

If Farmer's almost superhuman demands of himself make some
people think they should be more like him, to others it can
be off-putting. "One man wrote a letter to The New Yorker
saying, `Who does he think he is?' " says Kidder. " `We
should save him from the heart of goodness.' Paul offends
people like that. They say, `He must think he's better than
I am by virtue of doing all these things.' "

"Farmer sets a trap for Kidder," writes Herbert Gold in a
book review in the Los Angeles Times, "and part of the
fascination . . . lies in wondering: By the end of the
book, will Farmer be canonized or will Kidder slip out of
the trap and offer judgment? Kidder's generosity leads him
toward canonization."

Kidder doesn't call Farmer a saint, but he doesn't seem to
find anything in him to doubt, either. "I felt on that
first journey with Paul that I was on some sort of
altruistic adventure, a moral adventure," he says. "It was
exciting and uplifting and horrifying, and I learned that I
was with a guy you could trust. He was so intrepid. It was
like the harrowing of hell to be with him."

As for Farmer's view of himself, there's nothing in the
book, nor in his spoken manner, that sounds like
grandiosity or vanity. In an



e-mail sent a few days after his Harvard appearance, after
a long day seeing patients in Haiti, Farmer talks about the
discomfort some people feel about him. His charm is in his
words, but so is the angry edge evident at the reading: "I
hope I don't make everyone feel uncomfortable. I like
having friends, too, just like everyone else. I neither
want to nor feel qualified to fill the role of judge. But
the problems we work on -- the `we' being Partners in
Health -- are really rebukes, not to me or to them or to
you, but to all of us. Can you look at a problem like AIDS
and say, `We've all done our best; there's no blame to be
assessed, no judgment to be made'? Of course not. We're
total failures, all of us, in the equity department. People
are dying like flies of this and other treatable or
preventable illnesses, so how can you look at such a
situation and say, `We're all great; there's no one to be
blamed; it's all some big misunderstanding or a force of
nature'?"

Farmer has mixed feelings about the book. He has no
complaints about facts, and he praises the book's
"wonderful descriptions and dead-on analysis and funny
bits." Nevertheless, he says, "I was and remain torn by it.
I do not want the focus on me. First, such attention is
uncomfortable. Second, this is teamwork, so focusing on one
person is automatically incorrect and can cause troubles
with co-workers."

In the end, his colleagues persuaded him to cooperate with
Kidder: "Some of us have been at this work 20 years, and we
still see so many people dying unnecessarily. Getting the
story out more effectively, changing hearts and minds,
proved reason enough to reconsider doing this."

After the interview, Kidder was off on his 13-city national
book tour. (At the Harvard event, Farmer needled him
playfully: "I'm not touring, I'm going to Haiti.") After
the tour, he'll get on with his next book, a memoir of
Vietnam. But he says that moving on from this one won't be
easy.

"I'm not sure anything is going to seem as important," he
says. "I don't want to leave this subject behind. You don't
get away from Paul Farmer, once he's made you an ally. He
isn't going to let you."

David Mehegan can be reached at mehegan@globe.com.

© Copyright 2003 Globe Newspaper Company.

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