16994: (Lemieux) America's National Public Radio: Paul farmer (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: JD Lemieux <lxhaiti@yahoo.com>

The Quest of Dr. Paul Farmer
New Book Tells of an American Doctor's Life, Mission in
Haiti

In the mountains of Haiti, the village of Zanmi Lasante. At
the heart of Kidder's book is the Haitian proverb "Beyond
mountains there are mountains," which means as you solve
one problem, another problem presents itself.
Credit: Tracy Kidder



Author Tracy Kidder
Credit: Jose Ramon Garcia



Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a
Man Who Would Cure the World
Provided by: Random House




Oct. 20, 2003 -- Paul Farmer is a physician and an
anthropologist, and according to at least one of his former
patients in Haiti, he's a god. Farmer specializes in
infectious disease; he's made it his mission to transform
health care on a global scale, by focusing on the world's
poorest and sickest communities. Back in 1987, Farmer
helped found a nonprofit called Partners in Health, which
says its mission is both medical and moral. Now, the group
treats 1,000 patients daily for free in the Haitian
countryside. The group also works to cure drug-resistant
tuberculosis among prisoners in Siberia and in the slums of
Lima, Peru.

Writer Tracy Kidder profiles Farmer in his new book,
Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a
Man Who Would Cure the World. NPR's Melissa Block, host of
All Things Considered, talks with Kidder about his visits
to Haiti and the time he spent with Farmer.

Read an excerpt, from Chapter 1:

Six years after the fact, Dr. Paul Edward Farmer reminded
me, "We met because of a beheading, of all things."

It was two weeks before Christmas 1994, in a market town in
the central plateau of Haiti, a patch of paved road called
Mirebalais. Near the center of town there was a Haitian
army outpost -- a concrete wall enclosing a weedy parade
field, a jail, and a mustard-colored barracks. I was
sitting with an American Special Forces captain, named Jon
Carroll, on the building's second-story balcony. Evening
was coming on, the town's best hour, when the air changed
from hot to balmy and the music from the radios in the rum
shops and the horns of the tap-taps passing through town
grew loud and bright and the general filth and poverty
began to be obscured, the open sewers and the ragged
clothing and the looks on the faces of malnourished
children and the extended hands of elderly beggars
plaintively saying, "Grangou," which means "hungry" in
Creole.

I was in Haiti to report on American soldiers. Twenty
thousand of them had been sent to reinstate the country's
democratically elected government, and to strip away power
from the military junta that had deposed it and ruled with
great cruelty for three years. Captain Carroll had only
eight men, and they were temporarily in charge of keeping
the peace among 150,000 Haitians, spread across about one
thousand square miles of rural Haiti. A seemingly
impossible job, and yet, out here in the central plateau,
political violence had all but ended. In the past month,
there had been only one murder. Then again, it had been
spectacularly grisly. A few weeks back, Captain Carroll's
men had fished the headless corpse of the assistant mayor
of Mirebalais out of the Artibonite River. He was one of
the elected officials being restored to power. Suspicion
for his murder had fallen on one of the junta's local
functionaries, a rural sheriff named Nerva Juste, a
frightening figure to most people in the region. Captain
Carroll and his men had brought Juste in for questioning,
but they hadn't found any physical evidence or witnesses.
So they had released him.

The captain was twenty-nine years old, a devout Baptist
from Alabama. I liked him. From what I'd seen, he and his
men had been trying earnestly to make improvements in this
piece of Haiti, but Washington, which had decreed that this
mission would not include "nation-building," had given them
virtually no tools for that job. On one occasion, the
captain had ordered a U.S. Army medevac flight for a
pregnant Haitian woman in distress, and his commanders had
reprimanded him for his pains. Up on the balcony of the
barracks now, Captain Carroll was fuming about his latest
frustration when someone said there was an American out at
the gate who wanted to see him. There were five visitors
actually, four of them Haitians. They stood in the
gathering shadows in front of the barracks, while their
American friend came forward. He told Captain Carroll that
his name was Paul Farmer, that he was a doctor, and that he
worked in a hospital here, some miles north of Mirebalais.

I remember thinking that Captain Carroll and Dr. Farmer
made a mismatched pair, and that Farmer suffered in the
comparison. The captain stood about six foot two, tanned
and muscular. As usual, a wad of snuff enlarged his lower
lip. Now and then he turned his head aside and spat. Farmer
was about the same age but much more delicate-looking. He
had short black hair and a high waist and long thin arms,
and his nose came almost to a point. Next to the soldier,
he looked skinny and pale, and for all of that he struck me
as bold, indeed downright cocky.

He asked the captain if his team had any medical problems.
The captain said they had some sick prisoners whom the
local hospital had refused to treat. "I ended up buyin' the
medicine myself."

Farmer flashed a smile. "You’ll spend less time in
Purgatory." Then he asked, "Who cut off the head of the
assistant mayor?"

"I don't know for sure," said the captain.

"It's very hard to live in Haiti and not know who cut off
someone's head," said Farmer.

A circuitous argument followed. Farmer made it plain he
didn’t like the American government's plan for fixing
Haiti's economy, a plan that would aid business interests
but do nothing, in his view, to relieve the suffering of
the average Haitian. He clearly believed that the United
States had helped to foster the coup -- for one thing, by
having trained a high official of the junta at the U.S.
Army's School of the Americas. Two clear sides existed in
Haiti, Farmer said -- the forces of repression and the
Haitian poor, the vast majority. Farmer was on the side of
the poor. But, he told the captain, "it still seems fuzzy
which side the American soldiers are on." Locally, part of
the fuzziness came from the fact that the captain had
released the hated Nerva Juste.

I sensed that Farmer knew Haiti far better than the
captain, and that he was trying to impart some important
information. The people in this region were losing
confidence in the captain, Farmer seemed to be saying, and
this was a serious matter, obviously, for a team of nine
soldiers trying to govern 150,000 people.

But the warning wasn't entirely plain, and the captain got
a little riled up at Farmer's denunciation of the School of
the Americas. As for Nerva Juste, he said, "Look, that guy
is a bad guy. When I do have him and the evidence, I'll
slam him." He slapped a fist into his hand. "But I'm not
gonna stoop to the level of these guys and make summary
arrests."

Farmer replied, in effect, that it made no sense for the
captain to apply principles of constitutional law in a
country that at the moment had no functioning legal system.
Juste was a menace and should be locked up.

So they reached a strange impasse. The captain, who
described himself as "a redneck," arguing for due process,
and Farmer, who clearly considered himself a champion of
human rights, arguing for preventive detention. Eventually,
the captain said, "You'd be surprised how many decisions
about what I can do here get made in Washington."

And Farmer said, "I understand you’re constrained. Sorry if
I've been haranguing."

It had grown dark. The two men stood in a square of light
from the open barracks door. They shook hands. As the young
doctor disappeared into the shadows, I heard him speaking
Creole to his Haitian friends.

I stayed with the soldiers for several weeks. I didn't
think much about Farmer. In spite of his closing words, I
didn't think he understood or cared to sympathize with the
captain's problems.

Then by chance I ran into him again, on my way home, on the
plane to Miami. He was sitting in first-class. He explained
that the flight attendants put him there because he often
flew this route and on occasion dealt with medical
emergencies on board. The attendants let me sit with him
for a while. I had dozens of questions about Haiti,
including one about the assistant mayor's murder. The
soldiers thought that Voodoo beliefs conferred a special,
weird terror on decapitation. "Does cutting off the
victim’s head have some basis in the history of Voodoo?" I
asked.

"It has some basis in the history of brutality," Farmer
answered. He frowned, and then he touched my arm, as if to
say that we all ask stupid questions sometimes.

I found out more about him. For one thing, he didn't
dislike soldiers. "I grew up in a trailer park, and I know
which economic class joins the American military." He told
me, speaking of Captain Carroll, "You meet these
twenty-nine-year-old soldiers, and you realize, Come on,
they're not the ones making the bad policies." He confirmed
my impression, that he'd visited the captain to warn him.
Many of Farmer's patients and Haitian friends had
complained about the release of Nerva Juste, saying it
proved the Americans hadn't really come to help them.
Farmer told me he was driving through Mirebalais and his
Haitian friends were teasing him, saying he didn't dare
stop and talk to the American soldiers about the murder
case, and then the truck got a flat tire right outside the
army compound, and he said to his friends, "Aha, you have
to listen to messages from angels."

I got Farmer to tell me a little about his life. He was
thirty-five. He had graduated from Harvard Medical School
and also had a Ph.D. in anthropology from Harvard. He
worked in Boston four months of the year, living in a
church rectory in a slum. The rest of the year he worked
without pay in Haiti, mainly doctoring peasants who had
lost their land to a hydroelectric dam. He had been
expelled from Haiti during the time of the junta but had
sneaked back to his hospital. "After the payment," he said,
"of an insultingly small bribe."

I looked for him after the plane landed. We talked some
more in a coffee shop, and I nearly missed my connecting
flight. A few weeks later, I took him to dinner in Boston,
hoping he could help make sense of what I was trying to
write about Haiti, which he seemed glad to do. He clarified
some of the history for me but left me wondering about him.
He had described himself as "a poor people's doctor," but
he didn’t quite fit my preconception of such a person. He
clearly liked the fancy restaurant, the heavy cloth
napkins, the good bottle of wine. What struck me that
evening was how happy he seemed with his life. Obviously, a
young man with his advantages could have been doing good
works as a doctor while commuting between Boston and a
pleasant suburb -- not between a room in what I imagined
must be a grubby church rectory and the wasteland of
central Haiti. The way he talked, it seemed he actually
enjoyed living among Haitian peasant farmers. At one point,
speaking about medicine, he said, "I don't know why
everybody isn't excited by it." He smiled at me, and his
face turned bright, not red so much as glowing, a
luminescent smile. It affected me quite strongly, like a
welcome gladly given, one you didn't have to earn.

But after our dinner I drifted out of touch with him,
mainly, I now think, because he also disturbed me. Writing
my article about Haiti, I came to share the pessimism of
the soldiers I'd stayed with. "I think we should have left
Haiti to itself," one of Captain Carroll's men had said to
me. "Does it really matter who's in power? They're still
gonna have the rich and the poor and no one in between. I
don't know what we hope to accomplish. We're still going to
have a shitload of Haitians in boats wanting to go to
America. But, I guess it's best not even to try and figure
it out." The soldiers had come to Haiti and lifted a terror
and restored a government, and then they'd left and the
country was just about as poor and broken-down as when they
had arrived. They had done their best, I thought. They were
worldly and tough. They wouldn't cry about things beyond
their control.

I felt as though, in Farmer, I'd been offered another way
of thinking about a place like Haiti. But his way would be
hard to share, because it implied such an extreme
definition of a term like "doing one's best."

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. Over the next five years, I mailed some small
sums to the charity that supported Farmer's hospital in
Haiti. He sent back handwritten thank-you notes on each
occasion. Once, from a friend of a friend, I heard he was
doing something notable in international health, something
to do with tuberculosis. I didn't look into the details,
though, and I didn't see him again until near the end of
1999. I was the one who made the appointment. He named the
place.

Excerpted from "Mountains Beyond Mountains" by Tracy Kidder
Copyright© 2003 by Tracy Kidder. Excerpted by permission of
Random House, a division of Random House, Inc. All rights
reserved. No part of this excerpt may be reproduced or
reprinted without permission in writing from the publisher.


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