MOUNTAINS BEYOND MOUNTAINS - Tracy Kidder - Nonfiction

Without his clinical practice, Paul Farmer believes he would be nothing. It seems that, without Paul Farmer, his clinical practice also believes it would fail. The organization he has set up, Partners in Health, is a model for third-world healthcare, an oasis in the drought- and TB-stricken central plateau of Haiti. There's not much Paul Farmer can do about the drought, though he does stigmatize the foreign city planners who proposed the dam that shut off much of central Haiti from the river that used to irrigate its plains. What he and his team can fix, though, is TB, and through a combination of begging, borrowing, and stealing, they have dramatically lowered the number and severity of instances of TB throughout the region of Haiti which they serve. He and his collaborators have also started programs in Peru and Siberia to deal with MDR-TB, multiple-drug resistant strains, and the World Health Organization has, after much prodding, accepted his criticisms and proposals for change in the way they deal with TB and MDR-TB in rural and developing areas.

A worthy life, to be sure. Farmer has also written multiple books and more than 100 articles, received an MD and a PhD in anthropology from Harvard Med, and was awarded a MacArthur genius grant. He heads many boards of directors for organizations dealing with global health. As of the writing of Mountains Beyond Mountains, Farmer had one daughter with his wife Didi, who was living in Paris finishing up her doctoral studies. This is what we know about Farmer from the book, as far as facts go. But a book with the author as a pivotal character becomes as much a work of fiction and of fact, and with a life as large and conspicuous as Paul Farmer's, it is just as important to note where Tracy Kidder has tried to spin Farmer's story.

Although Farmer's relief efforts in Haiti and his proselytizing for better global healthcare are portrayed as unambiguously good, and a little scattershot--Farmer is portrayed as being mostly unable, or unwilling, to prioritize--his personal life is given a little more glamor than it, perhaps, deserves. Much is made of Farmer's wife and children living in another country, and seeing Paul only when he is forced to delay his business activities, such as when he is injured. One is given the impression that his daughter is growing up fatherless, and his wife is being neglected. True as it may have been at the time, Farmer now lives with his family, which has grown to include two more children, another daughter and a son. Whatever we can say his responsibilities may or may not be, with regard to his family, he certainly doesn't seem to be as much of a failure as Kidder portrays. Another juicy plotline involves Ophelia Dahl, one of the five co-founders of Partners in Health. Farmer met her when she was 18, doing charity work in Haiti, and we are led to believe that they shared a great romance, which ended when Farmer proposed, and Dahl realized that Farmer was too single-mindedly dedicated to be anything more to her than a friend. Later, when Farmer meets Didi, a Haitian, Ophelia sends her well-wishes, but the tone of the narrative is that Dahl is somewhat regretful. Now, perhaps this is true, but Dahl is open about her lesbianism, and has a child with her (female) partner. It's hard for me to believe that much love was lost between Dahl and Farmer.

It also seems nearly incredible that someone as much of a whirlwind as Farmer could do as much as he has done--complicated, time-consuming endeavors like running charity organizations, writing nonfiction books about Haitian politics, teaching at Harvard Med and Brigham and Women's hospital, and working on global healthcare policy with the WHO. Farmer is shown as nearly frenetically active, and I'm not doubting his sheer ability to perform these feats; rather, I question Farmer's seeming lack of premeditation and planning. If we are to believe Kidder, a man who cannot remember to change his clothes every day is simultaneously capable of working with a multinational policy organization, drafting changes and additions to a laborious document that will lay out the steps that need to be taken by any organization dealing with tuberculosis outside of a first-world hospital. At the very least, there must be more to Farmer than meets the eye. Though we are, again, given only brief snapshots into his medical and graduate careers, in order to have been successful, he must have also been able to at least borrow an eye for detail, for taking care of loose ends, and figuring out what needs to happen when, in order to get an MD, a PhD, a functioning healthcare organization, and a TB mandate. Kidder is happy to make it seem as though Dahl runs the show from behind the scenes, but Farmer and his list-making deserve some of the credit.