Book SummaryMountains Beyond Mountains, by Tracy Kidder

1-Page Summary1-Page Book Summary of Mountains Beyond Mountains

In Mountains Beyond Mountains, Tracy Kidder tells the true story of Paul Farmer, a doctor and anthropologist committed to both serving the poor and demonstrating that the health of a nation’s people is the product of its culture and political history. Kidder first met Farmer in 1994 during a political intervention in Haiti. Kidder was embedded with US Army officials who were attempting to restore a democratic leader, Jean-Bertrand Aristide, in Haiti, which had been ruled by a military junta for the previous three years.

Meeting Doctor Paul Farmer

Farmer, who operated a hospital in Haiti, came to express his grievances to the US Army officials about their plans. He considered the US partially responsible for the military junta—one of the junta’s leaders had trained in the US Army’s School of the Americas—and thought that the US cared more about its business interests than helping the Haitian people, the vast majority of whom were very poor. Farmer tried to show the officials that the locals weren’t happy with the US Army, a potentially huge problem—the Army had just 9 soldiers working to control 150,000 locals.

Connecting With Farmer

Kidder and Farmer happened to be taking the same flight on the way back to the states, and Kidder used the opportunity to learn about Farmer’s life. Farmer was 35 years old and worked part of the year at a hospital in Boston. For the rest of the year, he worked at his hospital in rural Haiti.

Farmer was frustrated by how many diseases around the world would be preventable if people were only given the appropriate treatment. He thought that people in the US, particularly “white liberals,” needed to recognize that big change couldn’t happen without some sacrifice on their part. For example, Farmer hoped that if someone learned about a disease afflicting the poor, they’d give money to help treat it rather than assuming it’d resolve itself.

In Haiti, there is an expression that says, “beyond mountains, there are mountains.” Though Farmer faced immense obstacles to bring care to those in need, he felt a sustained and urgent drive to deliver the best care possible.

Farmer at Work In Haiti

In 2000, Kidder visited Farmer in Haiti to observe the area and the hospital he worked in first-hand.

Péligre Dam

Farmer worked in an area of Haiti where the local farmers had lost farmland due to the construction of a hydroelectric dam, the Péligre Dam, which holds back the waters of Haiti’s largest river. The US Army Corps of Engineers built it in the 1950s to provide water to agricultural businesses downstream—which were owned by the US at the time—as well as electricity to affluent Haitians and foreign-owned factories operating in the capital of Port-au-Prince.

Before the dam, people lived along the river, which had some of the best farmland in the region. They produced enough to feed their families, and then some. Once the dam was built, they were forced to relocate their farms up the steep mountainsides, where farmland was much less productive and more prone to erosion. In these conditions, they struggled to get by.

Zanmi Lasante Hospital

Farmer’s hospital, called Zanmi Lasante, means “Partners in Health” in Creole. It served a great need for medical care in the local area. Though there were other hospitals and clinics, many required patients to pay more than they could afford for treatment, including for the medical equipment used to treat them, like gloves. Furthermore, many clinics lacked basic sanitation.

In contrast, though the staff at Zanmi Lasante sometimes made mistakes or botched lab testing, they were able to offer more affordable services. Farmer insisted that the hospital treat nearly everyone, regardless of their ability to pay.

The Role of Sorcery

In rural Haiti, practitioners of most religions, including Voodooists, Catholics, and Protestants, all tended to believe that illness was caused by sorcery, or magic spells sent by enemies. Sorcery offered a method to explain the world.

From Farmer’s perspective, it made sense that, due to the general lack of knowledge and access to medicine, people would continue to believe in sorcery, a relic of French colonial history. Yet with exposure, most people accepted both modern medicine and sorcery. Some people thought of Farmer’s role in the community as similar to a Voodoo priest—he knew how to heal people. And Farmer knew many Voodoo priests who brought ill patients to his hospital for treatment.

Farmer’s Early Life, Education, and Initial Time in Haiti

Farmer’s early life greatly shaped his later life and career as a doctor. He grew up as one of 6 siblings. His family moved from Massachusetts, to Alabama, to Florida. His father worked as a salesman, and later as a teacher, while his mother held sales jobs.

Farmer’s family lived in humble quarters, such as a bus in a trailer park and a sailboat, for most of his childhood. The unconventional close quarters helped Farmer develop the ability to work and sleep anywhere.

Farmer was a bright child and was enrolled in his school’s gifted and talented program. He relished reading books like Lord of the Rings and started his own herpetology club. In high school, he was popular with young women, which his mother said was because he was a good listener.

College

Farmer accepted a full scholarship at Duke University. His first semester, he was extremely busy taking in the college experience. It was his first exposure to wealth, as many of the students there came from wealthy families, and he had access to the theater and other cultural experiences he hadn’t before.

Ultimately, Farmer realized that he was more drawn to the values he grew up with, such as helping the underdog and the truly poor, than he was to wealth. **He observed the farmworkers employed near Duke, many of whom were Haitian and lived in conditions far worse than he had grown up with. He grew fascinated with Haiti and...

Mountains Beyond Mountains Summary Part 1: Meeting Doctor Paul Farmer

In Mountains Beyond Mountains, Tracy Kidder tells the true story of Paul Farmer, a doctor and anthropologist committed to both serving the poor and demonstrating that the health of a nation’s people is the product of its culture and political history. Kidder first met Dr. Paul Farmer in 1994 during a political intervention in Haiti. Kidder was embedded with US Army officials who were attempting to restore a democratic leader, Jean-Bertrand Aristide, in Haiti, which had been ruled by a military junta for the previous three years.

Farmer, who operated a hospital in Haiti, came to express his grievances to the US Army officials about their plans. He considered the US partially responsible for the military junta—one of the junta’s leaders had trained in the US Army’s School of the Americas—and thought that the US cared more about its business interests than helping the Haitian people, the vast majority of whom were very poor.

(Shortform note: The US Army School of the Americas, now called the Western Hemisphere Institute for Security Cooperation, was founded in 1946 to train Latin American leaders in US warfare tactics. Since then, it has trained leaders who have gone on to...

Mountains Beyond Mountains Summary Part 2: Farmer at Work in Haiti

In 2000, Kidder visited Farmer in Haiti to observe the area and his hospital first-hand.

Péligre Dam

Farmer worked in an area of Haiti where the local farmers had lost farmland due to the construction of a hydroelectric dam, the Péligre Dam. It holds back the waters of Haiti’s largest river, the Artibonite River.

The US Army Corps of Engineers built the dam in the 1950s to provide water to agricultural businesses downstream—which were owned by the US at the time—as well as electricity to affluent Haitians and foreign-owned factories operating in the capital of Port-au-Prince.

Before the dam, people lived along the river, which had some of the best farmland in the region. They produced enough to feed their families, and then some. Once the dam was built, they were forced to relocate their farms up the steep mountainsides, where farmland was much less productive and more prone to erosion.

Zanmi Lasante Hospital

Farmer’s hospital was called Zanmi Lasante, which means “Partners in Health” in Creole. It served a great need for medical care in the local area. Though there were other hospitals and clinics, many required patients to pay more than they could afford...

Shortform Exercise: Access to Medicine

Reflect on Farmer’s approach to medicine.

Farmer saw the value in not trying to argue against patients’ religious beliefs. What are some of the merits of this approach? Some of the downsides?

Mountains Beyond Mountains Summary Part 3: Farmer’s Early Life, Education, and Initial Time in Haiti

Farmer’s early life greatly shaped his later life and career as a doctor. He grew up as one of six siblings. His family moved from Massachusetts, to Alabama, to Florida. His father worked as a salesman, and later as a teacher, while his mother held sales jobs.

Farmer’s family lived in humble quarters, such as a bus in a trailer park and a sailboat, for most of his childhood. The unconventional close quarters helped Farmer develop the ability to work and sleep anywhere.

Farmer was a bright child and was enrolled in his school’s gifted and talented program. He relished reading books like Lord of the Rings and started his own herpetology club. In high school, he was popular with young women, which his mother said was because he was a good listener.

College

Farmer accepted a full scholarship to Duke University. His first semester, he was extremely busy taking in the college experience. It was his first exposure to wealth, as many of the students there came from wealthy families, and he had access to the theater and other cultural experiences he hadn’t before. He became a critic for the school paper and experienced high culture for the first time. He also joined a...

Shortform Exercise: The Role of the US

Reflect on the role of the US in Haiti.

Why would the US involve itself in the affairs of countries like Haiti?

Mountains Beyond Mountains Summary Part 4: Treating Tuberculosis in Peru

In 1997, Farmer and Partners in Health’s work expanded beyond Haiti to Peru. Father Jack, a priest and member of PIH’s board of advisors, had decided to open a parish in a slum outside of Lima, Peru and thought PIH should open a clinic there.

Establishing a Clinic in Lima

A long-time colleague of Farmer’s at Partners in Health, Jim Yong Kim, worked to establish the clinic, modeling it after Zanmi Lasante. Farmer advised Kim while working from Haiti.

Just as Farmer had in Haiti, Kim conducted a health census to find out what the community needed. Community members asked for a pharmacy where medicine could be dispensed. Shortly after the pharmacy’s completion, it was bombed by guerrilla leaders who were in a civil war with the government. The guerrillas thought that the pharmacy offered helpful medicines and services that would pacify locals to the point that they wouldn’t support the guerrilla’s cause to force change from Peru’s government.

Kim opted to rebuild the pharmacy in another location.

Drug Resistant Tuberculosis

In Partners in Health’s early days in Lima, Farmer thought it’d be worthwhile to look into treating tuberculosis there. **From his...

Mountains Beyond Mountains Summary Part 5: Traveling to Cuba and Russia

In addition to his project in Peru, and some smaller side projects in the US, Farmer spent time traveling to raise money for his work in Haiti and helped develop a TB treatment program for Russia. Even in less-busy months, he spent ample time traveling the world to do this work.

Cuba

Despite previously losing the backing of the Soviet Union and currently facing an embargo from the US, Cuba didn’t let lack of funding or a history of poverty affect its citizens’ health—the country made public health a priority and created one of the most renowned health care systems in the world.

For Farmer, it represented a glimmer of hope that even poor countries can develop a robust system to give people access to healthcare, bettering the people’s quality of life. He traveled to Cuba to attend a conference on AIDS in 2000. While there, he attempted to gather leads on people that would be able to fund AIDS treatment, serve as doctors in Haiti, or help train Haitian medical students. He cultivated a number of leads in anticipation of only 1-2 coming to fruition. Sometimes he got an answer right away: One doctor agreed on the spot to allow two Haitian medical students to study at a new...

Mountains Beyond Mountains Summary Part 6: Innovative Treatments for Haitian Patients

Back in Haiti, Farmer and PIH continued to work on finding effective treatments for patients in need. This involved detailed planning and making decisions about how money should be spent.

Expanding AIDS Treatment

Though antiretroviral drugs provided a proven treatment for AIDS, many world health experts at the time didn’t think it was practical to treat people in poor countries. They said the treatment was too costly and preferred to focus funding on prevention efforts instead. But Farmer and PIH believed in treating AIDS regardless of cost or the patient’s ability to pay.

However, Farmer encountered significant obstacles as he tried to treat AIDS patients in Haiti. One pillar of Zanmi Lasante’s AIDS program was trying to prevent the spread of HIV from mothers to babies. This one program alone required massive coordination, including providing educational programs to people in a 400 square-mile area, as well as drugs to pregnant mothers, and later, to their newborn babies.

Another obstacle to treatment came from the US leaders, who were discouraging foreign leaders and international agencies from giving Aristide’s government funding for infrastructure and services....

Shortform Exercise: How to Treat Patients

Assess Farmer’s approach to treating patients.

Think of a time you had to make a decision involving a significant trade-off. What did you ultimately decide and why?