An Altruist without Borders

By Catherine Arnst

MOUNTAINS BEYOND MOUNTAINS

The Quest of Dr. Paul Farmer,

a Man Who Would Cure the World

By Tracy Kidder

Random House -- 317pp -- $29.95

America tends to see itself as a generous nation, and certainly most of its citizens donate at least some of their money or energy to charity. But realists may question anyone who sacrifices too much comfort, time, or financial stability. You can't save the world, they say, and you'll only get frustrated trying.

Then there is Dr. Paul Farmer, a person who has made a huge difference in the lives of thousands of the world's poorest citizens -- primarily because he believes that he can. Farmer is the subject of Mountains Beyond Mountains, the latest book by Pulitzer Prize-winning author Tracy Kidder. It is an engrossing and many-layered account of a man who, says Kidder, "seems to be living, as nearly as any human can, without hypocrisy."

Farmer's story is both compelling and disturbing. This brilliant, charming, and irreverent doctor, a professor at Harvard Medical School, has saved the lives of hundreds of Haitians, changed the world's treatment regimen for drug-resistant tuberculosis, and inspired countless efforts to bring medical care to the least-developed nations. He is the founder of Partners in Health, a small but influential nonprofit in Boston that funds clinics in some of the world's poorest spots. The winner of a MacArthur "genius" grant in 1993, he is a renowned infectious-disease expert, yet still takes time to treat indigent AIDS patients in Boston. But don't call him a saint: Farmer enjoys practical jokes and expensive meals, dotes on his young daughter and anthropologist wife in Paris, and can belt back vodka with the best of them at a Russian banquet.

So why is this well-written book disturbing? Because it's impossible to keep at arm's length. If you have an altruistic bone in your body, by the time you reach the end you'll be questioning why you aren't doing more to help others. The book is not preachy, but Farmer "taps into a fundamental place in some troubled consciences...the often unacknowledged uneasiness that some of the fortunate feel about their place in the world," writes Kidder. "So we got dat goin' for us," as Farmer would say -- quoting, of all things, a line from the movie Caddyshack.

This is an unusual book for Kidder, best known for his detailed, entertaining examinations of much smaller subjects. The Soul of a New Machine depicted the creation of one of the first minicomputers. Among Schoolchildren recounted a year in the life of a fourth grade class in western Massachusetts. Mountains Beyond Mountains is far more wide-reaching: In one month described in the book, Kidder and Farmer traveled to Haiti, Peru, France, Massachusetts, Cuba, and Siberia.

Kidder for the first time also inserts himself into his own book, standing in for the reader as he puzzles out loud about what makes Farmer run. "I imagine that many people would like to construct a life like Farmer's, to wake up knowing what they ought to do and feeling that they were doing it," writes Kidder. "But I can't think that many would willingly take on the difficulties."

Certainly Farmer is a hard act to emulate. Born in 1960, he is the second of six children raised by iconoclastic parents who lived in a converted school bus and ramshackle boat on Florida's Gulf Coast. The father, a public school teacher, expected a lot of his children and raised them to be both self-sufficient and open-minded. Farmer grew up with no running water, picked fruit in the summer with migrant workers, yet still managed to graduate as valedictorian of his high school class, with a full scholarship to Duke University. There, he became interested in liberation theology, a branch of Catholicism that considers oppression of the poor to be a sin. In North Carolina, he also met a number of Haitian migrant workers and realized that their wretched living conditions made his own childhood look idyllic. He graduated from college having a fascination with all things Haitian and traveled to Port-au-Prince in 1983 with a determination to help.

This resolve was more than challenged by the conditions he discovered in Cange, the poorest part of one of the poorest countries in the world. The dusty land offered little sustenance, most of the populace lived in dirt-floor lean-tos, disease was rampant, and there were no medical services to speak of. It was there that Farmer took to heart the old Haitian saying that gives this book its name: "After mountains there are mountains." Each problem leads to another problem, and you solve them one at a time. To Farmer, the first mountain was the need for a clinic in Cange, and he entered Harvard Medical School in 1984 determined to start one.

Farmer graduated in 1990 at the top of his class, simultaneously receiving an M.D. and a PhD in anthropology. He was able to achieve this even though he had spent most of the previous six years in Cange founding Zanmi Lasante, a clinic that has transformed health care in the area. And he still regularly hikes through remote sections of Cange to treat patients.

His influence, meanwhile, has spread far beyond Haiti. He was instrumental in the mid-1990s in convincing the world's health organizations that multi-drug-resistant tuberculosis, a deadly version of TB, could be cured. Back then, many experts thought it was pointless to treat drug-resistant TB in poor countries -- the drugs were too expensive, and the regimen too hard to follow. But Farmer came up with an effective combination of drugs and spent more than a year persuading the World Health Organization to make the necessary medicines affordable for use in poor nations.

Mountains Beyond Mountains is more than a recitation of one man's good deeds. It relates the stories of one desperately ill patient after another and shows how clean water, shelter, and decent nutrition can vastly improve their lot. The book also gives Farmer space to expound on the "hyperconnections" he sees between the massive accumulation of wealth in one part of the world and the abject misery in another.

Most of all, Mountains Beyond Mountains questions the complacency of the comfortable. Those are the people who, says Farmer, "think all the world's problems can be fixed without any cost to themselves." His example urges a different approach. After all, says Farmer, "there's a lot to be said for sacrifice, remorse, even pity. It's what separates us from roaches."

Senior Writer Arnst covers science and health issues.

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