The impetus to cure
===================

* Mark Frutkin

*   © 2008 Canadian Medical Association

**Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World** Tracy Kidder; Random House; 2003; 317 pp $37.95 ISBN 0-375-50616-0

Pultizer Prize winner, Tracy Kidder, the highly regarded American author of *The Soul of the New Machine*, *House* and many other celebrated nonfiction books, recently turned his finely honed powers of observation to world-renowned physician Dr. Paul Farmer. *Mountains Beyond Mountains* is a magnificent and inspiring profile and arguably Kiddder's most important work. This is the kind of book that can, literally, change people's lives. 

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/179/11/1177/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/179/11/1177/F1)

Photo by: Random House 

As with Kidder's previous books, the author immersed himself completely in the life of Farmer, a graduate of Harvard Medical School who also holds a doctorate in anthropology. Kidder shadowed Farmer constantly for almost 4 years and learned that the doctor had one great obsession — utter dedication to curing his patients, wherever they were.

And his patients were indeed all over the map: from Boston to Haiti to Peru, Cuba and Russia. Farmer's main obsession in the years Kidder was following in his frenzied footsteps (1999–2003) was Haiti, especially a denuded rural region in the mountains where the peasants had lost their land to a hydroelectric project, one of the poorest areas of the Western Hemisphere with little medical service available. 

Farmer established a clinic in the town of Cange under extremely difficult and dangerous circumstances, both medical and political. Some of his work included raising funds in the United States (his name is well-known at the Bill & Melinda Gates and Soros Foundations, as well as the World Health Organization), but most of his effort involved a day-to-day medical practice on the ground.

Farmer said he “never cared much about the religious dogma he'd been taught as a child,” but that he did have faith in “penicillin, rifampin, isoniazid, and the good absorption of the fluoroquinolones, in bench science, clinical trials, scientific progress, that HIV is the cause of every case of AIDS, that the rich oppress the poor, that wealth is flowing in the wrong direction, that this will cause more epidemics and kill millions.”

Eventually, much of Farmer's medical work began to focus on multidrug-resistant tuberculosis and he travelled to Russia numerous times where tuberculosis was rampant in the prison population. There are memorable scenes of Farmer drinking vodka in dingy surroundings with prison officials anxious to fete the famous doctor. In official circles, multidrug-resistant tuberculosis was considered too expensive to treat in poor countries. Farmer refused to accept that and found ways to begin to defeat drug-resistant strains in poorer nations.

Without a doubt, Farmer was a highly unusual, charismatic character with seemingly boundless, superhuman energy. When Kidder followed him on treks through the mountains of Haiti to provide medical assistance to distant villages, or sat next to him on flights back to the United States while he worked ceaselessly answering emails offering advice to medical colleagues around the globe, the reader experiences how Farmer would push himself almost beyond endurance.

Kidder tells Farmer's story with verve and skill, weaving together the doctor's experiences in dusty villages and high-tech Boston hospitals with his unusual, middle-class upbringing in the American south (he was raised on a bus and a boat), and including enough medical science to intrigue both layman and specialist. Occasionally, the story bogs down in attempting to track the complex machinations of international medical agencies, but this is a minor flaw. The author also offers views on Farmer from colleagues, friends, supporters and former lovers, providing the reader with a rich, multifaceted picture of a truly absorbing individual. 

Tracy Kidder, with this penetrating, thorough, intelligent biography, has placed his stethoscope on one dedicated doctor to learn what truly makes Paul Farmer tick. 

## Footnotes

*   Mark Frutkin's latest novel, *Fabrizio's Return*, won the 2006 Trillium Award for best book in Ontario. His latest nonfiction book is *Erratic North: A Vietnam Draft Resister's Life in the Canadian Bush* (2008).