Review-mountains beyond mountains
Pulitzer Prize winning author, Tracy Kidder recounts an extraordinary story of selflessness, conviction and dedication through his book Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World, a biography of a living legend, an unconventional American doctor and medicinal anthropologist who have touched the lives of millions across the globe through his mission to heal the world. The riveting story explores the life of the very unassuming yet remarkably ambitious humanitarian, Dr. Paul Farmer and how he actually succeeds in changing the nature of health care and treatment for the poor across the globe. It also reveals streaks of frustrations and obstacles that Dr. Farmer has to surmount in order to accomplish what he has. In retrospect, Dr. Farmer’s story could be that of success through trials alone and proves how radical change can be fostered in most daunting situations.
Dr. Paul Farmer’s commitment to improving health care accessibility for the poor is beyond doubt most genuine and awe inspiring just as his achievements are extraordinary. The visionary that he is, Dr. Paul Farmer believes that there could be positive change even in darkest of human civilizations. This relentless spirit of hope in him let to the formation of ‘Partners in Health’, a non profit organization of selfless health workers dedicated to serving the poor and the sick, waging an endless war against AIDS and Tuberculosis. Dr. Farmer’s success story began with this endeavor while he was still studying in Harvard Medical College in 1987. Dr. Farmer is no doubt the guiding force of a movement in health care which grew to capture the imagination of many likeminded enthusiasts. However, Dr. Farmer is not a lone messiah, for his story also acknowledges the contributions of many selfless diehards like Jim Yong Kim, Tom White and Ophelia Dahl who have been his support every step of the way.
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Haiti was the birthplace of Dr. Farmer’s tireless social service, which later spread to other parts of the world in many forms and ways. In the town of Cange, Farmer almost singlehandedly created a highly effective public-health system the Zanmi Lasantea, a sister organization to the Boston-based Partners In Health, which soon grew as an organization providing primary health care for a million poor Haitians. AIDS and Tuberculosis being biggest killers in the country, Farmer took these daunting challenges and fought headlong to minimize their presence in the lives of the people. Located in one of the poorest parts of the poorest country in the western hemisphere, Zanmi Lasantea serves almost two hundred thousand people annually. The facility has grown remarkably to include a general hospital, a women’s clinic, an ambulatory clinic, a large Anglican church, a school, a kitchen that prepares meals for about two thousand people a day, and a centre for the treatment of tuberculosis.
Dr. Paul Farmer’s influence internationally can be seen through the breath taking success of Partners In Health (PIH). PIH has bases established in places as diverse as Peru, Cuba, Russia apart from Haiti and Boston. As seen through Kidder’s book, the programs developed there by PIH have transformed even the World Health Organization’s (WHO) approach to treating multi-drug-resistant tuberculosis. In Peru, for example, Farmer and fellow PIH founder Jim Yong Kim found a disturbing fact that the WHO approach to treating TB actually led to a greater resistance to first-line drugs. Second-line drugs needed to treat resistant strains were prohibitively expensive. Challenging health policies at the international level became inevitable for Dr. Farmer and so in February 1997, he spoke at a meeting of the International Union Against Tuberculosis and Lung Disease, publicly challenging current TB treatments. Without bothering to weigh the costs involved, Kim and Farmer defied prevailing wisdom and worked tirelessly to find a solution. They finally discovered an alternative method for treating MDR-TB that led to an astounding 85 percent cure rate. He now had a result to share with an international audience and did so in Boston in 1998, at a session of the American Academy of Arts and Sciences.
Dr. Farmer soon entered into direct negotiation with concerned leaders like Arata Kochi, who headed the WHO’s TB division and was also responsible in developing the current TB treatment norms. Gradually, the Partners In Health Peru project started to be heralded as a model and to have influence on a much larger scale. Among other accomplishments, Jim Kim worked tirelessly to lower drug costs, and succeeded in some cases to the extent of bringing the price down by 97 percent. This is one instance how Farmer’s innovation brought about a glaring change in the health care scenario at an international level.
It is interesting to see that Dr. Farmer is not one to be bogged down by conventional wisdom and surrender before bureaucratic roadblocks. He believed that bending the law to help a dying destitute should not be a problem and so, never hesitated from doing whatever it takes to help his patients. Perhaps this is how he successfully challenged policy makers to look at new options that might actually help more people at more places. Farmer rebelliously rejects the judgment of his supposedly informed medical peers that some patients stay ill because of their “noncompliant” attitude. He rather reasons that the responsibility is completely on the physician, stating flatly, “If the patient doesn’t get better, it’s your own fault.” Dr. Farmer seems to have defined the phrase ‘doing one’s best’ to a whole another extreme level, thereby raising the bar a tad too high for many to criticize his ideas and even work sheer out of frustration.
Dr. Paul Farmer’s story cannot be called a one man’s success story at a local level as his influence in international health care policy making have been enormous especially in the sphere of treatment of TB and AIDS. Moreover, the models devised by him and his PIH colleagues have greatly been admired and adopted in many countries. These accomplishments also point to the fact that Dr. Farmer’s dedication and enthusiasm has been very well sustained and supported by his friends and well wishers. Many of the achievements accredited to Dr. Farmer may not have been plausible had he been a one man army. The success of Farmer’s vision lies in the fact that his personal intervention at all times is not the unavoidable prerequisite. He has been blessed with generous and hard working people in hundreds, all of whom work to together to realize the dream they all share. Tracy Kidder thus presents a tale of hope and positivism in the form of Dr. Paul Farmer’s biography and also inevitably stirs serious questions on goodwill and dedication in every reader’s mind.