Saturday, January 9, 2010

Mountains beyond Mountains, Tracy Kidder

Imagine that you were born into a small, unassuming house in Birmingham Alabama. You then spent the formative years of your life in a trailer park in Florida, and with your father losing even that, you start living, with your large family in a good-for-nothing boat called Lady Gin permanently moored in an uninhabited bayou on the Gulf Coast. You start from these humble beginnings, and through the force of your intellect, you wrestle your way into Duke and then into Harvard Medical School. Defying every odd of an unorthodox childhood, you dominate at Harvard on your way to a joint degree as a doctor anthropologist. Imagine you were that guy. What would you do? Would you thank your stars for allowing you to break out of a tough life, rake in the six figure staring salary of a Harvard doctor, and live the good life? Or would you give it all up to go to Cange, Haiti, a place with no electricity, no sanitation, every type of disease imaginable (including many that Western civilization has long forgotten), abject poverty of a kind barely describable in mere words? Would you go to Cange, Haiti and start offering top-end medical services to the local population for free? Not for a day or a week. Forever. Which path would you take?

Mountains Beyond Mountains, Pulitzer Prize winner Tracy Kidder's narration of the true life story of Dr. Paul Farmer, is one of the most stark moral challenges I have seen laid out in a book in recent times. Early in the book, Kidder is with Farmer as Farmer does another of his good deeds (this time for a patient called Joe) -

As Farmer was leaving the shelter, he heard Joe say to another resident, just loudly enough to make Farmer wonder if Joe meant for him to overhear, "That guy's a fuckin' saint."

It wasn't the first time Farmer had heard himself called that. When I asked him his reaction, he said that he felt like the thief in Hawthorne's novel The Marble Faun, who steals something from a Catholic church and, before his escape, dips his hands in holy water. "I don't care how often people say 'You're a saint.' It's not that I mind it. It's that it's inaccurate."

This was unseemly, I thought, resisting beatification. It wasn't that the words seemed immodest. I felt I was in the presence of a different person from the one I'd been chatting with a moment ago, someone whose ambitions I hadn't yet begun to fathom.

Paul Farmer lives a life most cannot imagine, truly giving it all for the poor, and he does it with hard-headed practicality and some genuinely good humor. Mountains Beyond Mountains is a book a friend gifted me over Christmas, and it is my first book of 2010. Early in the year, fresh with good intentions, reading this book in the coziness of my home is a moral wake-up call. This story of one man and his passionate commitment to make a difference to the lives of those beyond much hope shook me up. The fact that he actually does make a difference makes this a feel-good story like nothing Hollywood could cook up.

Farmer's position, and he has backed it up with his life, is this - you cannot look at the problems of poverty and disease distinctly. They are fundamentally the same. Trying to solve for contagious, epidemic potential diseases like TB or AIDS without a view to solve the underlying social and economic conditions that enable them, is futile. And the developed world, with their fingerprints all over the poverty of some of the poorer nations, have an obligation to intervene. At the very least, individuals who feel 'ambivalence' about how much they have compared to some of the poorest in the world, should step up and contribute to make those lives better.

Some of the most powerful passages in the book come where Kidder is quoting Farmer making some version of this case. Not just what he is saying either, also the how. Farmer is a genius at creating his own little verbal innovations, words and phrases that come to life once he explains them. There is, instance, his use of the word Comma placed at the end of a sentence. It stands, Farmer explains, for the word that would follow a comma, which is asshole. Comma, Kidder informs us, is always directed at 'those who felt comfortable with the current disposition of money and medicine in the world.' Here is a passage where Kidder, after spending some time in Haiti with Farmer, is speaking with him.

On an evening a few days after arriving in Cange, I wondered aloud what compensation he received for all these hardships. He told me, "If you're making sacrifices, unless you are automatically following some rule, it follows to reason that you are trying to lessen some psychic discomfort. So, for example, if I took steps to be a doctor for those who don't have medical care, it could be regarded as a sacrifice, or it could also be regarded as a way to deal with ambivalence." He went on, and his voice changed a little. He didn't bristle, but his tone had an edge: "I feel ambivalent about selling my services in a world where some can't buy them. You can feel ambivalent about that, because you should feel ambivalent. Comma."
Fighting words. There are many more where those came from. They are the gems of the book. Sample this one where Paul Farmer is speaking with his partner Jim Kim -

They talked about political correctness, which Jim Kim defined as follows: "It's a very well-crafted tool to distract us. A very self-centered activity. Clean up your own vocabulary so you can show everybody you have the social capital of having been in circles where these things are talked about on a regular basis." (What was an example of political correctness? Some academic types would say to Jim and Paul, "Why do you call your patients poor people? They don't call themselves poor people." Jim would reply: "Okay, how about soon-dead people?")

They talked about appearance: "The goofiness of radicals thinking they have to dress in Guatemalan peasant clothes. The poor don't want you to look like them. They want you to dress in a suit and go get them some food and water. Comma."

Farmer's Zanmi Lasante medical services in Haiti are a remarkable success story in eliminating TB and many other ailments from an area where the population has no means to pay anything for medical services. His organization, Partners in Health, has also been successful in replicating the model in other countries like Peru and Russia. But through it all, you are left with the nagging doubt that all this success owes too much to the genius of one man. That Farmer's disdain for 'cost efficiency' or 'appropriate technology' ("It just means the best things for the rich and shit for the poor") are powerful in the hands of someone with his moral certitude, but can't possibly be replicated. That Zanmi Lasante is a once and done deal. Tracy Kidder, as the narrator we can more easily relate to, plays out these fears, aloud, fearfully to Farmer. And we feel glad it was him risking an earful from Farmer, and not us. Once, having raised a cynical question about Farmer's child-like faith in a slogan, Kidder sees the air go out of Farmer, sees him folding, and says -

I felt as though I'd punched him. Among a coward's weapons, cynicism is the nastiest of all.

And that's how I feel when I find my doubts coming over me.

Mountains Beyond Mountains is a riveting account of a life lived to towering high standards. It will move you, it will shock you, and in spots it will make you laugh. A great way to start my reading for the year!

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