Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World

Farmer meets Ophelia Dahl, a volunteer who is the daughter of Breakfast at Tiffany’s actress Patricia Neal and Charlie and the Chocolate Factory author Roald Dahl. Ophelia is attentive and unassuming, and Farmer charms and educates her about Haiti’s history and ecosystem while learning Creole at rapid speed. At one point, they drive by an accident involving an overloaded tap-tap passenger truck, which leaves one woman crushed to death by mangoes. Farmer writes a poem about it to Ophelia. Farmer studies medical ethnography, and Ophelia aims to be a doctor.

Collaborating with priest Fritz Lafontant, Farmer goes to the central plateau in search of work and briefly visits Cange, a town of “obviously ill” people where homes lack even tin roofs. Over the year, he contracts dysentery, attends Voodoo ceremonies, engrosses himself in liberation theology, and questions why other foreigners feel that they could leave Haiti whenever they wanted. After failing to save the life of a malaria-stricken women and her unborn child because they cannot do a blood transfusion, Farmer raises money from overseas contacts to build a blood bank at Hôpital St. Croix. Upon learning that patients would have to pay for blood, Farmer leaves the project to “build my own fucking hospital” in Cange (81).

Envisioning a health system that addresses the real needs of the residents, Farmer enlists young locals to conduct a census of births, deaths, and morbidities. Infant and juvenile mortality are high, and the deaths of mothers create cascading social problems. Farmer conforms his medical practices with traditional Voodoo beliefs rather than replace them, and his essay “The Anthropologist Within” affirms his belief that anthropology should guide public health rather than remain a passive activity. He begins studying at Harvard Medical School in 1984, traveling to Haiti between classes while maintaining good grades.

Although Farmer doesn’t adhere to Catholic dogma, he wears crosses and allies religious Haitians over the Harvard residents who dismiss such beliefs. As Farmer and Ophelia complete the census, they find that infant deaths fall after a team of engineers redirect freed water from a dam to communal spigots. Farmer envisions a healthcare system that includes protected water systems, vaccination systems, locals with basic medical training, and gynecological and literacy services for women. Lafontant teaches him that “appropriate technology,” the idea that only the simplest technology should be used for a project, often discriminates against the poor. This idea leads Farmer to steal a microscope from Harvard rather than build the World Health Organization (WHO)-recommended solar version. He justifies his ambitions by comparing them to Lafontant’s work in building schools: The education they provide does not directly address the area’s crushing poverty, but they give patients hope and a willingness to trust medical science.

In 1985, Farmer partners with Tom White, a Boston construction magnate and anonymous philanthropist who contacts the student after reading his anthropology paper. Farmer initially worries that White is a conservative, but White recognizes the plight of the Haitian people and Farmer’s decisive nature. White becomes Farmer’s financial backer and confidant, discussing topics with him such as whether guilt is good if it convinces the rich to give to the poor.

As Farmer enters the clinical rotations phase of his education, he establishes a charity, Partners in Health (PIH), to collect donations to its sister organization, Zanmi Lasante. In addition to Farmer, Ophelia, and White, the board of advisors includes Todd McCormack, a wealthy friend of Farmer’s from Duke, and Jim Yong Kim, a fellow Harvard student. The group thinks little of political correctness that obscures reality and “self-styled radicals” who obsess over optics and philosophical purity (100).

Farmer’s relationship with Ophelia becomes intimate, but she is increasingly frustrated over his seeming perfection and commitment to his mission, such as when he escapes from a political crackdown in Port-au-Prince only to return to help more demonstrators. He refuses to go on romantic trips and resists her efforts to help him recover from a leg injury in 1988. Ophelia rejects a marriage proposal and resists Farmer’s efforts to cut her from his life by taking on a financial role in PIH. The two eventually reconcile and become confidants.

By the time Farmer returns to Haiti in 1988, Duvalier is out of power, with a series of military dictators taking his place, while AIDS infects the countryside. Farmer becomes friends with the liberation theology priest and resistance leader Jean-Bertrand Aristide, and militants threaten Farmer as Aristide wins Haiti’s first free democratic election in 1990.

That same year, Farmer earns both his Ph.D. and M.D. degrees, and both he and Kim obtain residencies at Brigham and Women’s Hospital. In his Ph.D. thesis “AIDS and Accusation,” Farmer criticizes the belief that Voodoo rituals are the cause for the spread of AIDS into the United States, instead singling out how American sex tourists are responsible for bringing the virus to the island. Farmer wins a MacArthur genius grant a few years later. Home improvement projects in Cange, including tin roofs, raise its standard of living to that of other Haitian villages, and Zanmi Lasante is close to securing funding for a hospital.

The next year, however, the military overthrows Aristide and places Farmer on a banned flight list. He returns to Haiti in 1992 after Lafontant bribes an official. He later writes an anonymous Boston Globe article after treating a mutilated Aristide sympathizer who dies after an attack by soldiers and civilian militias. As the junta kills his allies and friends, a furious Farmer smuggles money in for the resistance and openly defies soldiers, knowing that he has some protection as the only competent physician in the plateau. The junta bans Farmer again after he writes a pro-intervention editorial and The Uses of Haiti, a book on the United States’ enabling of the island’s military dictatorships. He advocates for Haiti but struggles to get his message across in an uncritical American media environment.

Farmer returns to Haiti after Aristide’s reinstatement in 1994, and Lafontant builds the Zanmi Lasante hospital. The junta’s activities disrupt outreach programs, scare away staff, and discourage villagers from seeking aid: Measles cases are 22 times the pre-coup average, and AIDS cases increase by 60%. Coupled with rising malnutrition and tuberculosis, the human cost of the junta stands much higher than just those who died in fighting or fleeing.