Margaret Mead once said, “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” This quote perfectly describes the book Mountains Beyond Mountains, a thrilling biography of the life of Dr. Paul Farmer, by Tracy Kidder. Dr. Farmer epitomizes the founding tenets of medicine, devoting himself to curing patients of their ailments at any cost.
When Dr. Farmer first went to Haiti, he witnessed the poverty and lack of adequate healthcare there firsthand. The experience stuck with him, and he found himself unable to leave Haiti because he believed he needed to help the people there. Thus, he set up a hospital called Zanmi Lasante in Cange, which is an arid region in Haiti filled with some of the most destitute people in the world. It was a place where most houses had dirt floors, thatched roofs, and no clean drinking water. He needed to treat poverty along with a symptom of poverty, sickness. Soon enough, he built schools to increase literacy among the people, and he improved communal sanitation. However, he mainly focused on treating and curing tuberculosis and HIV. Many criticized him for not being sustainable because he provided free treatment to all even though the drugs needed to treat these diseases were very expensive. It was impossible that Haitians in Cange could ever foot the bill for their medical treatment. Nevertheless, Dr. Farmer persisted. He did not listen to their criticism because he only saw it only one way: he needed to provide high-quality healthcare to the people that needed it the most, regardless of the cost. To pay the enormous bills that this hospital was generating, he began his charity Partners in Health to funnel money from donors to his projects in Cange. Dr. Farmer once remarked that he could not get any sleep because there was always a patient not getting treatment. Whenever he would focus on a goal, he would see it completely to the end, doing whatever he could to ensure the best outcome. Because of his passion and drive to help the people of Haiti, he was actually seen as a God with the gift of healing. Indeed, Dr. Farmer profoundly affected the lives of many destitute Haitians, saving them from an otherwise miserable fate.
One of the biggest battles that Dr. Farmer fought was the battle against the World Health Organization to recognize multidrug-resistant tuberculosis as a disease that was feasible to treat. Multidrug-resistant tuberculosis is a strain of tuberculosis that is caused mostly because of inadequate treatment (perhaps due to interruptions) or improper therapy. The bacteria undergoes many mutations and becomes resistant to most cheap first-line drugs, making the disease very difficult to cure at that point. Treating MDR required expensive second-line drugs, some of which have very severe side effects, to be administered, and sometimes, that was not enough to cure the patient either. The WHO issued guidelines on how to treat tuberculosis in its DOTS (Directly Observed Treatment Short-Course Chemotherapy) program. The guidelines called for treating patients with one first-line drug at the start. If there were no results, then the doctor was supposed to treat the patient with that same drug plus one other first-line drug. While this worked in Africa where noncompliance or treatment being interrupted was the primary reason for increased resistance of tuberculosis, this was not the case in many countries like Peru where patients took their medications under observance of the hospital staff. Dr. Farmer deduced that the real reason for the spread of MDR in Peru among other countries was improper therapy under the DOTS program. He thought that “they had gone to the clinics with one- or, more likely, two-drug resistance, and through treatment and repeated retreatment under the standardized DOTS formulas, they had emerged with four- and five-drug resistance” (Kidder 139). By listening to their doctors, they had actually become sicker. Dr. Farmer pushed for MDR treatment to become acceptable and more of a norm, but his pleas fell on deaf ears. They said that MDR was too expensive to treat or DOTS would solve MDR in the long run. While he was certain that DOTS would not solve MDR, he knew that MDR was very expensive to treat because it took him one million dollars to treat ten patients with MDR in Peru. He soon realized that the main cost associated with MDR was the cost of second-line drugs because there was virtually no demand for them under the then current WHO guidelines. He had one of his allies in the WHO to set up the “Green Light Committee,” which became the official distributor of second-line MDR drugs, and this prompted the WHO to put second-line MDR drugs on essential drugs list. Thus, he was able to reduce the price of second-line drugs by over 95% in some cases, making it feasible for governments to treat MDR, saving hundreds of thousands of lives that would not have been thought as cost-effective enough to save before.
In one particular instance, there was a Haitian boy in Cange named John who had nasopharyngeal carcinoma, a rare type of cancer that could not be properly treated in Haiti. Without thinking twice, Dr. Farmer decided to try to bring him to Massachusetts General Hospital in Boston, which was one of the only hospitals in America with the facility and the doctors to cure John’s syndrome. Thankfully, the doctors at Mass General decided to take John’s case for free, which normally would have cost over $100,000. However, it took few months to make the diagnosis, get the passport/visa, and prepare transport for John to Mass General. In fact, when they were finally about to take him there, he had been given a tracheotomy, which is an “opening surgically created through the neck into the trachea (windpipe) to allow direct access to the breathing tube” (Molnar). Moreover, John was having secretions, clogging his airways, that needed to be sucked out with a machine every so often (Kidder 266). He was medically unable to go on a commercial flight, so he had to be medevacked to Boston, costing Partners in Health over $18,000. Despite the best efforts of Partners in Health and the Mass General oncologists, the boy died because he had arrived too late; the cancer had already progressed throughout his body. Many thought that this $18,000 was wasted on John and could be spent elsewhere on patients who had better chances to survive; however, Farmer vehemently disagreed. He brought him here because “A, he’s a human being, and B, because [he] didn’t know [John] couldn’t be treated, and C, why shouldn’t [John] have a comfortable way to die” (277). Dr. Farmer emphasized the idea of fighting the long defeat. All doctors want and strive to win, but if it means turning their back against a patient who might die or “lose,” then it’s not worth trying to win.
I was always interested in medicine ever since taking basic biology in elementary school; however, Dr. Farmer’s story has ignited a passion in me for healthcare. Dr. Farmer is a role model of how to change the world, one saved patient at a time. He represents the epitome of dedication and persistence in medicine, inspiring countless of others like me behind him. He did not do all this for the money nor the fame; he did it to help the people living in poverty throughout the world who were being ignored. This riveting biography by Tracy Kidder put me in the eyes of Dr. Farmer, leaving me with a new appreciation for medicine and the doctors who shape it.
The Idea That Some Lives Matter Less. A Pondering Mind, aponderingmind.org/2013/02/24/the-idea-that-some-lives-matter-less-dr-paul-farmer/. Accessed 28 May 2017.
Kidder, Tracy. Mountains Beyond Mountains. Random House deluxe trade pbk. ed.,
New York, Random House, 2009.
Molnar, Heather. “What Is a Tracheostomy?” John Hopkins Medicine, 18 May 2017, hopkinsmedicine.org/tracheostomy/about/what.html. Accessed 28 May 2017.
Multi-drug Resistant Tuberculosis. 2015. Kolly Talk, kollytalk.com/national/cases-of-multi-drug-resistant-tuberculosis-not-increasing-256920.html/attachment/multi-drug-resistant-tuberculosis-mdr-tb. Accessed 28 May 2017.
Paul Farmer Examines AIDS Patient Thelemaque Innocent at the Partners In Health Hospital in Cange, Haiti. 2004. Academy of Achievement, achievement.org/achiever/paul-farmer/. Accessed 28 May 2017.