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

This is the principle that a project’s technology should be the simplest available. In theory, this approach makes it easier for developing countries to maintain and fix projects by themselves, but priest Fritz Lafontant tells Farmer that it means “good things for the rich and shit for the poor” (90). The explanation convinces Farmer to prioritize performance over cost as he steals a microscope from Harvard University over building the WHO-approved solar-powered model. In the final chapter, Farmer complains about the difficulty of acquiring crutches because of this philosophy.

This is a comparison of a project’s expenses to its potential benefits. Nonprofits must prove to donors that their work will deliver meaningful results to obtain funding. Farmer argues that, in a world where the wealthy earn much more than they could ever spend, the cost-effectiveness analysis is less a tool of fiscal responsibility and more an excuse to nitpick expenditures. Food is necessary for people to recover from illness, but Farmer must label it as vitamins in Russia’s World Bank loan to get funding. Farmer and Kidder also debate the medevac flight cost for a cancer patient who already appeared beyond saving.

Short for directly observed treatment short-course chemotherapy, DOTS was developed by the World Health Organization and practiced at Zanmi Lasante for years. It is an inexpensive regimen that treats tuberculosis patients with five first-line drugs. However, PIH connects a rise in drug-resistant strains in Peru to the program as it requires a second round of treatment that only enables more resistance. Initially defensive about outside clinicians criticizing their system, the Peruvian government requires PIH to follow “las normas” (literally “the rules”) and only treat patients after two rounds of DOTS treatment. Unfortunately, this is often too late for some patients. Thanks to PIH’s efforts, the WHO introduced a DOTS-plus program that improved access to second-line drugs.

A creole language results from the fusing of two or more languages, and Haitian Creole originated from enslaved peoples who applied French words to West African speaking systems so that they could understand each other. While elites in the country prefer French, Haitian Creole is dominant in the rural areas where Zanmi Lasante operates. (“Haitian Creole.” MustGo Travel, www.mustgo.com/worldlanguages/haitian-creole/. Accessed 7 Apr. 2021). Farmer learns the language at an astonishing speed, and Kidder includes terminology and sayings throughout the text. These include:

Tap-taps: Public transportation with often colorful designs.

Maji: Sorcery encompassing a belief that diseases are curses from other people.

Blan: A white person or foreigner of any race.

Zenglendos: Roadside robbers who target broken-down vehicles.

Dèyè mòn gen mòn: “Beyond mountains there are mountains.” This is the source of the book’s title, which references Haiti’s geography and the challenges that Farmer faces over his career.

This is an intense form of starvation that inflicts many in developing countries. Symptoms include frail arms, a bloated belly from a lack of protein, and reddish hair.

In this book, liberation theology refers to leftist branch of Catholicism that is prevalent in Latin America and speaks of social oppression as “institutionalized sin.” Farmer discovers this perspective at Duke University, where local nuns fight for the rights of migrant Haitian workers. Farmer prefers this form of socialism to Marxists who proclaim solidarity with the poor but look down on their beliefs and expect the downtrodden to incite a revolution on their own.

Farmer’s shorthand for “a preferential option for the poor” (174) is a word-for-word tenant of liberation theology and a centerpiece for his philosophy. This term also reflects Farmer’s practice of using acronyms in his speech, such as “WL” for privileged white liberals and “H of G” for the hermeneutic of generosity through which he views good people. Kidder names the final part of his book after this phrase.

This novel by Graham Greene is set during the reign of François “Papa Doc” Duvalier in Haiti. Farmer is a fan of the author, and Kidder relates him to a Graham Greene character several times—an unusual man who lives in a world of palpable evil. The Duvaliers and the military states that came after them banned the book. Greene meets Ophelia after she returns from Haiti the first time and finds her impressive, but she wonders what he would make of Farmer.

Tuberculosis, or TB, is a bacterial respiratory infection that attacks patients’ lungs and bones. TB killed around 2 million people in 2000 and is a common co-malignancy for those who suffer from malnutrition and AIDS. TB can lay latent for years before becoming active and requires a regimen using five first-line drugs. While these drugs are inexpensive, they require months of treatment and often have painful side effects. Innovation in the field is slow after the decline of TB rates in developed nations. Delayed and abandoned treatment plans can produce multi-drug resistant strains (MDR-TB), but PIH discovers that the WHO’s own DOTS program is enabling the development of these strains through overtreatment.