Books That Can Change Your Life

Dan Boylan
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Wednesday - April 23, 2008

Years ago, in a graduate class at the University of Michigan, a young professor warned us against reading Henry David Thoreau’s Walden in a crowded library reading room. “Thoreau says things that can change your life,” he said. “Really change your life.

“And when you first read them, you may be given to shouting and pumping your arms in the air. The people around you will think you’re mad.”

I don’t remember a line of Thoreau’s that ever brought me to my feet to shout and pump my arms, but I recognized the danger in Thoreau’s words: They could change your life - or at the very least question the manner in which you had lived it.

So, too, could Tracy Kidder’s Mountains Beyond Mountains. It was first published in 2003, then in paperback the following year. I didn’t stumble upon it until this past February at an academic conference in San Francisco, where book publishers were pushing their wares in hopes that professors would require their freshmen to buy and read them.

If I were a rich man, I would give a copy of Mountains Beyond Mountains to every freshman, every student, every relative, every colleague, every person who appeared literate that I passed on the street - particularly if the passerby had a stethoscope hanging around his neck.

In Mountains Beyond Mountains, Kidder tells the story of Dr. Paul Farmer, a Harvard Medical School-trained physician who has devoted his life to caring for people in “one of the poorest parts of the poorest country in the Western Hemisphere” - Haiti.

Farmer first ventured into the Haitian mountain village of Cagne as a medical student. There he found a ramshackle clinic that, over the next decade, he would turn into an oasis of care for the people of Haiti’s central plateau.

To do so, Farmer would beg from wealthy friends in Boston, steal from the laboratories of Massachusetts General Hospital, with which he was affiliated, and spend practically every dime he made - including the $220,000 he received as a MacArthur Foundation “genius” awardee in 1993.

At the Cagne clinic, anyone who is sick, no matter how poor they may be, will be treated - often by Farmer himself. “Patients were supposed to pay user fees,” Kidder wrote, “the equivalent of eighty American cents for a visit. Haitian colleagues of Farmer’s had insisted on this. Farmer was the medical director, but he hadn’t argued.

“Instead ... he had simply subverted the policy. Every patient had to pay the eighty cents, except for women and children, the destitute and anyone who was seriously ill. Everyone had to pay, that is, except for almost everyone. And no one - Farmer’s rule - could be turned away.”

Farmer gives all his salary as a medical anthropology professor and affiliate with a Boston hospital to Partners in Health, the organization he founded with friends in 1987 to promote the Cagne clinic - and social justice. As a doctor, Farmer says, “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 about it.”

Farmer’s work in Haiti - and Russia, Rwanda, Lesotho, Malawi and Peru - over the past quarter century has made him one of the world’s most honored physicians and public health experts. But he remains, fundamentally, a chest-and-back-thumping doc who works 14-hour days in the Cagne clinic.

The never-ending line of patients who await the attention of the Cagne clinic doctors has left Farmer angry - even with his natural allies, the white liberals of the United States and Europe. “I love WL’s, love ‘em to death,” says Farmer. “They’re on our side. But WL’s think the world’s problems can be fixed without any cost to themselves. We don’t believe that. There’s a lot to be said for sacrifice, remorse, even pity. It’s what separates us from the roaches.”

So, too, does faith, which Farmer claims to have, but “I also have faith in penicillin, rifampin, isoniazid and the good absorption of the fluoroquinolones, in bench science, clinical trials, scientific progress, that HIV is the cause of every case of AIDS, that the rich oppress the poor, that wealth flows in the wrong direction, that this will cause more epidemics and kill millions.

“I have faith that those things are true, too. So if I had to choose between lib theo, or any ology, I would go with science, as long as service to the poor went along with it.”

Farmer may have faith in his work at Cagne, but he often despairs at a world that spends so much frivolously while so many of the poor die needlessly. And he knows that his work may be futile. “I have fought for my whole life,” he told Kidder, “a long defeat. ... That’s all it adds up to is defeat ... (but) I’m not going to stop just because we are losing.

“You know, people from our background ... we’re used to being on the victory team, and actually what we’re really trying to do in Partners in Health is to make common cause with the losers. We want to be on the winning team, but at the risk of turning our backs on the losers, no, it’s not worth it. So you fight the long defeat.” Day after day, patient after patient.

Mountains Beyond Mountains is an inspiring book, one that may make you stand up shouting in a crowded room, pumping your arms in the air. It’s available in paperback; and if you haven’t got the 16 bucks to buy it, you know my e-mail address. I’ve got a dog-eared copy I’m willing to pass around.

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