Saturday, December 27, 2008

Book review - Mountains beyond Mountains: A Book Review

I don’t often use this blog to review books. But Mountains beyond Mountains: the Quest of Dr. Paul Farmer Who Would Cure the World (Random House Paperbacks, 2003) is different. It tells the tale of a doctor who works at the intersection of politics, economics, social systems, and medical practice. It is not a pretty tale, for millions of poverty stricken people are starving and dying of malaria, TB, and AIDS around the globe.

To a limited extent, I can identify with Dr. Farmer. I’ve been observing and writing about the interaction of government, the corporate cultures, and the transformation of medicine in the U.S. capitalistic and managerial U.S. culture. We have little TB here, no malaria, and AIDS is under control. Yes, we have political, social, and economic conflicts. Yes, critics say our system is “broken,” an overstatement in my opinion, considering the level of sickness in the rest of the world.

Doctor Paul Farmer is a polymath - an infectious disease specialist, Harvard professor of medicine, medical anthropologist, and world traveler. He treats the poor, the starving, and the sick in the third world – in Haiti, Peru, Russia, Mexico, and elsewhere – wherever he finds them and wherever he is asked to help.
Paul has zero sympathy for American doctors who complain about income, managed care hassles, and government intrusions upon their autonomy. He has other fish to fry. His philosophy is: get off your duff, and go out and treat the people who need you. Rise above politics. Do what you have to do to help the sick, and damn your personal economic consequences.

The Farmer story is remarkable. He was raised in the America South in a nomadic family who lived on a bus, a boat, and in trailers. Farmer, who has a photographic memory and who reads voraciously and omnivorously, early on developed an affinity and compassion for Haitian workers the U.S. The title of this book, Mountains beyond Mountains, is a Haitian expression denoting there is always another mountain to climb in Haiti.

Farmer received a full scholarship to Duke University, where he graduated sum cum laude, even though he spent much of his time in Haiti treating the poor. He continued this pattern of being a student and traveling to Haiti while at Harvard Medical School, where he received a dual MD and PhD in Medical anthropology.

While at Harvard, he helped found Partners in Health, an organization that build a medical complex high on the central plateau of Haiti. He and his followers changed the health system and did a systematic survey of its needs. They studied its interworking and culture, visited and traded the poor, built a hospital, and took all comers. Farmer and his crew had no electricity or running water or other modern conveniences and depend mostly to infusion of cash form benefactors who fell under Farmer’s spell.

As a believer in the American health and political system, I found the book unsettling a t times. Famer deplores and criticizes Americans for their neglect of the poor, consorts with left wing sympathizers like George Soros, and openly admires and praises the work of Communist Cuba who government has provided universal health care, educated thousands of doctors, and effectively eliminated starvation.
Farmer himself is non-ideological. He does not believe in “ologies,”or political movements. Instead he works with whoever supports his cause, whether they are Cuban politicians, Soviet prison managers, Peruvian health officials, and Bill Gates, George Soros, or Boston philanthropists – anybody who will advance his cause to save the poor.

Farmer is tireless – a jet setter shuttling back and further between Boston, Haiti, Misgovern, Lima, or anywhere the World Health Organization is meeting. He can be profane and does not profess to be a saint. He is courageous- exposing himself to drug resistant TB, AIDS, and other infectious diseases, socializing with dictators, wading into crowds of soldiers who are shooting Haitians, all the while studying medical textbooks, conducting clinical trials, and challenging the Boston medical establishment to leave him alone to do his world.

This book will appeal to two audiences: 1) idealistic medical students and young doctor who want to make difference; 2) physicians who toil at the intersection of politics, social systems, and medicine and who wonder if they are making a difference.