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

While Zanmi Lasante now has excellent facilities, it still depends on the Brigham for advanced treatments. On one occasion, a mother brings her roughly 11-year-old son, John, to Cange for suspected tuberculosis in the lymph nodes. With Farmer away on various missions, treatment falls on Brigham doctor Serena Koenig. After a tissue sample that requires a surgeon in Mirebalais and testing in Boston, Farmer and Koenig determine that the boy has nasopharyngeal carcinoma, a rare childhood cancer with an above-average cure rate. However, John would need to travel to Boston, and obtaining pro bono treatment for the $100,000 procedure takes a month, after which Serena still must get a passport for someone with no birthdate and find a traveling companion.

Kidder goes with Serena to Cange and finds John in a skeletal state with bulbs growing out of his neck. He requires a breathing tube and regular removal of throat secretions. Koenig suggests an immediate medevac flight but knows that a $18,500 trip will harm PIH’s reputation if John dies mid-flight. Farmer worries about the precedent of sending some patients to Boston and not others but agrees to the trip. Koenig hires a private ambulance that endures hours of breakdowns, flooding, and the installation of the suction device before taking John to Port-au-Prince.

During the trip to Massachusetts General Hospital, Serena becomes frustrated with a customs agent who mocks Haiti and an intern who implies that Zanmi Lasante didn’t feed John enough. Unfortunately, the doctors determine that the cancer has spread too far to cure it. Serena and other PIH staff feel that the costs were worth it as “A, he’s a human being” who was potentially treatable and didn’t deserve to die in horrible conditions (277). The team gives him palliative care in a comfortable room until his death several weeks later, and Farmer both flies John’s mother over and gives her a job at Zanmi Lasante. Serena’s commitment to John leads Massachusetts General Hospital to build a partnership with PIH.

Two months later, Kidder meets with Farmer and Ti Jean, a young handyman and witness to Cange’s transformation over the years. As Farmer’s informant on local customs, Ti Jean explains how people shapeshift into animals due to trickery or punishment, and he tells Farmer, “Your nest is Haiti” (282).

Kidder travels with Farmer and a team to the town of Casse to visit the family of a boy with similar symptoms to John whom Farmer treats for scrofula. Kidder struggles to keep up with the group but trusts Farmer. Farmer helps diagnose Kidder’s heartburn and dehydration issues even while considering how to get an older couple Canadian crutches. The author considers how Farmer dedicates his life to a form of triage that prioritizes the sickest over those with the highest chance of survival. When Kidder brings up concerns about the cost of John’s treatment, the doctor insists that the patient was still considered treatable at that point and that standing up for every patient is core to his philosophy. Farmer notes that it’s difficult to convince staff members to “fight the long defeat” that does the best for patients even if it isn’t pragmatic (288). This is also a world where airliners and doctors make so many times the cost of treatments that it’s wrong to exclude them from culpability.

The group visits the boy’s family—10 people in a small hut—and devises a plan to diagnose the family while providing concrete floors, nutrition plans, and schooling. Some feel that Farmer focuses too much on individual patients or that he is the sole reason for PIH’s success, but Farmer believes that maintaining a personal link to patients is critical and that “the idea that some lives matter less is the root of all that’s wrong with the world” (294). As the group returns home, Farmer and Ti Jean talk about how most Voodoo ceremonies are about healing. Thinking back to his first trip to Haiti, Kidder wonders whether just that fact alone would change people’s attitudes about the country.