with Tracy Kidder, author of Mountain Beyond Mountains
How did you meet Paul Farmer, and what made you want to write about him? I met him in Haiti in 1994. I was doing a story on American soldiers sent
there to reinstate the countrys democratically elected government. Farmer
showed up one night at the barracks and got into an argument with the commander.
I wasnt very interested in him then, but a few weeks later I ran into him on
the plane to Miami and I began to learn some of the outlines of his life, which
I found very interesting. Farmer was the second of six children, and spent most
of his childhood in Florida, the whole family living on a bus and a houseboat
that was moored in a bayou on the Gulf Coast. He went to Duke on a full
scholarship, and then, while he was earning his M.D. and Ph.D at Harvard, he
conceived and helped to build an amazing health care system in one of the
poorest corners of Haiti. Around the time when I met him, he and his small band
of colleagues were about to go to war against the dominant ideologies in
international health eventually theyd actually win some significant
And I was drawn to the man himself. He worked extraordinary hours. In fact, I
dont think he sleeps more than an hour or two most nights. Here was a person
who seemed to be practicing more than he preached, who seemed to be living, as
nearly as any human being can, without hypocrisy. A challenging person, the kind
of person whose example can irritate you by making you feel youve never done
anything as important, and yet, in his presence, those kinds of feelings tended
to vanish. In the past, when Id imagined a person with credentials like his,
Id imagined someone dour and self-righteous, but he was very friendly and
irreverent, and quite funny. He seemed like someone Id like to know, and I
thought that if I did my job well, a reader would feel that way, too.
My favorite teacher once used to talk about how writers often have their best
stories bestowed upon them, seemingly by accident. I felt as though, in meeting
Farmer, Id been offered a rare opportunity.
What was Farmers initial response to your wanting to write a book about
him and his work? I think the idea made him uncomfortable. At any rate, it took him some
months to make the decision. I cant speak for him, but I think he agreed
mainly because he was persuaded by some of his closest friends that a book about
his life and work might bring attention both to the issues that he cares most
about and also to the little organization that he helped to create Partners
What was involved in doing the research for this book?
A lot of time in airplanes. I traveled with Farmer to Haiti more times than I
can now remember. I also went with him twice to Moscow, and to Siberia, to Peru,
to Cuba, to Paris, to Chiapas in Mexico, to Montreal and New York City and, many
times, to Boston. And I went to Geneva, Switzerland, with one of his closest
I also visited his mother and some of his siblings, and the places of his
childhood. I interviewed dozens of people. And I read a great deal, about
medicine and public health, about the places where Farmer works, especially
What does the title, Mountains Beyond Mountains, mean? The title comes from a Haitian proverb, which is usually translated as: "Beyond the mountains, more mountains." According to Farmer, a better
translation is: "Beyond mountains there are mountains." I first heard the
proverb from Farmer, and I remember that he told me, "The Haitians, of course,
use it in a zillion different ways." Sometimes its used to express the idea
that opportunities are inexhaustible, and sometimes as a way of saying that when
you surmount one great obstacle you merely gain a clear view of the next one. Of
course, those two meanings arent inconsistent, and I meant to imply both in
the title. To me, the phrase expresses something fundamental about the spirit
and the scale and the difficulty of Farmers work. The Haitian proverb, by the
way, is also a pretty accurate description of the topography of a lot of Haiti,
certainly as I experienced it in my hikes with Farmer through the mountains of
the central plateau.
Farmer didnt have a conventional upbringing. Tell us more about that. Do
you think Farmers childhood was influential in the path hes chosen? Farmers father was a great big man, a ferociously competitive athlete nicknamed Elbows by people who played basketball with him, a sometime salesman
and school teacher, with a lot of unconventional ideas and an absolutely
pig-headed determination to have his family live by them. He took his family to
a town north of Tampa, Florida, where for about five years they all lived in a
bus in a campground. Then he took them to a bayou on the Gulf Coast where all
eight of them lived in a leaky old 50 foot-long boat. As a boy, Farmer thrived
in these unusual circumstances. He was a tall, skinny kid and he disappointed
his father by not being much of an athlete, but he excelled in every
intellectual department. He seems to have been precocious spiritually as well.
At 11 he was given a copy of Tolkiens Lord of the Rings, which he read
and then immediately re-read in the space of a few days. Then he took it to the
public library and said to the woman at the desk, "I want more books like
this." She gave him adventure and fantasy novels and he kept coming back and
saying, "This isnt it." Finally, she gave him Tolstoys War and
Peace, which he devoured, at the age of 11. It wasnt adventure or fantasy
that interested him; it was the epic struggle between good and evil. He didnt
have the words to say that then. Returning the librarys copy of War and
Peace, he simply told the librarian, "This is it! This is just like Lord
of the Rings."
It was a childhood full of family adventures and misadventures and completely
unconventional. Farmer himself didnt like to make too much of the connections
between his background and the life he chose. At the very least, though, that
childhood was good preparation for a life of travel and doctoring in difficult
places like Haiti. He emerged from living on a boat in a bayou with what he
called a "very compliant GI system," and from dinners of hot dog bean soup
without much fussiness about food, and from years of cramped quarters with the
ability to concentrate anywhere. He could sleep in a dentists chair, as he
did at night for most of one summer in a clinic in Haiti, and consider it an
improvement over other places he had slept, and I imagine that his fondness for
a fine hotel and a good bottle of wine had the same origins.
There were other advantages, Farmer insisted. The kind of father who thought
it reasonable to house his family in a bus, then a boat, was also the kind who
saw no reason his son shouldnt keep a large acquarium inside. Farmer insisted
that he never really felt deprived throughout his childhood, though he did
admit, "It was pretty strange." After living through some of his
fathers very public misadventures, it was hard to feel embarrassed or shy in
front of anyone. He allowed that growing up as he did also probably relieved him
of a homing instinct. "I never had a sense of a home town. It was, This is
my campground. Then I got to the bottom of the barrel, and it was Oh, this
is my hometown." He meant the central plateau of Haiti.
In your travels with Farmer, what most surprised and interested you? Did
you learn something from the experience? The thing about travel with Farmer is that you dont visit the brochure
sights. His itinerary is pretty much restricted to visiting hospitals, slums,
and prisons. The dreadful places of the world. I hadnt imagined that there
were so many of those, and I hadnt known just how dreadful they were. But the
trips werent dreary and depressing, because Farmer and his colleagues were
doing something tangible, something meaningful, something that was actually
improving those places. This was especially true in Haiti and Peru. Id say
that I learned two things above all. That medicine and public health are a
powerful lens for looking at the world. And that a small group of determined
people can actually alter some of the pictures seen through that lens. I think
that as a very young man Farmer chose to work in one of the most impoverished
parts of Haiti because he was moved by the suffering he saw there. But if hed
wanted to prove a point about what is possible in public health, he couldnt
have chosen a better site. If you can do a good thing in central Haiti, it
stands to reason that you can do it anywhere. And what he and his friends have
done and are doing in Haiti and elsewhere - is nothing short of remarkable.
Has your life or outlook about life changed as a result of spending time with
Farmer and writing this book? One of my favorite characters in this book is a woman named Ophelia Dahl.
She met Paul Farmer when she was 18 and he was 23. She told me that she
remembered, from many years ago, deciding that Farmer was an important person to
believe in. Not as a figure to watch from a distance, thinking, Oh, look, there is
good in the world. Not as a comforting example, but the opposite. As proof that
it was possible to put up a fight. As a goad to make others realize that if
people could be kept from dying unnecessarily from what Haitians call "stupid deaths" then one had to act. I dont plan to give away all my
worldly goods and go to work with Farmer in Haiti. For one thing, Id just get
in the way. But I cant tell myself anymore that the great problems of the
world, such as the AIDS and TB epidemics, are beyond all hope of amelioration,
or of repair. In other words, I dont think I can feel comfortable anymore in
this world, by resigning myself to despair on behalf of billions of other
people. Theres always something one can do.
Its not my place to make a fund-raising pitch for Farmer and his
organization, Partners In Health. Well, actually, I dont know why it isnt
my place. I happened onto something remarkable and I sat down to try to describe
it to others. I hope what Ive written is artful. I believe it is at least
accurate and truthful. And one true fact is that Farmers organization,
Partners In Health, represents a real antidote to despair. A person with a
little money to give away can send it to Partners In Health and be certain that
it will be used well. 95 percent of the money thats donated to Partners In
Health goes to pay for direct services to people who are both destitute and sick
in Boston, in Russia, in Chiapas, in Peru, and especially in Haiti, where
the poorest and the sickest people in our hemisphere reside. A donation to
Partners In Health of, say, $200 will save an impoverished Haitian from dying a
horrible death from tuberculosis.
How does this book differ from your other projects? Well, for one thing this book has a pretty large geographical spread,
whereas all my previous books are set in New England. And all the others are
about what might be called "ordinary people." Of course, no one is ordinary.
But Farmer is less ordinary than anyone Ive ever met. This is the main reason
I wrote this book in the first person, something Id done in only one other
book. After Id spent a lot of time with Farmer, I began to feel that altruism
was plausible after all, indeed maybe even normal. But the sacrifices hes
made arent usual, and I knew that readers of my book would need an everyman,
someone a lot less virtuous than Farmer, to interpret him and to make him
believable. Someone to testify, in effect, that this guy is for real, and
someone who could register the occasional discomfort that anyone would feel in
such a persons company. Finally, although I like to think that the subjects
Ive written about in my other books are important, I dont think theres
much question but that the subject of this book is more important. After all,
what its about at bottom is the attempt of one small group of people to heal
a sick world.
Farmer doesnt work alone. He is surrounded by some extraordinary
people. Can you tell us a little about some of them? There are more than a thousand people working for Partners In Health
these days. They range from Haitian peasants who have been trained as community
health workers to extremely bright young American epidemiologists, medical
students, and doctors, who have enlisted to work in places such as central Haiti
and Siberia and the slums of Lima, Peru - some of them work for nothing, some
earn much less than they could elsewhere and some raise their own salaries
through grants. Ophelia Dahl has been involved in Farmers work from the
start, and shes a crucial member of Partners In Health, the manager, the
peacekeeper. Shes a warm and charming person, and she knows how to manage
Farmer and Farmers colleague, Jim Yong Kim. Kim is, like Farmer, a Brigham
doctor. He joined up only a few months after Partners In Health was founded.
Hes brilliant, an inspiring speaker, a fountain of ideas, and indefatigable.
Finally, and maybe most important, theres a man named Tom White. He built
a small family business into one of the largest heavy construction firms in
Boston. He and Farmer met when Farmer was still a doctor in training. He founded
Partners In Health along with Farmer and until recently provided most of the
money for its projects, millions and millions of dollars over the past 20 years.
White is in his eighties now, and has given away almost all of his large
fortune. He told me once, "Sometimes I think how much money I used to have
before I met Paul and Jim. But thats all right. If I go to a restaurant and
they give me a steak, I can only eat half of it anymore." He plans, he told
me, to leave this life without a nickel. I think its accurate to say that
White has lifted death sentences from thousands of people, and the organization,
the movement, that he helped to start may in the end save millions.
Unless otherwise stated, this interview was conducted at the time the book was first published, and is reproduced with permission of the publisher.
This interview may not be reproduced or reprinted without permission in writing from the copyright holder.
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