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Searching For Hope In Haiti

As if Haitians have not suffered enough already, living in what is often identified as “the poorest nation in the Western Hemisphere,” now the earth itself betrays them. The amount of human suffering there is overwhelming, and our most common response is to turn away in denial and frustration. What can one person do?

Paul Farmer does something, and the portrait of him in “Mountains Beyond Mountains” argues for his inclusion among the highest legions of inspiring human figures. Tracy Kidder, winner of both the Pulitzer Prize and National Book Award for previous books ("The Soul of a New Machine,” “House,” “Hometown"), followed Farmer around the world on his tireless mission to combat disease among the poorest people in Haiti, South America and Asia. Kidder says that Farmer and the issues he confronts are the most important topics he has written about. He is right, and he's done so splendidly here.

Paul Farmer grew up in mobile homes as self-described “white trash” and hardly seemed marked for greatness. But by the time he reached 35, he had medical and doctoral degrees from Harvard and was a professor there, had won a coveted MacArthur “genius” grant, had authored two respected books and dozens of important articles and was renowned in medical and anthropological circles worldwide.

Yet all those lofty accomplishments mean less to him than -- and were really a means to an end to -- his single-minded devotion to healing deathly ill people and preventing diseases like tuberculosis, AIDS and a host of others. Along the way, Farmer became acutely aware of -- and attacks -- “structural violence,” his term for the entrenched inequality and resulting poverty that is the root of so much human illness.

Inspired by reading Tolstoy and Tolkien as a young student, Farmer won a scholarship to Duke University, where he was “nearly taken in” by the wealth he encountered among preppies there. But after his first trip to the slums of Haiti while still a medical student, that seductive infatuation was arrested, and Farmer was to wind up what his bookkeeper calls “the hardest-workin' broke man I know,” as he contributed most of his income, and all the prize money and large sums he raised, to setting up clinics there and health projects elsewhere.

Haiti was to become his ministry, if not his primary home. When Kidder first visits Farmer's clinic “in what seemed to me like the end of the earth, in what was in fact one of the poorest parts of this poorest country in the Western Hemisphere, I felt I'd encountered a miracle.” People carried their sick children for miles on foot over dirt paths to receive expert treatment. “Every patient had to pay the eighty cents, except for the destitute, women and children, and anyone who was seriously ill. Everyone had to pay, that is, except for almost anyone,” Kidder learns. “And no one -- Farmer's rule -- could be turned away.”

Furthermore, Kidder notes, Farmer's Partners in Health organization in Haiti had built schools and clean water systems, vaccinated all the kids around, stopped outbreaks of diseases that devastated other communities, and “reduced the rate of HIV transmission from mothers to babies to 4 percent, about half the current rate in the United States.” All this was accomplished amid political turmoil and corruption, a mounting body count from continuing brutality and threats of violence (Farmer was expelled from Haiti at one point).

The dual functions of direct patient treatment and public health projects and policy consume Farmer's life. “At one ear he heard friends and allies saying he should concentrate on the big issues of world health and, at the other ear, the groans of his Haitian patients; the voice of the world saying, 'This meeting's important' and the voice of Haiti saying 'My child is dying.' ” Farmer listens to and acts on both, and Kidder observes that he rarely sleeps and travels relentlessly to and from Harvard to Haiti, Peru and other remote areas and high-level conferences, returning always to treating patients to become “medically recharged.” He cajoles money out of reluctant donors and persuades top-flight hospitals in the United States to accept nonpaying patients and trains younger doctors and students to follow his examples.

What really drives such a heroic crusader? Farmer obviously enjoys not only practicing medicine but also challenging epidemiological orthodoxies, whether in the Haitian countryside or in TB-ridden Russian prisons. Kidder confronts Farmer with counterarguments from other experts but can't help but observe that Farmer's perspective on how to accomplish things “was completely impractical, it seemed to me, but it seemed to be working.”

Beyond using Farmer's quests as a vehicle for excellent summaries and first- line encounters with complex international health issues, Kidder returns repeatedly to this more personal issue. Farmer himself is succinct in his self- reflections: “One thing that comes back to me . . . if I saved one patient in my whole life, that wouldn't be too bad. What did you do with your life? I saved Michela, got a guy out of jail. So I'm lucky. . . . To have a chance to save a zillion of them, I dig that.”

4,000 people attend Farmer's Haitian wedding, as he seems a kind of national hero there. The rewards of being revered as “the best Haitian I know,” a “fake gringo” in Peru, even “a god,” seem an important part of the payoff. But Farmer also alludes to his ingrained “psychic discomfort” with profiting from medicine in a poverty-stricken world: “You can feel ambivalent about that, you should feel ambivalent.”

Still, for all his humanistic urges and actions, Farmer remains something of an enigma and cannot be pigeonholed as some kind of liberal do-gooder. In fact, he castigates “white liberals” who “think all 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 roaches.”

Rather than being dogmatic, Farmer continues his singular focus on fighting suffering among the poorest of the poor. Farmer also seems not overtly religious, although he embraces the Latin American Catholic-based liberation theology, which urges political action on behalf of the poor and oppressed. “All the great religious traditions of the world say, Love thy neighbor as thyself. My answer is, I'm sorry, I can't, but I'm gonna keep on trying.”

So, what can one person do? Farmer admits that his contribution, in Haiti at least, is a drop in the bucket but uses that as a message. “It's embarrassing that piddly little projects like ours should serve as exemplars. It's only because other people haven't been doing their jobs.” Kidder doesn't quite deify Farmer here, but he's right, on many counts. And this sensitive, compelling portrait just might, beyond its educational value and absorbing reading, spur at least some readers to help with the kind of action Farmer has dedicated his life to, directly or otherwise. Very likely that would be Farmer's preferred response to his inspiring story.

So: Partners in Health is very much still on the ground in Haiti, and any amount of support is put to good use:

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Mountains Beyond Mountains. The Quest of Dr. Paul Farmer, a Man Who Would Cure the World by Tracy Kidder. RANDOM HOUSE; 324 PAGES; $14.95.

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