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

“And I can imagine Farmer saying he doesn't care if no one else is willing to follow their example. He's still going to make these hikes, he'd insist, because if you say that seven hours is too long to walk for two families of patients, you're saying that their lives matter less than some others', and the idea that some lives matter less is the root of all that's wrong with the world.”

“WL’s [White Liberals] 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”

“among a coward's weapons, cynicism is the nastiest of all”

“Paul's face grew serious. 'I think whenever a people has enormous resources, it is easy for them to call themselves democratic. I think of myself more as a physician than an American. We belong to the nation of those who care for the sick. Americans are lazy democrats, and it is my belief, as someone who shares the same nationality as [a Russian doctor], I think the rich can always call themselves democratic, but the sick people are not among the rich [...] I'm very proud to be an American. I have many opportunities because I'm American. I can travel freely through the world, I can start projects, but that's called privilege, not democracy.”

“That's when I feel most alive, he told me once on an airplane, when I'm helping people.”

“Among a coward's weapons, cynicism is the nastiest of all.”

“...Attempts at imitation would put the emphasis where it didn't belong. The goal was to improve the lives of others, not oneself.”

“I have fought the long defeat and brought other people on to fight the long defeat, and I'm not going to stop because we keep losing. Now I actually think sometimes we may win. I don't dislike victory. ... You know, people from our background-like you, like most PIH-ers, like me-we're used to being on a victory team, and actually what we're really trying to do in PIH is to make common cause with the losers. Those are two very different things. 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.”

“Little sleep, no investment portfolio, no family around, no hot water. On an evening a few days after arriving in Cange, I wondered aloud what compensation he got for these various hardships. He told me, “If you’re making sacrifices, unless you’re automatically following some rule, it stands to reason that you’re trying to lessen some psychic discomfort. So, for example, if I took steps to be a doctor for those who don’t have medical care, it could be regarded as a sacrifice, but it could also be regarded as a way to deal with ambivalence.” He went on, and his voice changed a little. He didn’t bristle, but his tone had an edge: “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. Comma.” This was for me one of the first of many encounters with Farmer’s”

“If disease is an expression of individual life under unfavorable conditions, then epidemics must be indicative of mass disturbances of mass life.”

“I think Farmer taps into a universal anxiety and also into a fundamental place in some troubled consciences, into what he calls "ambivalence," the often unacknowledged uneasiness that some of the fortunate feel about their place in the world, the thing he once told me he designed his life to avoid.”

“The idea that some lives matter less is the root of all that is wrong with the world.”

“The goofiness of radicals thinking they have to dress in Guatemalan peasant clothes. The poor don't want you to look like them. They want you to dress in a suit and go get them food and water. Comma.”

“It is the curse of humanity that it learns to tolerate even the most horrible situations by habituation.” “Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community.” “The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.”

“Margaret Mead once said, 'Never underestimate the ability of a small group of committed individuals to change the world.' He paused. 'Indeed, they are the only ones who ever have.”

“Medicine is a social science, and politics is nothing but medicine on a large scale.”

“One time I listened to Farmer give a talk on HIV to a class at the Harvard School of Public Health, and in the midst of reciting data, he mentioned the Haitian phrase “looking for life, destroying life,” Then he explained, “It’s an expression Haitians use if a poor woman selling mangoes falls off a truck and dies.” I felt as if for that moment I could see a little way into his mind, It seemed like a place of hyperconnectivity, At moments like that, I thought that what he wanted was to erase both time and geography, connecting all parts of his life and tying them instrumentally to a world in which he saw intimate, inescapable connections between the gleaming corporate offices of Paris and New York and a legless man lying on the mud floor of a hut in the remotest part of remote Haiti. Of all the world’s errors, he seemed to feel, the most fundamental was the “erasing” of people, the “hiding away” of suffering. “My big struggle is how people can not care, erase, not remember.”

“some years later, that he had “faith,” then add, “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 is flowing 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. But I don’t have to make that choice, do I?”

“Resources are always limited.” In international health, this saying had great force. It lay behind most cost-effectiveness analyses. It often meant, “Be realistic.” But it was usually uttered, Kim and Farmer felt, without any recognition of how, in a given place, resources had come to be limited, as if God had imposed poverty on places like Haiti. Strictly speaking, all resources everywhere were limited, Farmer would say in speeches. Then he’d add, “But they’re less limited now than ever before in human history.” That is, medicine now had the tools for stopping many plagues, and no one could say there wasn’t enough money in the world to pay for them.”

“Doctors are notorious for taking peculiar views of their own bodies. They tend to develop hypochondria in medical school and, once they get over it, if they do, tend to think they're invulnerable.”

“Sure,” I said. “But some people would ask, ‘How can you expect others to replicate what you’re doing here?’ What would be your answer to that?” He turned back and, smiling sweetly, said, “Fuck you.” Then, in a stentorian voice, he corrected himself: “No. I would say, ‘The objective is to inculcate in the doctors and nurses the spirit to dedicate themselves to the patients, and especially to having an outcome-oriented view of TB.’ ” He was grinning, his face alight. He looked very young just then. “In other words, ‘Fuck you.”

“We can spend sixty-eight thousand dollars per TB patient in New York City, but if you start giving watches or radios to patients here, suddenly the international health community jumps on you for creating nonsustainable projects.”

“I think that the rich can always call themselves democratic, but the sick people are not among the rich.” I thought he was done, but he was only pausing for the interpreter to catch up. “Look, I’m very proud to be an American. I have many opportunities because I’m American. I can travel freely throughout the world, I can start projects, but that’s called privilege, not democracy.”

“In the process Paul laid out a comprehensive theory of poverty, of a world designed by the elites of all nations to serve their own ends, the pieces of the design enshrined in ideologies, which erased the histories of how things came to be as they were.”

“fraternité”

“When others write about people who live on the edge, who challenge their comfortable lives—and it has happened to me—they usually do it in a way that allows a reader a way out. You could render generosity into pathology, commitment into obsession. That’s all in the repertory of someone who wants to put the reader at ease rather than conveying the truth in a compelling manner.”

“Virchow would write, ‘My politics were those of prophylaxis, my opponents preferred those of palliation.’ He had a knack for aphorism. ‘Medicine is a social science, and politics is nothing but medicine on a large scale.’ ‘It is the curse of humanity that it learns to tolerate even the most horrible situations by habituation.’ ‘Medical education does not exist to provide students with a way to make a living, but to ensure the health of the community.’ ‘The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.’ This last was Farmer’s favorite. Virchow put the world together in a way that made sense to Farmer. ‘Virchow had a comprehensive vision,’ he said. ‘Pathology, social medicine, politics, anthropology. My model.”

“The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.” This last was Farmer’s favorite.”

“Change the world? Of course they could. He really believed this, and he really believed that “a small group of committed individuals” could do it. He liked to say of PIH, “People think we’re unrealistic. They don’t know we’re crazy.”

“If you say that seven hours is too long to walk for two families of patients, you're saying that their lives matter less than some others. And the idea that some lives matter less is the root of all that's wrong with the world.”