The title is a haitian proverb that translates “beyond the mountains, more mountains.” As it relates to the book, I believe mountains beyond mountains means the never ending struggle to control disease involving the poor. In this case, the poor are the haitian people who are in a struggle to improve their health and the institution in place allow this to perpetuate. Farmer sees health in a way that differs from most.
Farmer believes improvement of health is not only the actual treatment of the disease. Instead, it is the complete assimilation of institutions where the poor are given power to succeed politically as well as the access to health care. This is evident in what resources Farmer’s clinic has available to his patients that go beyond access to equipment and medications that are not easily attainable in Haiti. In order to provide the necessary resources for a healthy community today and into the future they provide a school, housing, kitchen that feeds people daily, sanitation, as well as filtered water systems. These different resources combined make up what a community needs to have an improvement of health today and into the future. This philosophy rings true for me. How can you expect to have a healthy community when these basic needs are not available. In a country like the United States these resources are at at your disposal in the most rural locations and their benefits forgotten because of it.
Farmer’s Story shows how a small group of practitioners can make a positive and lasting impact in a world with poverty and a lack of health care provisions to those without insurance. One major component to this ability is the level of sacrifice these practitioners were able to endure. For many, the dreams of being a doctor include the big bucks that come along with it. In order to provide the level of care Farmer believed was necessary he sacrificed an extraordinary amount of his personal wealth. Another major sacrifice was his time with family. He split his year in Boston and Haiti so the geographic aspect was limiting. Then, the enormous amount of work that seemed never ending (mountains beyond mountains) kept him busy way beyond an average 9 to 5, leaving no time for vacation to visit. These sacrifices are not to be taken lightly. I don’t know if I would be willing to live for others like Farmer has. It takes a certain character that one is born with to do this.
Farmer used every tool he had to help. He sweet talked workers at hospitals and walked away with tuberculosis medicine for the poor and even paid for it himself. When caught he paid back the 96 thousand dollars in medicine he had take. When he was with others he would lecture all he came into contact with on the plight of the poor. He felt as though the poor were all too often forgotten. Tuberculosis control was the perfect example of this. Pharmaceutical companies had controlled TB in wealthy countries and made no effort in poor nations like haiti because it did not make sense financially. Once Farmer came into contact with a resistant form of TB in haiti he was on a mission to make MDR available for all not just the wealthy.
The biggest block was cost. His goal of MDR for all was not shared by pharmaceutical companies that wanted to keep the prices high. That didn’t sway him one bit. Ultimately, Farmer was able to acheive his goal and make MDR affordable for all. This motivation with no regard to a personal financial benefit is an attribute I have seldom seen in my lifetime. I imagine Farmer had been approached or had the opportunity to make huge profits from his position and public image. This ethical character seems mythical in today’s world of business and bottom lines. His ethical standard is something to aspire to.
The most intriguing quality I see in Farmer is his ability to understand the position of the poor in all its complexity. Wether the person is from Haiti or the United States he treats the patient with a respect that puts the patient at ease. His overall goal is to help the patient in a manner where it improves their overall health. One example that stuck out was Farmer’s experience with Joe a drug addict who doesn’t take his medication or eat properly. He sits with him and asks what his needs are in order to have a successful change in health. The response was definitely unique. His needs were a warm place to stay, 6 pack of beer, person to make sure he takes his medication, and someone to make sure he eats.
Instead of listening and completely dismissing his needs as out of the question he promises to try his best. On a board he writes what Joe’s current situation and the situation he wants to place him in and begins his mission. Ultimately he finds Joe a homeless shelter but they do not allow alcohol, but that doesn’t stop Farmer from pleading Joe’s case. This unorthodox method for providing the care Farmer felt would make a real change in Joe’s health was impressive. Farmer’s story is impressive. After reading this book I understand that a medical career is more than the good life. The abilities we are about to have can help so many and we need to know that is the goal of a good practitioner.