A crusade to heal the world

Manipulative and cunning in the service of his political and medical causes, a crusader against disease on a worldwide scale, Paul Farmer is an immensely complicated contemporary American. With his brilliance, charisma and effectiveness -- and his heedlessness -- Farmer offers a formidable subject for the prize-winning journalist Tracy Kidder.

Farmer sets a trap for Kidder, and part of the fascination of “Mountains Beyond Mountains” lies in wondering: By the end of the book, will Farmer be canonized or will Kidder slip out of the trap and offer judgment?

Kidder’s generosity leads him toward canonization. He races around Haiti and the world, accompanying Farmer on his lunges toward fulfilling a vision of the Good, applying the familiar thoroughness that became his trademark in “Among Schoolchildren,” a year in the life of an elementary school class, and in “The Soul of a New Machine,” his story of a small company’s race to build a computer. Kidder notes the damage, in the form of disappointed love and insulted friendships, Farmer caused by his persistent demands that others fulfill his own particular dreams.

The history of Haiti is filled with saviors, gurus and messiahs. It’s brave of Kidder to place so much faith in the colorful figure of the self-sacrificing Dr. Farmer, who indeed treats the sick, stirs up trouble for the complacent, stimulates philanthropists, fights against the manipulations of American power. The best part of Farmer’s philosophy is plain crazy American rage against injustice.

Farmer’s soul seems to have been formed by an eccentric Catholic boyhood (his family lived in a school bus, a tent and a rickety boat), his scholarship days at Duke University and Harvard, the curiosity that led him to graduate work in anthropology, his contact with liberation theology and Marxism, and the maturing of a passion for righteousness combined with a gift for medicine.

What might have seemed like attention deficit disorder, mania or mere oppressive fanaticism was tamed by an extraordinarily agile mind and the ability to enlist others in impossible projects. Whatever blocked his path only spurred him to force his way through. Kidder chronicles the extraordinary degree of his success.

In Haiti in 1983, he found the blocked path that most challenged him. At that time, Jean-Claude “Baby Doc” Duvalier, son of the monstrous Francois “Papa Doc” Duvalier, used to brag that he was bringing democracy to Haiti but never saw a contradiction in his title, President-for-Life. Organizing a health center in a desolate region, Farmer found the world that needed him most and, later, met Jean-Bertrand Aristide, the priest who seemed to fit his ideals. Aristide left the priesthood, became president, was overthrown in a coup and was brought back, thanks to American arms, in 1995.

But the guru on the pedestal did what gurus tend to do. Aristide had feet of clay; he poured water on his own feet, assenting to the murder of his opponents, lavishly rewarding his followers, not living up to his promises. The empty pedestal is still worshiped by the faithful; this book gives no indication of how Farmer, who still works in Haiti, deals with his friend’s extreme devolution.

A fascinating undertow in this narrative is the tension between Kidder’s will to believe and his journalistic skepticism. Kidder surrenders quickly, perhaps too quickly, in favor of an acolyte’s enthusiasm for disheveled energy. He is clear-eyed enough to allow glimmers through the display of so much virtue, and one tender strand in the book is an account of a despairing love affair between Farmer and Ophelia, the daughter of Patricia O’Neal and Roald Dahl. (They seem to remain close friends even after he marries a Haitian woman who is willing to let him ignore her and follow his star.) It also comes as an unpleasant shock to Farmer to discover that he loves his own baby more than the stillborn child of a Haitian peasant. He describes this as “a failure of empathy.” How a reader responds to “Mountains Beyond Mountains” may depend on where one stands on the spectrum of belief in guru saints. The example of Mother Teresa gushing over Baby Doc’s wife -- noted by Kidder -- offers a cautionary note. (A woman who went to Haiti with Mother Teresa to work in her AIDS hospice told me, upon her return, that she hated “Mother” more than anyone she had ever met. The candidate for sainthood turned off the hot water in the hospice “because not everyone in Haiti has hot water.”)

Kidder shows how Farmer’s empathy and Haiti’s needs work productively in a symbiotic relationship. Though Farmer believes in penicillin, he also accepts the efficacy, for Haitians, of potions, curses, magic, voodoo. He also struggles against a pervasive indifference both to the misery of Haitians and to their inspiring humanity. Having written about Haiti, I understand that struggle, knowing that Americans tend not to look in that direction. A common question is: Tell me about Haiti, I’m very interested. Once, irritable and suspicious, I asked a very interested person, “Do you know where Haiti is?” He answered: “Not personally.”

If Farmer is contemptuous of international bureaucrats, it could be partly due to his taste for decent language. Kidder quotes from a World Health Organization manual: “In settings of resource restraint, it is necessary for rational resource allocation to prioritize TB treatment categories according to the cost-effectiveness of treatment in each category.” Farmer translates this as: “Let ‘em die.”

And one doesn’t have to be a bleeding heart to agree with Farmer’s colleague, microbiologist Alex Goldfarb, who points out that abandoned TB patients are a continual “epidemiological pump” of the illness for the rest of us.

Indignation is justified. Sometimes Farmer’s indignation gets results. He remembers Matthew 25: “Inasmuch as you have done unto the least of these my brethren, you have done unto me.” And again he retranslates: “Inasmuch as you did it not, you’re screwed.” He is a good hater; he hates the “stupid deaths” caused by the failures of compassion.

Farmer tells a World Bank official that he suspects bankers don’t need much sex “because they spend a lot of time screwing the poor.” Kidder doesn’t record the banker’s reaction, but moves on in the next sentence -- no new paragraph! -- to Guatemala and digging up Maya Indian bodies slaughtered by the Guatemalan army. Entertainment is not Farmer’s trade, nor is it Kidder’s here -- though a long chronicle of the struggle to save a cancer-riddled Haitian child succeeds as an engrossing account of the devotion of the team Farmer has inspired.

Haiti is Farmer’s touchstone: “He was like a compass, with one leg swinging around the globe and the other planted in Haiti.” His example challenges educated Haitians to work for their own people, not a frequent occurrence in a nation where the separation between rich and poor has many of the aspects of racism, despite a shared African ancestry.

A few years ago I met a group of Harvard Medical School professors who were spending their vacation in Haiti, teaching the staff at rural clinics to inoculate against infantile tetanus. The Haitian medical bureaucrat required to escort them would keep them waiting in the morning while she bathed, dressed and adjusted her makeup; when they came for her on a Saturday, the good doctor informed them haughtily that she didn’t work on weekends. As a result, they couldn’t complete their task. Dr. Farmer, genial MacArthur Award winner, might have persuaded Madame la Doctoresse to give up her Sabbath repose.

Occasionally Kidder comes up with clunky prose, as in this description of Paris: “that great dove-colored epicurean city.” Mainly, however, the book is efficiently driven by his passion for his subject. And he detects the moments of Farmeroid comedy, as when a Russian colonel asks a question and Farmer responds with a lecture on socialism and democracy. The question was: “Mind if I smoke?”

Kidder’s book is a tribute to Farmer’s family of associates: a Korean-American doctor, an English ex-lover, a Boston Irish philanthropist, a Russian-Jewish microbiologist, Peruvians, Cubans, many Haitians, the quirky billionaires George Soros and Bill Gates -- and, above all, to their shooting star, their exasperating mobilizer.

On the evidence of “Mountains Beyond Mountains” -- the title refers to the Haitian saying, “Beyond the mountain rises another mountain” -- Farmer is more secular hero than saint, bearing a few conspiracy theories along with his religio-Marxist motivations. He seems to believe in God’s inadequacy, quoting the enigmatic Haitian saying, “God gives but doesn’t share,” which he interprets as “He’s not the one to divvy up the loot.”

“Giving people medicine for TB and not giving them food,” remarks one of Farmer’s Haitian colleagues, “is washing your hands and drying them in the dirt.” After Farmer performs a spinal tap on a child who says, “It hurts, I’m hungry,” he comments: “Only in Haiti would a child cry out that she’s hungry during a spinal tap.” And, when the mother of a Peruvian child he has saved thanks “Doctor Pol,” he answers: “For me, it is a privilege.”

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From Mountains Beyond Mountains

‘I don’t forget what you did for me, Dokte Paul. When I was sick

Ordinarily Farmer’s skin is pale, with a suggestion of freckles underneath. Now it reddens instantly, from the base of his neck to his forehead. ‘You’ve already given me a lot. Stop it!’