Dye Mon, Gen Mon

[bcholmes]

A few weeks ago, xthlcm recommended a book to me: Mountains Beyond Mountains by Tracy Kidder. I added it to my book list in Amazon.ca, and it arrived about a week ago. I finished it last night, and am completely blown away by it.

The book is, in essence, the story of Paul Farmer, a doctor who set up a free health clinic in Haiti and, in the process, became quite well-respected for his work with community-based health-care, and his work with multidrug resistant tuberculosis.

Tonight, I went through the book again and put sticky-notes on some of the sections that I wanted to think through some more. Here's an example. In the book, Kidder describes an incident that Farmer and his then-girlfriend, Ophelia Dahl, experienced. While travelling down a road on Morne Kabrit, in the central part of Haiti, they passed a tap-tap bus that had overturned. The tap-tap had been overloaded with packages and passengers, and a woman had been killed. This was in 1983, when Baby Doc Duvalier was still in power in Haiti.

A few pages later, Kidder would write this passage, that seems to say a lot about the way Farmer thinks:

Accidents happen. Sure. But not every bad thing that happens is an accident. There was nothing accidental about the wretchedness of the road down Morne Kabrit or the overloaded tap-tap, or the desperation of a peasant woman who had to get to the market and make a sale because otherwise her family would go hungry. These circumstances all had causes, and the nearest ones were the continuing misrule of the Duvaliers and the long-standing American habit of lavishing aid on dictators such as Baby Doc, who used money to keep himself and the Haitian elite in luxury and power and spent almost nothing on things like roads and transportation.

Later, Kidder wrote this following account of a speech Farmer gave in Cuba:

Farmer asked the audience to remember the days when expert opinion had retailed all sorts of nonsense about who caught HIV and why, the days when to be Haitian was to be part of a "risk group." He and his staff has designed a study in Cange, he said, to try to get at the local facts. Two hundred women were involved, half infected with HIV, half not. Almost none in either group had been exposed to risks often mentioned in expert commentary — intramuscular injections, blood transfusions, intravenous drug use. [...] Between the groups of women, only two differences stood out. Unlike the uninfected, many of the ones with AIDS had worked as servants in Port-au-Prince. Obviously domestic service hadn't given them HIV, but it did describe their economic desperation — working for Haiti's elite was rarely pleasant or remunerative. Uniformly, the infected women named that kind of desperation, deep poverty and illiteracy, as their reason for having taken what appeared to be the real risk for AIDS, which was cohabiting with truck drivers or soldiers.

[...]

Up at the podium, Farmer went on with the story: After the study was done, he returned to the United States and logged on to MEDLINE. He entered "AIDS" and the names of thousands of studies came up on his computer screen. Then he entered "AIDS and women," and only a handful of studies appeared. "And when I crossed 'AIDS, women, and poverty,' the message said, 'There are no studies meeting those specifications.'"

Farmer extended a hand toward the screen behind him, now filled with a gigantically enlarged graph of the study from Cange. "There are reasons why people are uncomfortable talking about this. Fine. But if we want to stop AIDS, we better find out about this. Countries with the steepest grades of inequality and the greatest poverty have the biggest AIDS problems, and I'm sure Professor Montagnier would agree that while coinfections are important cofactors, they're not as important as these. We need to erase social inequalities, and very few countries have done that." He closed in one of his favorite ways, by quoting a peasant. "A woman in Cange said to me, 'You want to stop HIV in women? Give them jobs.'"

Throughout the book, it's clear that Farmer is an unusual character. A Harvard-educated doctor who worked with Brigham, he directed most of his money into his free clinic in Haiti. For a good amount of his adult life, he slept in the basement of a Church while in Boston, and a back room at his clinic in Haiti. It's clear, again and again, throughout the book that Farmer lives outside of the norm. At one point, while Kidder was with him in Cuba, he made this comment:

"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. I want people to feel unhappy about Lazarus and all the others who are shafted. Otherwise why would I have you with me? I don't have a lot at stake in how you depict me. I've been yelled at by generals and denounced by people who don't have any data when I have a shitload. It does no harm to me, but plenty to my patients. If the very warm reception of me in Cuba is portrayed as because I'm thought to be a sycophantic ally of Cuba, then the Cuban doctors' concern for the poor in Haiti would be lost."

[...] "Jorge is chief doctor of the Infectious Disease Institute, director of the sanatorium, chair of the national AIDS program, visiting professor in many countries, on the board of director, by fiat, mine, of our program at Harvard. He has the ear of the president and the minister of health. He's at the pinnacle of power in Cuban medicine and he lives like a lower-middle-class American, and he doesn't care. I have no generic liking for modest living. What I like is that Jorge believes that this is right. He doesn't like social inequality. He believes in social justice medicine. That moves me. I hate to see that ridiculed. I hate it."

A part that I find myself thinking about again and again is a section in which Farmer says:

"I love WL's [white liberals], love 'em to death. They're on our side," he had told me some days ago, defining the term. "But WL's think all the world's problems can be fixed without any cost to themselves. We don't believe that."

This what I like most about this book: not just that Farmer is something of a genius who takes a community-based and holistic view of the problem of health care in a poor country. But that the points that are raised get in your face. It's not comfortable, and it shouldn't be. I find myself reading it and thinking: "what am I doing about all of this? What sacrifices am I making?" I could hand wave and point to the charity I support. But I don't feel like it's enough.

Farmer, himself, suggests that he's very skillful at making people feel guilty. And I feel guilty. I'm not sure, yet, what I'm going to do about this, but I'm sure that I want to start to figure it out.

Comments

[kalmn.livejournal.com]

yes. it's really a great book.

[lovelyangel.livejournal.com]

Feeling guilty is a good thing -- it's what drives us to take action. That's what I like about my church; it constantly challenges me to do more to make the world a better place. Guilt does a lot to keep complacency at bay. I'm never satisfied with the extent of my charitable work, and I have a long ways to go, but incrementally I think I do a little better each year.

I like how Tracy Kidder leads us through the minds of his protagonists. I still have a battered copy of The Soul of a New Machine.

[mathbabe.livejournal.com]

I'm glad this came to my notice - I've put it on hold at the library.

Back in the late 80's when all my CS-major friends were reading Soul of a New Machine, I bought a used copy of House instead. I just walked to the dining room door and spotted it still sitting on the bookshelves... I must re-read it again and see if it's really as good as I remember.