Study Guide Mountains Beyond Mountains by Tracy Kidder

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Paul was described by his college friends as a guy who made friends easily and had a photographic memory for facts about each one. He talked to everyone he met and was open to late night food fights and singing Broadway songs while walking across the campus.

After his first semester, Paul started getting all A’s. He also spent one summer and fall in Paris where he lived with a family that needed an au pair. He went frequently to political demonstrations and took four courses, among which was the last anthropology class taught by the great Claude Lévi-Strauss. By the time he returned to Duke, he read, wrote, and spoke French fluentlym and he had claimed as his personal mentor Rudolf Virchow, a German polymath who had been dead for the better part of the century.

Virchow isn’t very well-known in the medical world, but he is considered the “principal architect of the foundations of scientific medicine.” He made important contributions in oncology and parasitology, coined at least 50 medical terms in use today, and helped define the field of medical anthropology. He published more than two thousand papers and dozens of books. He was sent by the German government to Upper Silesia to report on an epidemic called relapsing fever. His report included a prescription for “full and unlimited democracy” as a means to help cure the epidemic. The government fired him. His aphorisms after such experiences included, “Physicians are the natural attorneys of the poor, and the social problems should be largely resolved by them,” a favorite of Farmer’s. Farmer made no secret of his admiration for Virchow. He said, “Virchow had a comprehensive vision. Pathology, social medicine, politics, anthropology. My model.”

After his study of Virchow, Farmer came to have a moral understanding of public health. He also became interested in current events after the murder of Archbishop Oscar Romero by a right-wing death squad in El Salvador. After this, his understanding of Catholicism changed radically when he saw Catholic prelates preaching against the oppression of the poor rather than the perils of premarital sex. He came to believe that there was so much more to countries like El Salvador that people in the United States knew. He later met a Belgian nun named Julianna DeWolf who was working with United Farm Workers. She was fearless, radical, and committed to the farmers of Haiti. Paul called women like her “the church ladies” and was very impressed by what they were willing to do on behalf of migrant workers. His discovery through her of the misery of the Haitians led to an article of over 6,000 words about those farmers laboring in the fields near Duke University, called “Haitians Without a Home.”

After graduating summa cum laude from Duke, Farmer joined protests at Krome Detention Center where American Immigation officials were allowing Cuban immigrants entrance and sending Haitians back. He became interested in all things Haitian including its violent history and its ongoing struggle between great and terrible, between good and evil. He had won a one thousand dollar prize at Duke and figured it would be plenty to last him when he went to Haiti. In the meantime, he applied to both Harvard and Case Western Reserve where he could get a joint degree as a doctor-anthropologist. He figured his time in Haiti would help him know if that’s what he really wanted.

In 1983, when Farmer landed, Haiti was still controlled by the Duvalier family. It had been controlled by the dictator Papa Doc Duvalier from 1957 until his death in 1971. Now it was controlled by his son, Baby Doc, who had declared himself President for Life. The tourist areas were patrolled by the tontons macoutes , the Duvaliers’ Praetorian Guard so Haiti seemed an exotic destination. But Farmer knew the interior would be different. Using his friendship with a member of the Mellon family on Pittsburgh, he hoped to get on the staff of the Hôpital Albert Schweitzer. Unfortunately, there was no opening, so Farmer looked into other situations, including Eyecare Haiti which had mobile outreach clinics and a base for their operations out in the central plateau in the town of Mirebalais. Farmer headed there.



This chapter explains the circumstances that led Paul Farmer to realize there is a moral understanding to public health and that his talents would be better employed on behalf of the poor of Haiti.


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