Sunday, November 18, 2007

I would call it a book review but that falls short

I have just read Tracy Kidder's book Mountains Beyond Mountains. It's an incredible book, incredible story. It gives you hope, it inspires…

So, the back cover says "an astonishing book that will leave you questioning your own life and political views…" Hmm. It affects you, this is sure.

What do I remember from the book? At one point, Kidder responds with cynicism to something Farmer (the doctor) said. Kidder then writes, "I felt as though I'd punched him. Among a coward's weapons, cynicism is the nastiest of all."

The book is written very honestly. Kidder writes about an encounter where he and Farmer had dinner with an important, high-ranking health official in Cuba, "Farmer made sure I noticed that Perez's driver ate with the family." He doesn't 'notice' it himself, he doesn't lionize the act, he writes matter-of-factly that it was explicitly brought to his attention, probably to highlight the egalitarian society in Cuba (my opinion, this last). Personally, the little section where they visit Cuba was a window on a country I know basically nothing about. A very interesting, and encouraging window.

One of my favorite parts is when one of Farmer's closest colleagues saves the day in Russia, uniting the health workers with the skeptical (to say the least) generals in charge of the jails – he does this by singing karaoke which breaks the ice and they all sing and dance and drink and become close friends. It's easy to disbelieve, question, react with cynicism to this little aside. But it's true.

I learned about the issues in global health. Did you know tuberculosis is still a real, active disease????? I feel like such a tool. It kills millions…of poor people. Farmer wrestles with different people's understanding of cost-efficacy relationships when it comes to treatment. Basically – poor people don't have healthcare, they will probably die and it isn't very cost-effective to try to help them….. there is a fair deal of blaming the victim involved as well.

Over and over again, Farmer and an assorted group of people who believe and care prove the naysayers wrong. They are told second-line TB drugs, to treat the drug-resistant kinds, are too expensive. They claim and then prove and then make happen over a 95% reduction in price in the drugs. They are told that their patient-centric approach to healthcare for the poor is unsustainable. But they cure and care for people who are so poor they don't have doors or roofs for their mud-and-stick-huts, and they do it at rates as high as places like Boston, Massachusetts. In Peru, they cured multiple-drug-resistant-tuberculosis patients 25 percentage points higher than the best lab in the US, located in Denver, Colorado, was able to achieve.

Farmer travels, travels some more, then sees some patients, then travels, then answers his hundreds of daily emails, then hikes through the mountains to visit some patients, speaks at international healthcare conferences, ……

People accuse him of setting an impossible and unsustainable example. Indeed – he is a hero and a man unique on this earth. He receives an email from a medical student who believes in Farmer but says he doesn't think that he could do what Farmer did (is doing). Farmer's response, "I didn't say you should do what I do. I just said these things should be done!"

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