Some thoughts on Tracy Kidder’s “Mountains Beyond Moutains”

Today’s post concerns Paul Farmer, activist/applied anthropology, and Tracy Kidder’s book, Mountains Beyond Mountains, the Quest of Dr. Paul Farmer, the Man Who Would Cure the World.  I’ll begin by explaining a little bit about the man, Paul Farmer – he is both a medical anthropologist and a medical doctor and his work has brought healthcare and opportunities to people across this world who need it the most.  He’s a southerner by upbringing, having been raised along the Gulf South most of his life,  and he attended Duke and then Harvard Med, where he received a joint MD/PhD, the latter in anthropology.  Among his numerous accomplishments, he wrote his doctoral dissertation while a practicing resident in both rural Haiti and at the Brigham in Boston.  As someone who’s trying to write a dissertation while not trying to save the world, all I can say is wow!

Paul’s accomplishments are significant,  but most emphasized in Tracy’s book,  was how he and his colleagues at Partner’s In Health (the non-profit he started)  radically defied how epidemiologists and infectious disease specialists target illness in the developing world.  Rather than simply submit to overarching structural challenges, like the cost of drugs for treating HIV or tuberculosis, Paul and his colleagues changed the system – if drugs were too expensive, well, then they changed the price of the drugs.  If transporting a patient was too expensive, well, then they changed the price of transport.   He convinced the World Health Organization that its methods of dealing with TB were simply just making it worse in the developing world and breeding TB that could not be treated with standard front line drugs.  Moving beyond directly observed therapy,  Paul used his anthropological training to develop protocols for treating multi-drug resistant TB (MDR) that worked particularly well in Haiti, where he developed his free hospital.  Subsequently,  he took his model, and applied it to contexts in Peru and Russia, each tailored for their specific applications.   His ideas about how to treat MDR were at the time incredibly unconventional – everyone gets treatment, no matter the cost.  Part of his reason, aside from the human element, is that TB is incredibly democratic and it will infect without bias – one stray cough and an epidemic can begin. Thus, MDR is the world’s problem, and treating it, no matter the costs, is of the utmost importance.  But he never forgot that he was serving the people of Cange, Haiti (among other places) – after reading this book,  I doubt I ever will do anything that even approximates “hard work” compared to Paul.  His devotion to patients and outcomes is utterly humbling, and for that, he has also been critiqued.   His opponents claim he is too focused on individuals, when instead he should be focused on populations,  but in my humble opinion, I’m quite taken with his approach.  Of course in today’s world, all anthropology is applied anthropology. I challenge anyone in my field to leave their nest and not feel the need to help those in need wherever they may work.  For me its the Mississippi Delta, and I have felt the yen to do something for my community since I started visiting them a few years ago.  I’ve felt overwhelmed about what I could do for them, and frequently at a loss, but perhaps its time I followed Paul’s example and just forged ahead.

So anyway, I guess my point is read this book!  Oh, and perhaps that all anthropology is applied, no matter what brand is practiced.  For example, Archaeology takes a centennial and millenial perspective on changes within human populations and no other other discipline has that angle – we look at change in the really long term. So, maybe the question is, how can we archaeologists take our knowledge further and work towards the betterment of the human race?  I think that question might apply to just about all of us, no matter what we’ve done with our lives, but as an archaeologist, I plan to follow Paul’s example and ask myself, “what have I done today”?