Mountains Beyond Mountains

Image via the Partners in Health website. Click on the photo to link to PIH.

I finished a rather fabulous book on the way to Vancouver.  I am there and in one piece now (YAY).

The book is Mountains Beyond Mountains by Tracy Kidder.  I vote that it should become a to-read for anyone in health care or interested in international affairs.  I would say this impacted me more than reading The House of God (coincidentally read during my Internal Medicine rotation).  The book was a Christmas present from Patrick, which he picked out for me, one because it said on the cover it was about a doctor and two it has a rather colorful cover that screamed “Trisha.”

The book narrates the story of the life of Dr. Paul Farmer and his colleagues who work in international infectious disease control, namely Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) management.  Dr. Farmer is a passionate and intelligent gentleman who continues to practice medicine currently.  I don’t want to spoil the entire story, but quintessentially, he began his medical career while touring Haiti for research in anthropology and became convicted of the suffering and inequality occurring in that nation.  He then went on to medical school and specialized in Infectious diseases.  Thereafter, he undertook public health projects promoting better treatment of multi-drug resistant TB in Peru and Russia while continuing to maintain teaching ties to his hospital of origin in Boston and managing a self built hospital in Haiti.

The book is well-written and personal.  You get to know characters from their beginnings and see them grow over time.  You get bits of others’ perspectives.  The only negative would be that there isn’t more on where he is today other than practicing medicine.  And there is some language to it… Many F-bombs.  Direct quotes, direct context.  I felt they were used as needed and relevantly.  These are real people, after all.

A few things struck me from the story.  First off, the history present in this.  The elaboration on the HIV epidemic and how we have come to manage TB today, although there is a long way to go in many countries.  Then, there was the human side of it.  The portrayal of this man’s passion and sacrifice to help prevent and cure disease, as well as protect a nation.  He gave up most of the comforts we know and love and take for granted.  The medicine in the entirety of the book was sound, based on what I know.  The details of some of the cases were enough to make you feel compassion, to wish you were there to help, to understand better the suffering and decision making behind practicing medicine in such an impoverished country.

Dr. Farmer was portrayed as the center of the story, though, throughout, it was mentioned that this would not have been what he had desired.  Reading about his life and passion, I feel insignificant, as if I can not make a difference the way he does.  I know we all have different purposes and places to do our work.  This man was called to Haiti, he had a passion for the nation and a passion for infectious diseases.  He had perspective.  He used his time effectively (using airport layovers to check emails and flights to sleep), but often missed out on time with family due to his commitment and travels.  I wouldn’t want to sacrifice family to the extent he did.  Infectious disease is not my passion.  I found it interesting though, he looked at things differently.  He states at one point that his wasn’t the life for everyone  and there is a place for specialists in large centers.  He spoke of how inequality should not be present in this world.  That you should have access to STANDARD care wherever you are.  Something we struggle to provide in many regions and nations.  That those who are poor or imprisoned should not have to pay for their care.   At times, they airlifited patients to hospitals for physicians to provide pro bono care.  I would be up for that. At another point, he mentions that it costs $20,000 to air lift a dying patient from Haiti to Boston.  This is a great sum of money and could do a lot.  But then again, that may have saved a life.  But that large sum of money is 1/5 of what many salaried physicians make when starting out.  1/5.  When you look at it like that, it isn’t much.

The main thing is this book made me think.  It made me want to do more.  It showed me what people are capable of in this world.  It reminded me of the need in this world and how diseases like TB that seem controlled in much of Canada are still on the rampage in other parts of the world.  It reminded me  that, unfortunately, medicine comes at a cost.


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