Mountains Beyond Mountains by Tracy Kidder
Published by Random House, 2003
Précis
In the second third of Mountains Beyond Mountains by Tracy KidderPaul Farmers second in command at Partners in Health, Jim Kim, became interested in trying to bring better health car to Carabayllo, a slum section of Lima, Peru. Paul took an interest there too especially after his old friend Father Jack, who had a church there, died of TB. It turned out he had multi-drug resistant TB (MDR). At the time Peru had a model TB program sponsored by the World Health Organization. TB patients received inexpensive “first-line” drugs, the drugs that had just about wiped out TB in the developed countries. By the end of the 20th century, TB was still killing more people than any other infectious disease but only in poor countries. Many people, some say one-third of the world population, have latent TB bacilli in them, but malnutrition and other diseases make them active. Paul was a world expert on TB, and he had treated many MDR cases in Haiti by raising money to give patients the extremely expensive second-line drugs. In Haiti, the MDR victims developed it because they missed treatments with first-line” drugs or there was a problem with drug quality. In Peru the model program made certain that patients received their standeard quality drugs everyday. It was a mystery how Father Jack developed MDR. Farmer figured out that giving first-line drugs that didn’t work again and again to patients made them resistant to more drugs was the cause of their getting MDR. The Peruvian health authorities did not want to hear about MDR from Paul and Jim. They had only been able to get the program due to demonstrations by poor people, nuns, and priests. These officials were not about to give them more money for expensive drugs and asking for it could risk the whole program of giving first-line drugs. They wanted to act as though MDR did not exist. Farmer started speaking out at conferences
about how badly resources were needed to treat MDR. Then one Peruvian doctor whose
daughter was dying of MDR wanted Farmer to treat her without anyone knowing because
he was afraid he would lose his job. Although Farmer wanted to say something like, “What is wrong with you people?” he said publicly that he was not sure why the little girl wasn’t getting better. The Peruvian doctors put him on the second-line drugs Farmer recommended, and she recovered. Inspired by Farmer, Jim then went after the drug companies to make them lower their prices. With the help of a Dutch non-profit organization that specialized in reducing the cost of necessary drugs and with money from Doctors Without Borders, Jim was able to start buying second-line MDR drugs for
Peru.
Quotes
Page 106
Some experts even hypothesized that the disease had originated in Haiti, where, it was said by soe , Voodoo houngans ripped the heads off chickens and guzzled their blood, then had sex with little boys… In his thesis he’d (Farmer) marshal a host of epidemiological data to show that AIDS had almost certainly come from North America to Haiti, and might well have been carried there by American and Canadian and Haitian American sex tourists, who could buy assignations for pittances in a Port-su-Prince slyum called Carrefour.
In this quote Farmer is talking about the need for people to find a scapegoat for bad things that happen and the terrible injustice that was done by blaming Haiti for starting and spreading AIDS.
Page 113
To classmates, later to his students, Farmer’s medical memory seemed encyclopedic and daunting, but it was not inexplicable. “I date everything to patients,”…Patients, it seemed, formed not just a calendar of past events buy a large mnemonic structure, in which individual faces and small quirks…were like an index to the symptoms, the patho-physiology, the remedies for thousands of ailments. The problem of course was that he remembered some patients all too well. In later years he didn’t like to talk about Chouchou. He told me, “I take active precautions not to think about him.”
This quote shows what the motivation is for Farmer’s challenging and sometimes dangerous work. Deaths and murders are not statistics for him. They are all individual people, and he makes a highly emotional connection to them. He had to make special efforts not to think about Chouchou, a young man who had been brutally tortured for criticizing the sorry state of a road in Haiti when the junta was in power. Farmer had been unable to save him, but he did write about what had happened to him, and the Boston Globe published the story.
Page 147
“Thank you, Paul, for that provocative talk,” said the moderator, a TB specialist from the U.S. Centers for Disease Control, a friend of Farmer’s named Ken Castro.
Farmer was on his way offstage. He turned back. “Excuse me, Ken, but why do you qualify my talk as provocative? I just said we should treat sick people, if we have the technology.”
In his talk Farmer had been challenging the World Health Organization for saying that MDR-TB should not be treated in poor countries because it is too expensive. This quote shows how Farmer would not let anyone, even his friend, get away with not considering healing sick poor people just because they are poor.
Page 162
I remember signing the oath to assist the patient and do him no harm. I don’t really remember signing that I would do it in a cost-effective way.”
In this quote Jim shows how close his thinking is to his mentor Paul Farmer. In the same way that doctors swear to help patients no matter who they are they should also not let cost keep them from helping patients.
Page 164
Jim said, “And let me just conclude this…by paraphrasing someone of our tribe, of Paul’s tribe and my tribe of anthropologists. Margaret Mead once said, Never underestimate the ability of a small group of committed individuals to change the world.” He paused. “Indeed, they are the only ones who ever have.”
In this quote Jim could be talking about how Paul Farmer and he convinced the world that MDR-TB could be treated successfully and that two million poor people a year did not have to die. He was actually inspiring his audience to join people who make change for the good happen instead of people who resist change for economic or self-serving reasons.
This section of the book made me think about hearing someone say recently that AIDS in Africa was a “natural form of population control for countries that couldn’t deal with so many poor people.” Poor people are just statistics to someone like this person and not individual faces the way they are to Paul Farmer. You know that if someone close to him developed AIDS, he would not think it was “natural.” He would try to blame someone and probably Haitians and Africans! Even for people who would not say something this heartless most of us don’t think too much about dying people especially dying poor people, because we don’t have an emotional connection to them and because the only way to help if we going stay in our comfortable lives is to give money for which we have a thousand other uses. It is tempting to yell at someone who says something stupid like this. When Farmer was not allowed to treat a man in Peru for MDR-TB and had to watch him die, he wrote an angry letter to TB health officials that did no good. He knew the only way they to change bad policies is taking constructive action. Farmer believes that well-off people should share their wealth with poor people who are just like us only poorer. We don’t have to be geniuses and saints like him to know he is right.
No comments:
Post a Comment