Review of Mountains Beyond Mountains by Tracy Kidder

Mountains Beyond Mountains is the story of a doctor named Paul Farmer, who is currently about fifty years old and has devoted his life to providing medical care to the poorest people in the world.

Farmer’s story would make a pretty good movie, because he is the kind of hero that Americans love—a maverick who faces impossible odds and succeeds nonetheless. For example, Farmer almost singlehandedly revolutionized the treatment of multiply-drug-resistant tuberculosis (MDR), going against conventional wisdom and the carefully planned programs of bureaucratic global health organizations, and eventually forcing those organizations to change their approach. But Farmer is no ordinary academic, limiting himself to research in a comfortable lab in Boston. Although he is a professor and has a stellar academic resume, he spends most of his time directly caring for the poor. Kidder details one typical day in Farmer’s life, during which he spends eleven hours on foot to visit two families of patients in Haiti who are too poor to pay him anything. Farmer prioritizes his patients’ welfare to what some would consider an insane extent, “borrowing” drugs illegally from Mass General Hospital and worrying about how to pay for them later, or signing away his paycheck in an emergency and leaving himself with inadequate funds even to buy his own food.

There is no question that Zanmi Lasante, the first health-care system that Farmer set up, is a stunning success. Located in one of the poorest parts of Haiti, and starting from impossibly wretched conditions, Zanmi Lasante is now an oasis, providing incredibly good health care to the area that it serves. A visit to Zanmi Lasante can be, and has been for many people, a life-changing experience. What others would not even dream of as a possibility has been made a living reality by Paul Farmer.

The book is an inspiring read on many levels. What interests me most, however, is an issue that lurks in the background throughout the book and is explicitly addressed near the end. Namely, is Farmer really going about things the right way? Should he be supported, imitated, replicated? Or is he an anomaly, doing things that would be crazy for anyone else to do, and succeeding only because of his brilliance and his extraordinary capacity for personal sacrifice? Will Zanmi Lasante and other Farmer projects evaporate after he dies?

For example, some have suggested that Farmer would be better off spending his time on big, global projects that impact millions of people. Why is he wasting his time trekking through the Haitian countryside to provide care for just a handful of patients?

Farmer does address this question when Kidder asks him. His reply is long and I will not reproduce it all here—you should read the book. One thing that stands out, though, is that he sees himself as primarily a doctor whose job is to heal the patients that come to him for help. His goal is not to save the world with some Grand Project, but to personally help those who need help the most—the poorest of the poor. There is nothing wrong with the Grand Project, but it is a means towards an end. When he personally delivers care to a patient—that is the end.

The tension here is one that every Christian should be familiar with, yet curiously it seems to be shoved under the rug most of the time. Is God more present in the huge evangelistic rally where thousands of people are saved, or in the cell where the prison chaplain prays alone with an inmate? Is it better to sell your perfume and donate the proceeds to the poor, or to use it all in one shot to anoint Jesus? Is the Lord present in the wind and the earthquake or in the still, small voice?

A strong argument can be made for what we might call the hard-nosed, practical approach. You might be able to do some good with a little money, but you can surely do a lot more good with a lot of money. Paul Farmer did benefit enormously from a millionaire who decided to spend almost all his fortune supporting Farmer’s projects. Are we not called to be good stewards? Resources are always limited; shouldn’t we always seek to use our resources more efficiently, and seek to do the greatest good for the greatest number?

The argument seems irrefutable, yet time and time again we see God refusing to abide by the dry calculus of practical logic. Philip Yancey describes this well in his book What’s So Amazing About Grace? The economics of grace is wildly inefficient. God sometimes pours out grace profligately, beyond anyone’s wildest dreams. Yet other times, he seems painfully silent and inactive. What gives?

We will never fully understand God’s ways, but one thing is clear: those of us who find the efficiency of practical logic alluring, often grossly underestimate the tremendous spiritual significance of two souls connecting. When God touches us, or enables us to touch one another, the resulting divine spark has incalculable, transcendental value. It is love, it is joy, it is peace. That is what we were made for.

This does not mean that we have the license to fritter away our resources thoughtlessly as long as we act—or think we act—out of love. But it does mean that if we see no point in abandoning 99 sheep in order to go find the lost one, then we have lost sight of what is most important.

Farmer seems to understand the tension intuitively. It is not surprising to learn that he is drawn to liberation theology, and to the preferential option for the poor. There is no question that Farmer is an exceptional individual, but this does not mean that the success of his efforts is due to his inimitable genius. Rather, this is simply how God works, and God is always faithful to his promises. If we are surprised at Farmer’s results, then it is our own expectations that need adjusting. Would that we were all as faithful to God’s call to serve as Farmer has been.

Posted November 2008

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