The heart of charity

A doctor's efforts to save the world, one patient at a time

As a boy growing up on Florida's Gulf Coast, Paul Farmer lived an unconventional life. His father chose to house their large family in a converted bus, dubbed the Blue Bird Inn. Later, they moved to a leaky boat moored in a bayou. Running water and privacy were luxuries reserved for other families.

Farmer concedes that his childhood was "pretty strange." Yet those experiences prepared him for an even more unconventional life to come. At Duke University, where he won a full scholarship, Farmer became interested in the Haitians living in migrant labor camps nearby. When he visited their country, he found his life's passion: being a doctor to the poor. So remarkable is his unselfish career that Tracy Kidder has made Farmer the subject of a powerful new book, "Mountains Beyond Mountains."

Haiti ranks as the poorest country in the Western Hemisphere. A quarter of Haitians die by age 40. Even their dogs, they joke ruefully, "are so skinny they have to lean against trees in order to bark."

Yet in a place where even cement must be transported by donkey, Farmer defies limitations to build a healthcare center. Thirty-five miles north of Port-au-Prince, along a boulder-strewn road, a walled citadel rises from a barren landscape. Inside, tropical greenery surrounds two clinics, a hospital, an Anglican church, a school, a laboratory, and a kitchen that serves 2,000 meals a day.

By Farmer's decree, no patient can be turned away. But medical aid alone is not enough. He also emphasizes the need to eliminate problems that contribute to illness: dirty water, inadequate nutrition, poor sanitation, illiteracy.

Shuttling between Haiti and the Boston hospital where he works part of the year, Farmer dreams of ending the disparities that define the two worlds of poverty and privilege. As Kidder explains, "He'd leave peasant huts full of malnourished babies and, arriving in Miami Airport, overhear well-dressed people talk about their weight-loss diets."

Encouraged by the success of his clinic, Farmer wants to replicate it as "a laboratory for the world, not just a marvelous anomaly." He fans out to hospitals, slums, and prisons in other poor countries, seeking to improve public health and eradicate infectious diseases.

"I'm an action kind of guy," he says simply. He travels 250,000 miles a year. He receives 200 e-mails a day and answers most. He charms money from individuals and foundations, and writes thank-you letters for $25 contributions.

During one of his absences from Cange, the settlement where his health-care center is based, a worker sends him a poetic e-mail: "We miss you as the dry cracked earth misses the rain." It is a lament that Farmer's Haitian wife, Didi, and their young daughter could echo. Unfortunately, Didi remains a shadowy figure in the book. We long to hear more about her life with the tireless, altruistic husband she shares with the world.

Kidder tells Farmer's story not as an unseen observer but as a traveling companion. When Farmer boards planes for Russia, Peru, Cuba, Mexico, and Boston, so does Kidder. When Farmer hikes 11 hours in one day over rugged Haitian terrain to visit two patients, Kidder scrambles, panting and sweating, to keep up. That proximity gives the story and its global settings immediacy and color. The two men circle each other warily at times, gauging motives or waiting for small irritations to pass. In one self-effacing moment, Farmer tells Kidder, "I'm not truly humble. I'm trying to be humble."

Still, even would-be saints have their detractors. Skeptics predict that Zanmi Lasante will not survive without Farmer. And they laugh at the inefficiency of walking for hours to visit one patient. Supporters counter that Farmer's concept of high-quality medical care for the poor has had huge effects, proving that intractable problems can be solved. They regard him as a model of what should be done, not for how it must be done.

Some readers may want to skip descriptions of diseases. But the book goes far beyond a recounting of Farmer's medical accomplishments. It also offers a sobering look at the myriad ways in which political and economic policies affect public health and well-being.

Farmer serves as a reminder that real heroes still exist. He illustrates the power of one person - in this case, one very driven person - to make a difference. As his longtime friend and co-worker Ophelia Dahl says, "You have to believe that small gestures matter, that they do add up."

Kidder's eloquent book leaves no doubt that she's right.

Marilyn Gardner writes about family issues for the Monitor.

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