Tracy Kidder. Mountains Beyond Mountains. United States: Random House Trade Paperbacks, 2009.
Précis[Chapter 17]:
In 1996 at the beginning of a hectic project in Peru, Famer found the time to marry his Haitian fiancé Didi. 3,000 people attended the ceremony in Cange, including all of Cange. Peru was taxing PIH's resources tremendously, while the number of patients in Caraballyo kept growing. Ophelia and Howard Haiatt (previously Harvard Medical schools dean) were worried that the project Farmer and Jim Kim had taken on was un-manageable. What they were doing looked reckless because the finite resources, other doctors did not believe in movement and they did not have proper institutional resources. Jim would travel to Carabayllo once a month, and Farmer more often. Farmer currently had his Peru & Haiti project, while teaching at Harvard, while working at the Brigham. In February 1997 Farmer began feeling ill but he continued to ignore his symptoms and plow through his work. He finally diagnosed himself with Hepatitis A, and when he finally gave in to being treated he spent 2 weeks on the hospital bed. After his recovery Ophelia sent him and Didi on a vacation to the south of France, and 9 months later they had their daughter Catherine. The MDR Project was making progress with patients but the Peruvian government was still denying acknowledgement of the fact. One day when we went to the hospital in Peru Farmer was walking rapidly to diagnose a patient when he encountered his first proof of success a little boy of 3 years of age once weighing 20 pounds with MDR TB now chubby and running. Farmer created a regime of second-line drugs based on his knowledge of TB, and children. It worked miraculously. Then the joy was over, on to the next patient the daughter of a Peruvian daughter with MDR TB, already known by the father but unable to treat correctly because of Peru's "norma’s" for the tuberculosis regime. So Farmer was able to conduct an official charade to diagnose the young girl to start her treatment, after many thanks to Farmer and bows from Farmer to the other staff we were in the parking lot leaving, on to the next 'bwat' to check off.
Quotes:
• “People think we’re unrealistic. They don’t know we’re crazy.”
• This explains everything I say in relation to most un-believing people.
• “MDR treatment was cost-effective in a place like new York, but not in a place like Peru.” This exemplifies the clear-cut fact that medicine evolves “cost-effective” where they measure the value of treating someone. HOW DO YOU PUT A COST ON LIFE? Of course, the person in NYC with an easier life deserves the treatment.
• “A couple of children were playing nearby with a ball. It got away from them. I watched the ball bounce downhill until I lost sight of it, thinking of gravity, sewage and disease.” I thought this was an arresting quote and showed this authors beautiful craft. The symbolism of even a child losing his playful joy as it rolls down an endless mountain of destitute.
Reflection of Illness and dying:
People around the world are dying simultaneously and constantly. As a doctor you can save many lives and the key is to remember even saving ONE life makes a difference. Every human in every corner of the world has a soul and is precious and deserves the seconds of existence to smile and frown. The hardships of illness and dying in this world (in subject of masses) are no longer dependent on the intelligence and knowledge to cure the maladies those have been found. Rather implementing them in our social atmosphere where greed powers in towering amounts for the few, preventing the rest to have the availability to be cured. Most people in this world that save lives for the sake of caring for all souls (such as Farmer) do not work for the money. In our world the most anti acquisitive
Happening; life now depends on the material of class status. A belief I already held true has been enforced by Farmer, when embracing all aspects of life, pain, beauty, suffering, inequality, greed, intelligence, arrogance, destitute, death, faith, and so on one can be more aware of the short process of living and as to what we want to do with it in relation to all the other beings we share this planet with. Ignoring the reality is ignorant, when one opens one eyes to all is when one can live thoroughly. The expression happiness can be bought with money in our world IS REALITY. If one has money one can, have health, nutrition, transportation, education, safety, a home, pets control, sanitation, and medicine IN OUR WORLD this constitutes the quality of ones daily life. Now it is true in absolute poverty one can still feel joy, the warming beams of the sun, the joy of family, the relief of knowing someone is safe but it is hard to enjoy life when the majority of daily life constitutes of absence.
Ahh, eloise! So much to comment on...I don't disagree with you, and your meditation on greed, the ability to buy health and treatments for disease. I would challenge the notion that happiness can be purchased. The thing is that medical treatment can be bought...no question. But health cannot be. All the money in the world will not save you if you are not healthy, do not invest or take action in maintaining health, or do not care about your health. Health and wealth are totally separate constructs. I had a patient tell me once, "we all have expiration dates. You just don't think you know yours yet." The idea being that we live under the illusion of having control of our bodies, of our selves. Being diagnosed with a chronic or terminal illness highlights the fact that we fail to control far many more things than we would like to think. We also live with the illusion that science can heal/cure anything and I think it has cultivated a sense of neglect around our own health care.
ReplyDeleteExcellent point though, about the limitations to distribution of treatment and the importance of prevention which costs less but is harder to quantify...oy. Quite a dilemma!
One day when we went to the hospital in Peru Eloise,
ReplyDelete"Farmer was walking rapidly to diagnose a patient when he encountered his first proof of success a little boy of 3 years of age once weighing 20 pounds with MDR TB now chubby and running. Farmer created a regime of second-line drugs based on his knowledge of TB, and children. It worked miraculously. Then the joy was over, on to the next patient..." This is a little confusing. Had I not read the book, I would not understand when Farmer created this second line drug regime. I wouldn't have known if he'd created right then and there in the hospital hallway, or years before. This is trivial, but I think it is important to be clear, especially in a well written precis.
I appreciate your discernment in finding symbolism in the quote about the childrens' ball; I did not see that deeper meaning before I read your blog.