This essay examines Tracy Kidder's Mountains Beyond Mountains through the lens of the ethical and political dilemmas faced by Dr. Paul Farmer in his crusade against infectious disease in Haiti and beyond. The paper explores three central tensions: Farmer's decision to engage with Haitian Voodoo and sorcery beliefs in order to build trust and deliver effective medical care; his struggle between focusing on Haiti versus expanding his work globally; and the broader political rationale for working in wealthier nations to shape global health policy. Drawing directly from Kidder's text, the essay argues that Farmer's approach was both pragmatic and deeply humanitarian.
The paper demonstrates effective use of textual evidence through integrated quotation. Rather than dropping block quotes without context, the writer introduces each passage with a framing statement that explains its relevance, then follows it with brief analysis. This "quote sandwich" technique — introduce, quote, analyze — is a foundational academic writing skill illustrated throughout this essay.
The essay opens with a thematic introduction to Farmer's mission and the book's central concerns. It then moves through three distinct dilemmas: the tension between science and indigenous belief, the choice between local and global service, and the political rationale for international expansion. Each dilemma receives its own section with supporting evidence. A short personal reflection closes the essay, connecting Farmer's logic to the writer's own reasoning. A single reference entry closes the paper in an informal citation style.
Tracy Kidder's Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World is a true story of one man's crusade against infectious diseases in some of the poorest nations in the world — most prominently Haiti. The story revolves around many philosophical, ethical, and political issues concerning healthcare, highlighting the inequalities and disparities in healthcare access and the distribution of wealth around the world. Dr. Paul Farmer goes to the heart of several pressing political issues, such as the role of the United States in Haiti and the inadequate healthcare situation that American intervention has not been able to meaningfully improve.
Farmer notices that despite their best intentions, U.S. peacekeeping forces in Haiti have not been able to bring about any real change in the social condition of the Haitian people. The soldiers have failed to engage with the cultural beliefs and traditions that heavily affect Haitians and their approach to healthcare. He understands the soldiers' cynicism, believing that they "had done their best" and felt they "would not cry over things beyond their control" in Haiti (p. 8).
Farmer's work in Haiti focused on far more than simply offering medical cures. He tried to get to the very roots of people's beliefs and noticed that Voodoo played a major role in their worldview, accounting for many healthcare issues. People did not always believe that they were sick in any biomedical sense; they would attribute illness to Voodoo, and so Farmer had to engage more deeply with their belief system in order to offer effective treatments for infectious diseases like tuberculosis.
As Kidder explains: "In one of his books, Farmer had written that there was a distinction, in the Haitian countryside, between belief in sorcery and the theories and practices called Voodoo, but virtually everyone — including Catholics, Protestants, and Voodooists — believed in the reality of maji, of sorcery. From many people around Cange, magic spells sent by enemies were the deep cause of many illnesses. And many people around Cange believed that Farmer, like all good Voodoo priests, knew how to contend with maji." (p. 28)
Sorcery was thus deeply embedded in the psyche of the Haitian people, and Farmer was perceptive enough to learn about these beliefs in order to work within them effectively and offer better healthcare options to poor and underserved communities. He was compassionate enough to recognize that there was a much deeper political reason why people in some of the world's most impoverished places still believed in the power of sorcery. Politics shaped their lives because, in the absence of modern education and medical infrastructure, communities had come to rely on the old practice of magic, which still held meaning for them. As Farmer explains: "Haitians believe in sorcery because their culture has evolved in the absence of effective medicine. So of course they believe in sorcery, in sicknesses that someone has sent to them. Why else would someone fall into a coma? And when someone is very sick and people are used to seeing them die with the same symptoms, and you give them meds and they rapidly recover, people think — and then they start talking." (p. 28)
Once Farmer became involved with Haitian culture, he found himself caught in several dilemmas, both ethical and political. The first took the form of a tension between science and magic: is it ethical to engage with sorcery and allow people to believe you are using magic to cure them, when you clearly place far greater faith in medical science? Farmer offered his own explanation for this engagement. He realized that without understanding the belief system governing the health behaviors of Haitian people, it would be impossible to offer them meaningful alternatives.
His reasoning was pragmatic: "A doctor who knew nothing about local beliefs might end up at war with Voodoo priests, but a doctor-anthropologist who understood those beliefs could find ways to make Voodoo houngans his allies." (p. 83) This was a critical step in Farmer's effort to introduce new ideas into Haiti. He understood that people would not accept new or unfamiliar treatments if they did not trust the person offering them. In order to earn that trust, he immersed himself in the cultures and belief systems of the communities he served — and this approach proved central to his success in fighting infectious disease.
Another dilemma arose in the form of the choice between working locally and working globally. When presented with an opportunity to work in more developed countries such as Russia, Farmer was torn between remaining in a poor country that desperately needed him and contributing to the broader global fight against disease. "Russia would mean even more days and weeks away from Haiti, a place much more afflicted by TB and every other disease." (p. 221)
If I had been in Farmer's position, I would have made the same choices, because his reasoning is both logically sound and attentive to the larger picture. His decision to expand his work to wealthier nations was not a retreat from his core mission but a strategic amplification of it — one that could influence health policy globally, including in Haiti itself. This kind of expansive, systemic thinking is precisely what made Farmer's crusade as remarkable as Kidder portrays it to be.
Kidder, Tracy. Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World. Random House Trade Paperbacks, 2009.
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