Overall Analysis



Paul Farmer - It would be difficult to analyze this great man in just a paragraph when the whole book was written to show what he has achieved in his life. However, there are some important aspects of his character to remember. First, he believes he can win the long defeat, his way of saying that he can overcome impossible odds to save the poor of the world. Second, he believes he can give up time with his family and put the guilt aside, because it’s his job to help the poor and the very ill. Third, he believes in the simple mantra: He is sick and I am a doctor. He was born for the work he does and is obligated to do it. Last, he can put aside his anger at a world that isn’t doing its job of helping the poor and ill, because he has no time for the anger. He must do his work which also includes lobbying the world and shaking it up in order that it pays attention to what it wants to forget.

Tracy Kidder - He is the author of this book, but he is also one of its main characters, because it is he who must document what he sees by living and working with Paul Farmer. He is a bit of realist and a pessimist who constantly wonders why Farmer continues his work in the face of almost certain defeat. It’s only at the end when he finally realizes that Farmer’s determination to win over the long defeat is what makes him great. It goes back to the axiom that having tried is just as important as winning.

Ophelia Dahl - Being the daughter of famous people, you might expect Ophelia Dahl to have been perfectly content to live her life among the wealthy. But her family faced a great deal of adversity as well, and so it is not unusual that she found herself in Haiti helping Paul Farmer. She didn’t like it there, but she stayed and worked alongside him to achieve the goals he set for himself. They became lovers, but she wise enough to know that she could never be his wife, because his life was so disjointed. She wouldn’t be able to stand knowing that she wouldn’t see him for long periods of time, so she realized that their relationship would always be characterized as a deep and abiding friendship.

Jim Yong Kim - He is the Korean-American doctor who grew up to be a good athlete, valedictorian of his class, and a more than competent doctor. He falls in love with the work that Farmer is doing in Haiti and like him, devotes much of life working among and caring for the poor. Eventually, he sees how Partners In Health could set up the same model as Cange in Carabayllo in Peru. He finds he has a gift for the bureaucratic side of medical care and eventually gets $45 million to help eradicate TB in Peru. By 2002, he has become the senior assistant to the Director of WHO, a position that will allow him to help steer money to those who need it most.


The novel is divided into twenty-six chapters beginning with the first time Kidder met Farmer in 1994 when the United States had invaded Haiti to place Aristide back in power. Then, he does some flashback into Paul’s life followed by a chronological presentation of Paul’s work through 2002. The story is told as a narrative argument, focusing on the struggle of Dr. Farmer to find social justice for the less fortunate people of the world. It makes a compelling argument regarding the distribution of wealth in the world and emphasizes that a small group of people that are committed to a change, can bring about change in the world.


The poor deserve decent health care and living conditions
The first theme – the poor deserve decent health care and living conditions – is the very essence of this book. Farmer learns in through his work that it starts with the individual patient and ends with the wealthy individuals who do not choose to close his or her eyes to the misery around them. It is a constant struggle, but if even one person’s life is changed as a result, it is a worthy effort.

The Long Defeat
Kidder comes to realize that Farmer has spent his entire life trying to win the “long defeat”. This means that the doctor knows that his goal of bringing medicine and better living conditions to all of the poor is probably not attainable, but trying despite the odds is everything. Farmer is realistic and idealistic at the same time.
The fortunate of the world turning their backs on the poor and needy
The theme of the fortunate of the world turning their backs on the poor and needy is evident throughout the book. It is the one aspect of life that angers Paul. If everyone just did their “job” – caring for those less fortunate than they are – then the world would change. Of course, this is but a dream, but he still strives to make it come true by lobbying the wealthy and powerful to do their part.
The importance of trying to imitate Paul Farmer even though no one can ever be like him
Paul Farmer is such a unique individual that being a carbon copy of the man is impossible. However, wanting to at least follow and continue his work is a blessing for those in need.


Tracy Kidder is honest in his documentation of the work of Paul Farmer. He does attempts to show Farmer both symbolically and metaphorically at times.


The rising action begins when Tracy Kidder meets Paul Farmer while he is stationed with American troops in Haiti in 1994 and ends with a final determination that Paul Farmer is a man who has spent his life carrying on valiantly despite endless obstacles.


Farmer is ultimately a clinician who very much loves working with and changing the lives of his individual patients. We also see in the falling action the outcomes of several of Farmer’s goals as presented in the Afterward.


The point of view is first person, from Kidder’s point of view. This allows the reader to learn and grow as Kidder himself learns and grows from his experiences with Farmer.


Another important element is irony – the incongruity between the actual result of a sequence of events and the normal or expected result.

1 Farmer had come to Captain Carroll to warn him. The Haitians in the area decision had challenged the doctor to stop and talk to a soldier. Ironically, as they were passing the compound, they got a flat tire and Farmer comments, “you have to listen to messages from angels.”
2 Farmer and his entourage pass smiling children, carrying water in buckets that had once held paint, oil, and antifreeze.
3 Farmer’s comment on his childhood was, “The way I tell myself the story is a little too neat. I’d like to be able to say that when I was young I lived in a trailer park, picked fruit with Haitians, got interested in migrant farm workers, and went to Latin America. All true, but not the truth. We’re asked to have tidy biographies that are coherent. Everyone does that. But the fact is, a perfectly discrepant version has the same ending.”
4 There is a Haitian phrase, ”looking for life, destroying life.” Farmer explained it as an expression they used about a woman selling mangoes whom falls off of a truck and dies. In other words, in an attempt to keep her family alive, she sells mangoes, only to die herself.
5 When they sit down to eat in Russia, Farmer tells an interesting story: he had been named the TB commissioner for the state of Massachusetts, and so every time he needed lab resources, he goes there. Massachusetts has many TB labs, plenty of TB doctors, lots of TB nurses, and scores of TB lab specialists. What Massachusetts doesn’t have is TB.
6 Ironically, at the opening banquet of the meetings with the Russian generals who run the prisons and have a difficult time finding common ground, it is karaoke that makes everyone friends.


An important element of a work of literature, is a motif, which is a recurring element used to develop the work. There is one major motif in this book:
Farmer is portrayed as a kind of priest of a belief system that he has named “liberation theology’. He believes that we are to bring a better life to as many people as we can, and he is the minister who serves them. Like a priest who is married to the church, Farmer is married to Haiti.


The following quotations are important at various points of the story (Random House, New York, 2003):
1. “That guy’s a fuckin’ saint.” (pg. 16; This comment is made by a homeless man named Joe in Boston who only wants to take his AIDS medication and drink a six-pack of beer every day. Farmer gets him the beer.)

2. “I feel ambivalent about selling my services in a world where some can’t buy them. You can feel ambivalent about that, because you should feel ambivalent. Comma.” (pg. 24; Farmer said this when Kidder asked him if he shouldn’t be compensated for what he does.)

3. “Only in Haiti would a child cry out that she’s hungry during a spinal tap.” (pg. 32; This comment emphasizes the sod plight of the poor in Haiti.)
4. “Are you incapable of complexity?” (pg.35; An old woman makes this comment to Farmer to emphasize that the problems of the poor are not written in black and white.)
5. Farmer says that to understand Russia, Cuba, the Dominican Republic, Boston, or Sri Lanka, you just have to be on the top of that hill in Haiti. (pg. 44; This comment makes the reader understand that all poverty can be understood if only you would stand on a hill in Haiti.)
6. Farmer’s comment on his childhood was, “The way I tell myself the story is a little too neat. I’d like to be able to say that when I was young I lived in a trailer park, picked fruit with Haitians, got interested in migrant farm workers, and went to Latin America. All true, but not the truth. We’re asked to have tidy biographies that are coherent. Everyone does that. But the fact is a perfectly discrepant version has the same ending.” (pg. 54; Farmer sums up the irony that a somewhat abusive childhood would still produce a doctor.)
7. “Physicians are the natural attorneys of the poor, and the social problems should be largely resolved by
them.” (pg. 61; This saying by Virchow was one of Paul’s favorites.)

8. “Accidents happen. Sure. But not every bad thing that happens is an accident. There was nothing accident about the wretchedness of the road . . . or the over-loaded truck . . . of the desperation of a peasant woman who had to get to market to make a sale, because otherwise her family would go hungry.” (pg. 73; This is Paul’s explanation of the death of the Mango Lady.)

9. “Redistributive justice – we were just helping them not to go to hell.” (pg. 90; This is Paul’s justification for stealing a microscope from Harvard Medical School.)

10. Ophelia knew Paul loved her, but for her, relations were strained: “Te strain of living with a fellow who was in love with something else, something that I could never compete with, even if I wanted to.” (pg. 101; This is Ophelia’s explanation for why she ultimately couldn’t marry Paul.)

11. “The rocks in the water are going to find out how the rocks in the sun feel.” (pg. 110; Aristide declared this in one of speeches; it was a spin-off of a Haitian proverb.)

12. Jim Kim quotes Margaret Mead who said, “Never underestimate the ability of a small group of committed individuals to change the world.” Jim then responds to that quote by saying, “Indeed, they are only ones who ever have.” (pg. 164; This is one of the speeches Jim makes to appeal for money to help Peru.)

13. The sights of Haiti remind Kidder of Matthew 25 which says, “Inasmuch as you have done it unto the least of my brethren, you have done it unto me.” (pg. 185; Kidder is reminded of how little most of us who proclaim to be good Christians actually follow what Jesus said.)

14. “It’s embarrassing that piddley little projects like ours should serve as exemplars. It’s only because other
people haven’t been doing their jobs.” (pg. 257; This is Paul’s reaction to his projects being exemplars in an article in Lancet.)

15. Paul tells Ophelia that he hears two sets of voices in his ears: the one from the world saying, “This meeting’s important;” and the one from Haiti saying, “My child is dying.” (pg. 260; Paul explains his feeling of being torn in so many directions.)

16. “Lord, a word on all this.” (pg. 280; This is a bumper sticker on the back of a truck in Haiti and seems to sum up the seeming despair of an entire country.)

17. “The world changed yesterday.” (pg. 299; Jim Kim writes this to Kidder when WHO finally adopted new prescriptions for dealing with MDR-TB.)


Other elements that are present in this novel include symbols and metaphors. Symbols are the use of some idea to represent something else. Metaphors are direct comparisons made between characters and ideas. There many symbols and metaphors used by the author such as:
1. Boston’s Brigham and Women’s Hospital symbolizes outside help for the poor.
2. A moaning thirteen-year-old has arrived by donkey ambulance. Paul must give her a spinal tap and when he inserts the needle, she cries out in Creole that it hurts and she is hungry. This is a metaphor for the entire country that cries out for food.
3. The truck was carrying people and mangoes to market and because it was overloaded, it couldn’t master the turn. The people stand beside the road in shock while one of the women lies dead on a bed of the fruit, a piece of corrugated cardboard laying over her. This is metaphor for the country which often faces death in search of life.
4. Farmer, will be Kidder’s Virgil. He symbolizes the great philosopher.
5. The Péligre dam is a subject that Farmer has discussed in all of his books and many of his journal articles. It symbolizes the misery of the central plateau part of which was destroyed when the dam was built.
6. Chouchou Louis is a metaphor for Haiti. In a moment of freedom, he speaks disparagingly about his country and is then beaten to death. In the same way, Haiti rises up to grab freedom momentarily and then is beaten back into submission.
7. A good cast of the net is a metaphor for fishing, something Farmer often uses both positively as here and negatively when talking about the lack opportunities for Haitians.
8. Farmer is the single stethoscope under which beat many hearts.

Another element that is very dominant in this novel is imagery – the employment of figures of speech, vivid descriptions, or mental pictures in writing or speech. Much of the imagery in this book comes from the language Farmer uses.


• Title: Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World
• Author: Tracy Kidder
• Date Published: 2003
• Meaning of the Title: It refers to the main character’s determination to bring health and happiness to the poor and comes from the Haitian proverb, “Beyond Mountains; There Are Mountains”.
• Setting: Boston and Cambridge, Massachusetts; Cange, Mirebalais, and Port-au-Prince, Haiti; Lima, Peru; Tomsk, Siberia, Russian Federation; Paris, France from 1982 through 2003.
• Protagonist: Dr. Paul Farmer
• Antagonists: Poverty and the lack of caring from people who might help eradicate it.
• Mood:. The mood is dark and serious.
• Point of View: The point of view is first person, told from Tracy Kidder’s viewpoint. This allows the reader to personally experience how Kidder learns and grows from his experiences with Paul Farmer.
• Tense: The story is told in the past tense.
• Rising Action: Begins when Tracy Kidder meets Paul Farmer while with American troops in Haiti in 1994. Ends with the recognition that Paul is a has spent his life in the trials of “the long defeat”.
• Exposition: The author tells us the story of Dr. Paul Farmer, the man who would cure the world. We follow him through Haiti. Both his successes and failures there as well as in Peru, Cuba, and Russia.
• Climax: The climax occurs when the author realizes what Farmer is made of.
• Outcome: Many of Farmer’s goals do come to fruition, but there is still the sense that he has more to do.
• Major Themes: Everyone deserves health care and decent living conditions; the long defeat; turning ones back on the needy; and the importance of trying to imitate Paul Farmer’s work in the field.

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