Sunday, May 25, 2014

Mountains Beyond Mountains

Despite being involved in global health for over a decade, I have only just read "Mountains Beyond Mountains" by Tracy Kidder. I had seen some criticisms of Dr. Paul Farmer and his model, and I think I expected the book to be a glossy overview of Partners in Health (PIH) and their good works. I was pleasantly surprised that it went into much more detail about Dr. Farmer's philosophy and development of the PIH approach to "curing the world" (perhaps explained by his interesting childhood).

Here is the thing that struck me about Dr. Farmer's work and the PIH model (this may be old hat to everyone else, but it was a bit of an epiphany for me). 'Public health' endeavors address community-level issues, and in this indirect way benefit individuals. Dr. Farmer's model attacks problems from the opposite direction - find the best way to treat individuals and that will benefit the community. For example, PIH's success in developing an effective approach to treating MDR TB in low-resource settings sprang from the desire to treat one or two individuals. This approach is now benefitting thousands through community-based programs in Europe, South America and Africa. It seems that Dr. Farmer is what Professor Easterly would describe as a 'searcher' rather than a 'planner'.

Overall, I enjoyed this book. Dr. Farmer is clearly a dedicated, charismatic and laudable character. While his projects may have deficiencies, some have been successful in situations where others have failed. In the diverse and chaotic field of global health, it is worth paying attention to one who has had success in the "long defeat".