Mountains Over Mountains
The Quest of Dr. Paul Farmer
by Tracy Kidder
Random House, 2003, hardcover
"The world is full of miserable places. One way of living
comfortably is not to think about them or, when you do, to send
In Haiti, Farmer told me ... 25 percent of Haitians die before
they reach forty. "It's because there's a near famine there.
... most peasants ... had their black, low-slung Creole pigs,
which they kept like bank accounts, to pay for things such as
school tuition. But in the early 1980s, they lost those as well.
Alarmed about an outbreak of African swine fever in the Dominican
Republic, afraid that it might threaten the American pork industry,
the United States led an effort to destroy all the Creole pigs
in Haiti. The plan was to replace them with pigs purchased from
Iowa farmers. But these were much more delicate, much more expensive
to house and feed, and they didn't thrive. Many peasants ended
up with pigs at all. 'When school started the year after the slaughter,
enrollments had declined dramatically, throughout the country
and around Cange.
Since the departure of Baby Doc Duvalier, various unelected governments
had succeeded one another, but it was really the Haitian army
that ruled the country from 1986 to 1990-with aid from the United
In 1987 the army's paramilitaries had massacred scores of voters
at polling places, aborting what would have been the first democratic
elections in Haiti's history.
Catholic churches were at the center of the popular revolt-not
the cathedrals where the Duvalierist hierarchy presided but what
was called ti legliz, the small churches of the ruined countryside
and of the cities' slums. The most important of these was St.
Jean Bosco in Port-au-Prince, where the priest Jean-Bertrand Aristide
Farmer had first heard him speak in 1986,
over the radio in Cange. He'd decided to go to Aristide's church
and hear him in person. The crowd was rapt, and so was Farmer.
Aristide said, as Farmer remembered his words, "People read
the Gospel as if it pertained to another place and time, but the
struggles described there are in the here and now. The oppression
of the poor, the abuse of the vulnerable, and the redemption that
comes with fighting for what is right-what ideas could be more
relevant in our dear Haiti?" Farmer remembered, "I'd
been looking all over for the progressive, liberation theology
church in Haiti, and here it was." He joined the crowd that
went up to meet Aristide after the Mass. Aristide could hardly
have failed to notice him. ("Not many of his parishioners
were white, tall, and Creolophone.") They had become friends,
but Farmer didn't see much of Aristide in 1988. He was very busy
himself in Cange, and Aristide was busy surviving a series of
attempted assassinations, including the firebombing of his church,
which the mayor of Port-au-Prince arranged
In 1990 he saw a lot of the by then famous priest. One day when
Farmer happened to be in the city Aristide stopped by the Zanmi
Lasante office, looking bedraggled, driving a white pickup truck
with a load of flour for his orphanage in the back. The truck
wouldn't start, so he and Farmer loaded the flour into Zanmi Lasante's
van and took off They hit a large puddle, the van stalled, and
Farmer said, "I don't think we're going to make it."
Then he said to Aristide, "In the newspaper it says you're
going to be a candidate for president. I guess they don't know
you very well, because you would never run for president."
Aristide said something noncommittal,
and a week later declared his candidacy. For a while Farmer felt
angry. "How could he participate in something as irremediably
filthy as Haitian politics?" But then he thought, "What
are the Haitian people saying about this? They're demanding that
he run." In a journal Farmer kept during this time, he wrote,
"Perhaps this is a singular chance to change Haiti."
Soon he was rooting ardently for Aristide,
like virtually everyone else in Cange, and like them listening
almost constantly to the radio dispatches from the capital. He
was in Port-au-Prince, along with Père Lafontant, on election
day. Many foreign observers, including Jimmy Carter, certified
the results-67 percent of the vote for Aristide, and only 33 percent
for the twelve other candidates. In his journal, Farmer exulted.
Haiti had not only the most popular elected head of state in the
world but one who professed liberation theology and had promised
to lift the country into "dignified poverty." The new
president had also promised, not very subtly, a change of fortunes
for the Haitian elite. "The rocks in the water don't know
how the rocks in the sun feel," said a Haitian proverb. In
one of his speeches, Aristide had revised it, saying, "The
rocks in the water are going to find out how the rocks in the
Farmer drove back to the central plateau
the next day. Entering Cange, he spotted an elderly man climbing
barefoot up an eroded hillside. Wincing, imagining the man's feet
being sliced on the shaley rock - "rocks with teeth,"
as the local people said-he had a somber thought. "I wondered
fleetingly what even a government of saints and scholars could
do in the face of such odds," he wrote shortly afterward
in his journal. But exultation returned. To Farmer, Aristide wasn't
the real victor. It was, he thought, the Haitian peasantry, people
like his friends and patients in Cange, who had really won the
election. They'd braved intimidation, even massacres, to make
it happen and to vote. It seemed as if, at last, after centuries
of misery, of slavery and subsequent misrule and foreign interference,
the people of Haiti had claimed their country. Nothing, he would
later say, had ever moved him so deeply.
In ten days in a hotel room, he wrote 220 pages, most of the draft
of a book he would eventually call The Uses of Haiti. It is, I
think, the best of Farmer's books, certainly the most passionate,
essentially a history of American policy toward Haiti. The history,
that is, as if written in collaboration with a Haitian peasant.
The perspective is interesting. One learns,
for instance, that the United States tried to help the French
put down the Haitian revolution in the 1790s and, during the time
of American slavery, refused to recognize Haiti and practiced
gunboat diplomacy there. Also that, during the American occupation,
the U.S. Congress had reconstituted the modern Haitian army and
helped to finance it right up until the time when it deposed Aristide;
that the head of the junta's death squads, whose minions had murdered
Chouchou, had been trained at Fort Benning's School of the Americas;
that some of the junta's henchmen and officers in the Haitian
army also worked for the CIA; that while formally deploring the
coup, Washington, with the help of a generally compliant mainstream
American press, was busily denouncing Aristide, even manufacturing
lies about him, and maintaining a leaky embargo that seemed calculated
to preserve appearances but not to drive the junta out of power.
In the book, a number of heroes don't
look so fine. The French revolutionaries, whose idea of fraternite
didn't include the slaves in St. Domingue, and the Haitian "mulattoes"
who went to France to aid those revolutionaries in the hope that
they could win the right to own slaves themselves. Woodrow Wilson,
who presided over the American invasion of Haiti. Even FDR, who
once boasted that, while serving as assistant secretary of the
navy, he had written the Haitian Constitution of 1918. (There
were others on this list whom Farmer often mentioned elsewhere:
the former American slave and great abolitionist Frederick Douglass,
who eagerly served as American ambassador to Haiti, in effect
representing the Monroe Doctrine there. And Mother Teresa, who
came to Haiti in 1981, during the time of Baby Doc, and, as one
historian put it, "gushed" over the profligate dictator
and his widely hated wife, Michele, who had looted millions from
the Haitian treasury for her worldwide shopping sprees. Mother
Teresa said Michele had taught her a lesson in humility and marveled
at the closeness of the first lady to her people.
Since its revolution, Cuba had achieved real control over diseases
still burgeoning ninety miles away in Haiti.
"For me to admire Cuban medicine is a given," Farmer
said. It was a poor country, and made that way at least in part
by the United States' long embargo, yet when the Soviet Union
had dissolved and Cuba had lost both its patron and most of its
foreign trade, the regime had listened to the warnings of its
epidemiologists and had actually increased expenditures on public
health. By American standards Cuban doctors lacked equipment,
and even by Cuban standards they were poorly paid, but they were
generally well-trained, and Cuba had more of them per capita than
any other country in the world-more than twice as many as the
United States. Everyone, it appeared, had access to their services,
and to procedures like open heart surgery. Indeed, according to
a study by WHO, Cuba had the world's most equitably distributed
medicine. Moreover, Cuba seemed to have mostly abandoned its campaign
to change the world by exporting troops. Now they were sending
doctors instead, to dozens of poor countries. About five hundred
Cuban doctors worked gratis in Haiti now-not very effectively,
because they lacked equipment, but even as a gesture it meant
a lot to Farmer.
One time he got in an argument about Cuba
with some friends of his, fellow Harvard professors, who said
that the Scandinavian countries offered the best examples of how
to provide both excellent public health and political freedom.
Farmer said they were talking about managing wealth. He was talking
about managing poverty. Haiti was a bad example of how to do that.
Cuba was a good one.
He had studied the world's ideologies.
The Marxist analysis, which liberation theology borrowed, seemed
to him undeniably accurate. How could anyone say that no war among
socioeconomic classes existed, or that suffering wasn't a "social
creation," especially now, when humanity had developed a
grand array of tools to alleviate suffering. And he was more interested
in denouncing the faults of the capitalist world than in cataloging
the failures of socialism. "We should all be criticizing
the excesses of the powerful, if we can demonstrate so readily
that these excesses hurt the poor and vulnerable." But years
ago he'd concluded that Marxism wouldn't answer the questions
posed by the suffering he encountered in Haiti. And he had quarrels
with the Marxists he'd read: "What I don't like about Marxist
literature is what I don't like about academic pursuits-and isn't
that what Marxism is, now? In general, the arrogance, the petty
infighting, the dishonesty, the desire for self-promotion, the
orthodoxy. I can't stand the orthodoxy, and I'll bet that's one
reason that science did not flourish in the former Soviet Union."
He distrusted all ideologies, including
his own, at least a little. "It's an ology, after all,"
he had written to me about liberation theology. "And all
ologies fail us at some point. At a point, I suspect, not very
far from where the Haitian poor live out their dangerous lives."
'Where might it fail? He told me, "If one pushes this ology
to its logical conclusion, then God is to be found in the struggle
against injustice. But if the odds are so preposterously stacked
against the poor-machetes versus Uzis, donkeys versus tanks, stones
versus missiles, or even typhoid versus cancer-then is it responsible,
is it wise, to push the poor to claim what is theirs by right?
'What happens when the destitute in Guatemala, El Salvador, Haiti,
wherever, are moved by a rereading of the Gospels to stand up
for what is theirs, to reclaim what was theirs and was taken away,
to ask only that they enjoy decent poverty rather than the misery
we see here every day in Haiti? We know the answer to that question,
because we are digging up their bodies in Guatemala."
For me, the first sights of communist
Cuba were a great relief after Haiti. Paved roads and old American
cars, instead of litters on the gwo wout Ia. Cuba had food rationing
and allotments of coffee adulterated with ground peas, but no
starvation, no enforced malnutrition. noticed a group of prostitutes
on one main road, and housing projects in
"I'm very proud to be an American.
I have many opportunities because I am an American. I can travel
freely throughout the world ... but that's called privilege,
About 20 people had worked at Partners In Health headquarters
in Boston when I had first visited, late in 1999. Now there were
50, and another 10 in Roxbury. The numbers in Haiti had grown
to about 400, and to 120 in Peru, and they were about to inherit
15 employees in Russia, because on top of everything else, PIH
had expanded to Siberia.
... in late 2000 ... the United States was leading a concerted
effort to block aid to Haiti's government-not just American aid
but also grants and loans from other sources, including loans
from an international agency that would have financed an increase
in the supplies of potable water and improvements in roads, education,
and the public health system. The stated reasons for this policy
were various and changeable. The real reasons probably included
longstanding institutional fear and distrust of Aristide, a hope
that Haitians might blame him for the country's continuing decline,
and general weariness with Haiti's problems. Farmer wrote to me,
about the blocked loans: "I think, sometimes, that I'm going
nuts, and that perhaps there is something good about blocking
clean water for those who have none, making sure that illiterate
children remain so, and preventing the resuscitation of the public
health sector in the country most in need of it." He added,
"Lunacy is what it is."