Mountains Over Mountains

The Quest of Dr. Paul Farmer

by Tracy Kidder

Random House, 2003, hardcover

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Tracy Kidder
"The world is full of miserable places. One way of living comfortably is not to think about them or, when you do, to send money.

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In Haiti, Farmer told me ... 25 percent of Haitians die before they reach forty. "It's because there's a near famine there. "

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... 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.

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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 States ...

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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.

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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 presided.

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

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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 sun feel."

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.

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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.

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Since its revolution, Cuba had achieved real control over diseases still burgeoning ninety miles away in Haiti.

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"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

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Paul Farmer

"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, not democracy."

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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.

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... 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."

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