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Chapter 16
Themes
Key
LitCharts assigns a color and icon to each theme in Mountains Beyond Mountains, which you can use to track the themes throughout the work.
Cost-Efficiency vs. the Value of Life
Saintliness
America, Imperialism, and the First World
Science, Magic, and Religion
Nonprofits, Politics, and Compromise
Summary
Analysis
In 1994, Farmer begins dating a new woman, Didi Bertrand. She’s the daughter of a schoolmaster in Cange, and said to be the most beautiful woman in the city. Farmer courts her for two years, and finally marries her in 1996. Jim Kim is Farmer’s best man.
Again, it’s remarkable that Farmer to get married in the first place, as he’s so busy that he has almost no time to spend with his family. Didi Bertrand seems well aware of this fact—unlike Ophelia, she doesn’t expect Farmer to spend a huge amount of time with her.
Themes
At 1997 comes to an end, Peru is costing PIH huge amounts of time and money. PIH treats about 50 MDR cases, representing approximately 10 percent of all cases in the slum. A friend of Farmer’s, Howard Hiatt—an influential professor at Harvard Medical School—advises PIH to find new methods of payment before it invests any more resources in treatment. At the moment, PIH owes Harvard tens of thousands of dollars. Farmer reluctantly agrees, and convinces Tom White to send Harvard the money.
At this point in his career, Farmer still depends heavily on one donor, Tom White. The advantage of such an arrangement is that Farmer doesn’t have to deal with much bureaucracy—the only person he has to convince is Tom. The disadvantage of such an arrangement is that it’s short-term: Tom’s not going to live forever, nor is his money going to last forever.
Themes
Jim Kim takes on a taxing schedule, in which he travels to Cange and then Peru, sometimes in the same day. Farmer’s schedule is even tougher, and he barely sleeps at all anymore. He develops nausea, and sweats profusely. To his horror, he realizes that he has MDR. Although Didi wants him to return to the U.S. for treatment immediately, Farmer insists on completing assignments in Cange and Peru beforehand. A few days later, Farmer returns to Brigham, where he’s “relieved” to find that he only has Hepatitis A. Farmer undergoes rigorous treatment for two weeks, after which he’s sent—with Didi—to the south of France for a vacation, the first he’s taken in many years. Nine months later, Didi gives birth to a daughter named Catherine.
Farmer’s schedule becomes increasingly hectic as he divides his time between his new wife and child, his work in Haiti, and his research in Peru. It’s unsurprising that Farmer contracts a disease during this time. The disease is an important reminder that Farmer, for all of his energy and determination, isn’t superhuman. Like everyone else, he has limitations, whether he likes it or not. (This is also one of the funniest moments in the book: only someone like Farmer could be diagnosed with Hepatitis A and be “relieved.”)
Themes
Farmer resumes his work in Peru working with MDR patients. The Peruvian government has “softened” its attitude to Farmer’s program, partly because of the influence of Farmer’s American connections. Kidder visits Farmer while he’s reunited with a young boy named Christian, whom Farmer treated for MDR two years previously.
It’s a mark of Farmer’s talent as a politician and a persuader that the Peruvian government backs away from its opposition regarding PIH. Although the entire process took months, Farmer’s speech has made waves. He’s convinced the U.S., and thus Peru, that it’s in everybody’s best interest to explore new TB treatments.
Themes
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Kidder backs up to explain Farmer’s experience treating Christian. Two years ago, Christian was severely ill with TB, and could barely breathe. His lungs were covered with TB bacilli, and his spine was weak. Farmer deduced that the TB in Christian’s body was drug-resistant, probably due to insufficient WHO (World Health Organization) treatments. Farmer supervised Christian’s treatment, using extra dosages of the drugs Harvard prescribed for MDR cases. Two years later, Farmer was overjoyed to see that Christian had made an incredible recovery.
Farmer is always thinking long-term, but he doesn’t lose sight of the individual patients he’s cared for. Kidder never lets us forget that Farmer is an excellent hands-on practitioner as well as a good researcher and speaker. This poignant episode reminds us of the qualities that make Farmer’s patients love him: his patience, his kindness, his humor, and his personal attention to each individual case he deals with.
Themes
On the day that Kidder sees Farmer reunite with Christian, Farmer proceeds with his other cases. He examines a young girl with pulmonary TB. The girl has already been treated for TB with WHO drugs—a treatment that’s resulted in a case of MDR, which is almost impossible to treat now. Farmer notes with frustration that the girl’s previous doctors knew full-well that she had MDR, but they didn’t dare go against the norms of the Peruvian government’s treatments. Farmer believes that with a few more successful cases, like Christian’s, the Peruvian government will finally embrace MDR treatments.
Farmer’s greatest asset as a medical practitioner is that he never loses sight of the connection between individual patients and the big picture. The end of Chapter 17 is an excellent example of this principle: Farmer knows that by spending time one-on-one with children like Christian, he has an opportunity to change the national policy on TB in Peru. On some level, it isn’t “cost-efficient” for Farmer to spend so much of his time on individual cases, but such personal attention seems to add up, and may end up doing even more good in the long run than if Farmer focused only on research or effecting political change.
Themes
