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Chapter 1
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 Boston, Kidder explains, the medical neighborhoods are eerily quiet. There’s Harvard Medical School, Dana-Farber Cancer Institute, the Children’s Hospital, and other legendary medical institutions. One such institution is the Brigham, a hospital where Farmer sometimes works.
The beginning of Chapter Two contrasts markedly with the beginning of Chapter One. In Boston, there are no beheadings or military juntas. Farmer’s life in America is one of relative ease and success compared to the conditions he and his patients face in Haiti.
Themes
The year is 1999. Farmer works in Brigham, and specializes in Infectious Diseases, or I.D. He’s a “big-shot” Boston doctor now, a professor of anthropology and medicine at Harvard Medical School. Today, Farmer has dealt with six cases, including the case of an HIV-positive man named Joe. The doctors suspect that Joe has contracted tuberculosis. Farmer examines X-rays of Joe’s lungs, and notices a spot that previous doctors have assumed is tuberculosis.
Farmer balances his work in Haiti with consultations in Boston. Although Farmer is a “big-shot,” and presumably could teach and lecture for the rest of his career, he chooses to instead work one-on-one with his patients—demonstrating his commitment to humanitarian work.
Themes
Farmer goes to talk to Joe, who’s very amiable, despite his condition. Farmer tells Joe that his X-rays indicate a case of pneumonia, and tells him he needs to gain some weight if he’s going to survive much longer. Kidder (who seems to be standing in the room with Joe and Farmer) notes that Farmer spends an unusually large amount of time with his patients—most “big shots” make some small talk and then leave as soon as possible. Joe tells Farmer he needs a warm place to stay—a place where, preferably, he could drink beer and get healthier by gaining some weight.
Farmer is a rarity: a famous, successful doctor who not only continues to meet with his patients, but also talks with them and clearly enjoys spending time with them. Farmer is thinking holistically about Joe’s healthcare—instead of simply prescribing a treatment, he gives Joe long-term advice about how to take care of himself. The long conversations he has with his patients help him to prescribe the most effective treatments.
Themes
A few days later, a note circulates around Brigham. The note tells the staff to get rid of Joe’s “cold, drugs, and vodka” and replace these things with “warmth, our drugs, and a 6 pack of Bud.” Everybody can tell immediately that Farmer wrote this note. Farmer has found a homeless shelter for Joe. Although the shelter forbids drinking, Farmer has snuck Joe a six-pack of beer, just as Joe had asked for. As Farmer walks out of the shelter, Joe says, “That guy’s a fuckin’ saint.” Farmer tells Kidder that he’d love to be a saint, but that he’ll have to work much harder to achieve such a goal.
Farmer’s decision to smuggle beer into Joe’s shelter is symbolic of his radical outlook on medicine and healthcare: he’s not an establishment figure, either in Boston or in Haiti. Farmer plays by his own rules, always looking out for the interests of his patients first and foremost. The idea of “saintliness” will show up again and again in this book. Farmer himself doesn’t even seem very interested in the concept, however—he is just working hard at what he thinks is right, and isn’t concerned with titles like “saint.”
Themes
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In early 2000, Farmer leaves Brigham and travels back to Haiti. He emails Kidder, telling him to come back to Haiti to see his work first-hand.
By now, the dynamic of the book is clear: Kidder is the observer and narrator, and Farmer is the protagonist—the hero whose life Kidder must try to understand.
Themes
