Dr. Paul Farmer and deye mon gen mon

The Haitian saying, deye mon gen mon, translated, “beyond mountains there are mountains,” is a perfect title for Tracy Kidder’s biography of anthropologist and Harvard Medical School alumnus, Dr. Paul Farmer. Kidder explains in Mountains Beyond Mountains, the Haitian proverb refers to a cycle where, “once you solve one problem, another problem appears, and so you go on and try to solve that problem too.” Farmer’s philosophy is that no problem is too big to tackle even when the problems are political and social mountains. Farmer encourages others to be altruistic and help eliminate health disparities and disease, acknowledging that his model is merely an example of what needs to get accomplished, not how to achieve it. Jim Kim, a friend of Farmer’s said, “If the poor have to wait for a lot of people like Paul to come along before they get good health care, they are totally f*cked” (244). Personally, I am both inspired by Farmer’s devotion to a philanthropic cause and disappointed to realize the limits of my own altruism. However, there are advantages and disadvantages to Farmer’s altruism. His patients benefit from his altruism yet he lacks balance with his personal life. Despite my personal limitations, I will sacrifice time, comfort, and family to help accomplish Farmer’s vision of world health and equity as a physician.

The Medical Professionalism Project outlines three main principles, the first of which is the principle of primacy of patient welfare. This principle, when the physician is not financial compensated is called altruism, yet in American health care is compensated and therefore it is a business. Altruism is a key aspect of building a patient-physician relationship, accomplished by developing trust through dedication to serving in the best interest of the patient. Altruism is what Dr. Paul Farmer does best. I believe there are many benefits to Farmer’s altruism. Primarily, his altruism benefits patients, which is everyone in the world who is in need of health care. Kidder reflects on Farmer’s method, “First, you perform what he calls “the distal intervention” and cure the family of [tuberculosis]. Then you start changing the conditions [including political situation] that made them especially vulnerable to TB in the first place” (293). Farmer re-emphasizes the idea that deye mon gen mon, despite a problem’s insurmountable appearance, it is important to attempt the ascent. Farmer redefines the notions of efficiency and cost-effectiveness, which in turn benefit his patients. His willingness to do “unglamorous scut work” is his secret to successful projects in poor places, like Haiti.
Secondly, Farmer benefits from his altruism. When Farmer hikes seven hours to make two house visits, he is helping himself and his patients. Critics refer to his house visits as inefficient; yet, Farmer insists the world’s problems are due to the false belief that some peoples’ lives matter more than others’ lives. He sees his patients in unsanitary conditions and suffering needlessly and it re-energizes his passions and gives him more power and authority to return to the United States and write about the health of populations. Critics view his altruism as egoistic because his work is selfish and accomplishes his personal goals, giving him power and authority. However, whether altruistic or egoistic, Farmer’s work follows a simple principle: everyone who is sick deserves help and he is a doctor.

His altruism has repercussions as well. Farmer is devoted to the principle of primacy of patient welfare that is admirable and self-sacrificing; however, difficult to duplicate. It would be difficult to be Didi and Catherine, Farmer’s wife and daughter, whom he has little time to see them. Kidder asked Farmer, “Where do you get off thinking you’re different from everyone and can love the children of others as much as your own?” He replied, “Love thy neighbor as thyself… I’m sorry, I can’t, but I’m gonna keep on trying, comma” (213). He rarely spends time with his family but it is sufficient to suit his needs. Does the balance, or lack thereof, reflect his altruism or egoism? People require a lifestyle balance with personal life. Farmer challenges the individualistic perspective that strives in large middle class, capitalistic, and democratic nation in favor of altruism.
Farmer believes that equity is the only acceptable goal. He transmits his anger from the systemic injustice into “something more productive, a dream of ending health disparities” (261). Dr. Ezekowitz said, “I think free care serves and important purpose, in that it centers people. Poverty … in front of you, it has a reality” (279). Farmer does not allow market forces, societal exigencies, or administrative constraints deter him from his dreams. He admires Cuba’s health care system: first-rate public health that is equitably distributed in spite of limited resources. However, Cubans pay the price in political freedom. Farmer argues it is a small price most people in the world would pay for freedom from illness and premature death. His philosophy is altruistic in theory but has repercussions socially and politically.
He has challenged and redefined limitations and notions of cost-effectiveness and efficiency in his projects in Haiti, Peru, and Russia. He delivers high quality medical treatment to his patients, regardless of whether or not they can afford the treatment. The repercussions of Farmer’s altruism involve redefining economic, political, and social systems, including admitting financial costs to developed nations. These repercussions are minimal to the tremendous benefits for his patients, the community, world health, and himself.

I agree with Farmer’s philosophy that no problem is too big to tackle. However, he has made me admire and resent his radical humanitarianism because I painfully acknowledge the limits of my own altruism. I believe that there are societal pressures that bestow females more family obligations making it more difficult for females, such as myself, to live Farmer’s altruistic lifestyle. I was struck by his devotion to the poor. Jim Kim said, “Paul has a gift for making people feel guilty.” I agree because Farmer makes other people feel inadequate, even though it is not his intent. Kidder explained: “Farmer counseled others to take vacations while taking none himself. He didn’t disapprove of others having luxuries, so long as they gave something to the causes of the poor. He demanded a great deal from protégés and colleagues, and he always forgave them when they didn’t measure up” (213). Farmer’s intentions are always to end health disparities. He acknowledges that there is a high cost to the wealthy in order to fix the world’s problems, including individuals sacrificing time, comfort, and family, as well as feeling remorse and pity (“qualities that sets us aside from roaches,” Farmer said). As Kidder writes, it is easy to take a passive role in world health, an epidemic called “collective amnesia.” Farmer helps people remember these issues, and acknowledges donations to Partners in Health with hand-written thank-you notes. I am impressed and motivated by Farmer’s altruism.

I value my family and my personal wellness, happiness, and health. Farmer’s altruism is my aim in life but I admit that helping others satisfies my self-interest. I achieve personal happiness and wellness, strengthen relationships, and lower my stress level when I help others. Overall, I believe in an altruistic philosophy. Farmer said, “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. Lunacy is what it is” (258). It is unfair to punish poor people for their lack of knowledge and unfair political situation that uses brutality, torture, and massacre and uses economic justification to perpetuate poverty. I will hike deye mon gen mon, tackling problems through volunteerism, locally and internationally, and financial support. Farmer is a motivating individual and I admire his altruism and dedication to world health.