Intensive Treatment

Paul E. Farmer is no stranger to the spotlight, but seeing his life set out in 336 frank pages was more than he had bargained for.

The world-renowned Harvard Medical School infectious disease specialist had spent parts of three years with Pulitzer Prize-winning author Tracy Kidder ’67 by his side. Now, with Kidder’s book on the verge of release, he wasn’t sure he liked what he saw.

“When I read the manuscript and told him I felt a bit over-exposed, [Kidder] expressed a bit of genuine sympathy with my predicament but did not offer to change anything,” Farmer writes in an e-mail.

Farmer’s intense, personal and sometimes combative relationship with Kidder had begun nearly a decade earlier with a chance meeting in Haiti, where Farmer operates a free medical clinic he founded in the mid-eighties. Kidder was researching an article on American military presence in the troubled island nation.

By 1999, Kidder was conducting interviews for a New Yorker profile of the outspoken doctor—and soon was shadowing Farmer on his daily routine of healing and advocating for the world’s destitute.

Kidder has just published the results in Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World—an account as challenging as it is edifying. His latest non-fiction book is really two works in one: alongside the litany of Farmer’s achievements, recited with his usual eye for detail, Kidder unflinchingly explores the moral and emotional complexity surrounding the book’s creation.

His previous books—including House and The Soul of a New Machine—have won him the highest accolades, including a Pulitzer Prize for Soul. But from the project’s inception, Kidder says, he realized that Mountains Beyond Mountains would differ from his acclaimed portraits of urban schoolteachers, small-town police officers and house-builders.

“I don’t mean to diss any of the subjects I’ve put my little efforts into, but this is clearly the most important subject I’ve ever written about,” Kidder says.

Farmer is an impossibly busy man: an influential medical fundraiser, a sharp critic of U.S. policy towards the developing world and a practicing physician with his feet in what seems like a thousand clinics at once. He splits his time between regular rounds at Boston’s Brigham and Women’s Hospital and the free medical complex he founded in Cange, a rural settlement in the most impoverished part of Haiti.

In between, he teaches courses at the Medical School, where he is a professor of medical anthropology, and stops by to supervise healthcare programs run in seven countries by Partners in Health (PIH), the non-profit medical organization he co-founded in 1987.

For months, Kidder compiled interviews on Farmer’s life and work, filling page after page with what he calls “compulsive” notes on the process. Kidder accompanied Farmer on innumerable red-eye flights and hiked to house-calls in the Haitian countryside, staining his notes with sweat. “Frankly, I’ve lost count of the times I went to Haiti,” Kidder says. In January of 2000, Farmer recalls, the author spent the full month with him, “pretty much 24/7.”

As a result, Mountains Beyond Mountains is much more than a reserved journalistic account of Farmer’s career in medicine and public policy. When Kidder writes of Farmer’s ceaseless push for a “preferential option for the poor,” for equity in health care and for the eradication of HIV/AIDS and drug-resistant tuberculosis, he also tells of his own thoughts on Farmer—both personally and professionally. While all but one of Kidder’s previous books have been written in the third person, Mountains Beyond Mountains has lengthy first-person narrative portions, and Kidder is a vocal character throughout.

“I very quickly realized that I’d have to tell a bit of the story of my relationship with Paul,” Kidder says.

He explains that he did this in part to ground the stranger-than-fiction events chronicled in the book.

“There’s a pervasive cynicism out there that I knew I’d be fighting against,” Kidder says. “I knew you needed a first-person narrator to tell you this is true…it’s this idea of having an everyman who’s much less virtuous than Farmer to bear witness to the fact that this guy’s real…It’s not enough to just say, oh, well it happened and therefore I can just set it down.”

But the first-person aspect of Mountains Beyond Mountains is more than an insurance policy on the book’s credibility. The work also contains passages exploring the enthusiasm and ambivalence Kidder felt as he watched and heard Farmer outlining the world’s inequities in the starkest and most accusatory of terms.

“The point about someone like Paul and his group is not to feel envious or to feel diminished by them,” Kidder says. “But it’s inevitable, we’re human, you will feel that way.”

By honestly reporting his own reactions in the book, Kidder says he aimed “to acknowledge the kind of discomfort that one’s bound to feel from time to time in the company of a guy like that”—to make his book truer and fuller than “a campaign biography.”

“I just had to acknowledge that it would at times wear on the reader,” he says. “It has the advantage of being true, and it would clear away those shallow discomforts.”

He also describes instances where he challenged Farmer’s inflexible idealism and doubted the man that many say is perfect. (Kidder dutifully records just how Farmer won almost all of their intellectual debates.) The pair, as Kidder tells it, are in nearly constant dialogue—and, towards the end of the book, something like conflict.

Writing a book on someone is “an odd basis for a relationship, for friendship,” Kidder says. “I’m not sure I’d let anyone do this to me.”

Farmer, too, has had his share of discomfort in connection with Kidder’s book—some of which showed through at a recent event the two held together at Longfellow Hall, sponsored by Harvard Book Store.

In between Kidder’s readings of excerpts from Mountains Beyond Mountains, Farmer—always smiling—tossed barbs the author’s way, repeatedly mocking Kidder’s educational pedigree of Andover and Harvard. Farmer also wryly announced plans to retaliate by publishing his own multi-volume version of the months he and Kidder spent together, including such installments as Cry, the Beloved Tracy. Playing on the titles of Kidder’s most laurelled works, he joked that he would publish more books about Haiti: Hut for Kidder’s House and Slum for his Hometown.

Still, the conflict has never crossed into outright hostility; Farmer echoes Kidder in calling their relationship throughout the research and writing process as close. “He’d be the first to admit, I suspect, that I’m a friendly person and you don’t hang around with someone for years and not become friends,” Farmer says. “Particularly if you’re talking a lot and living through dramatic experiences together.”

But none of this, Farmer says, could change the fundamental oddness of having a prominent author scrutinize his life while he was still living it.

“I pretty much interact with people, all people, in a limited number of ways,” he says. “People are either my patients, my co-workers, my students, or my family—or some combination of the above. Tracy was different mostly, I think, because he wanted to be different.”

But Farmer says he knew little of the internal dissension Kidder felt until after the research was over—and indeed, he says that several of the arguments and verbal fights Kidder narrates had gone unrecognized by him at the time.

“I wasn’t really aware that I got on Kidder’s nerves sometimes until I read his book,” Farmer says. “I knew that I was running him ragged, and that our travel styles didn’t match at all, but I learned more about what he was thinking when I read his book, which was pretty recently.”

Seeing Mountains Beyond Mountains for the first time—after the book was complete save for the fact-checking process—was a wrenching experience, Farmer says.

“The first time around wasn’t all that pleasant,” Farmer writes in an e-mail. “I mean, I laughed, I cried, and all that. But it’s very strange to be the topic of a book (I’m not even dead yet! I’m 43 years old!). And although the facts seemed right, and he caught wonderful things that I’d forgotten in the mad swirl of everyday work, I didn’t savor the book on round one. It scared me.”

Farmer says he remains uncomfortable with the book’s fairly extensive treatment of his personal life and history—chapters which, while uncovering no lurid scandals, hit close to home with accounts of his romantic life.

“I’m not happy having this kind of spotlight turned on me,” he says. “Would you be?”

“It’s not easy to be written about,” Kidder says. “I can only imagine what it’s like to open up a book and it’s you.”

Nevertheless, Farmer says that a second reading convinced himself that Kidder had written “a beautiful story about Haiti.”

“I think Tracy Kidder is one of the best writers out there,” he says. “I love the way he writes, his spare prose, his humor, his humility, his ability to refer back to previous events or expressions…I can’t say that I’ve ever read a better book about those topics, or seen a better written book.”

Much of Farmer’s discomfort is not so much with Kidder or the book as with his own fame—what he describes as the unintended side effects of his relentless efforts to promote Partners in Health’s agenda of a preferential option for the poor. Paul Farmer may not be a household name, but as infectious-disease doctors go, he is a veritable celebrity.

Farmer says he cannot embrace this role wholeheartedly; he would like to heal the world’s poor without becoming a celebrity.

“I don’t want to have a ton of e-mail or letters I can’t answer,” he says. “I’m pretty overwhelmed keeping up with patients and students as it is.”

Farmer is known for comprehensively responding to the flood of electronic messages that fill his inbox—often within hours, whether he is in Boston, Haiti or Siberia.

And beyond the pragmatic complications of fame, Farmer has philosophical objections about becoming the star of the show.

“The real reason not to do it is because the story is not about me or my co-workers, although it makes for interesting reading,” he says. “The real story is the scandal of poverty in the world today: people who in this affluent era have no food, no water and no medical care.”

Kidder says Farmer was reluctant when he first proposed writing the book.

“They sort of talked him into it,” he says of Farmer’s colleagues and friends.

Farmer says he is especially unhappy with the tendency of observers to build a cult of personality around him, calling him perfect or more than human.

“Should you have to be a saint or without foibles and flaws in order to fight for social justice?” he asks. “I hope not, because I’m certainly not worthy of the people we seek to serve. But just because we’re not good enough, not worthy, doesn’t mean we shouldn’t be allowed to do this work and to exhort others to do it, too.”

But Farmer realizes that the upshot of fame is more widespread awareness of the problems Partners in Health tackles—and, ultimately, more funding for the organization, whose coffers are perennially and intentionally low, as it spends 95 percent of its charity income on its projects. And so, he says, he overcame his distaste for celebrity and cooperated with Kidder.

“Hope springs eternal that the real story—about Haiti, about the causes of poverty, about all we can do to make things better—can and must get out there,” he says. “Most of what is written about why people die of AIDS or TB in Africa is a load of crap.”

Farmer says he is confident at last that Kidder managed to see beyond the single-hero mode and tell that fuller story. For his part, Kidder says he is moving on soon to a memoir of his year of service in Vietnam—but he says it would be impossible for him to close the door on Farmer and PIH when he concludes his current book tour.

“I don’t think I’d sleep well at night if I abandoned this,” he says. “I intend to know Paul Farmer for the rest of my life.”

Kidder says he has taken to spreading Farmer’s gospel outside of any promotion for his book, “clearing whole rooms at parties boring people telling them about Haiti.” And acknowledging that his continued presence in Cange would be “worse than useless,” Kidder says he wants to convince as many people as he can to join him in donating money to PIH.

“All you have to do is give a little of your superflux, and Paul Farmer and Co. will take care of the rest,” he says.

This is, of course, no more a conventional author’s role than Mountains Beyond Mountains is a conventional book.

“It isn’t the place of a journalist to raise money for something he’s written about,” he says. “But then I think, why shouldn’t I raise money? I know I have some colleagues who would think I’m on dangerous ground saying that, but so what? That’s the way I feel.”

—Staff writer Simon W. Vozick-Levinson can be reached at vozick@fas.harvard.edu.