For an assignment in one of my classes, I had to choose a book-length piece of journalism and share practical lessons that students could take away from the author’s storytelling. Here’s what I wrote.
Mountains Beyond Mountains
In Mountains Beyond Mountains, Tracy Kidder chronicles the life and medical quest of Dr. Paul Farmer and his associates at Partners in Health to provide optimal healthcare for the world’s poorest citizens. He takes his audience on a journey from the classrooms of Harvard Medical School to the homes, prisons and medical facilities of people infected with tuberculosis and HIV/AIDS in Haiti, Peru, Cuba and Russia.
From the very beginning we learn that Farmer “narrates” Haiti for those he comes in contact with. He explains the culture through the lives of the people there brings context to the circumstances, beliefs and actions of those who now – or once – called the island nation home. Kidder does the same for his audience in three ways that stand out to me: he uses of all of his senses to paint moving portraits of people, places and circumstances; he organizes Farmer’s story in such a way that keeps the reader engaged; and he weaves a web of complex characters that, in the end, “narrates” Paul Farmer.
1. Kidder uses all of his senses to transport his audience into a time and space that many will never experience.
Vivid descriptions bring the book’s characters to life and help navigate the many changes of location occur. As expected, he gives rich visual descriptions of the various settings into which he follows Farmer and his crew. Kidder not only tells the audience about what is there – he also points out what isn’t there. In Cange, Haiti, he paints a picture of a landscape with no trees, a makeshift village with no power lines, an oxcart with no ox. He describes men who ride on starved donkeys and beggars rubbing “concave bellies”. From the beginning, he sets the scene in Haiti in the reader’s mind, signaling this as the main artery from which the rest of Farmer’s crusade stems.
In addition to visual imagery, he uses other senses to engage the reader. In a prison in Moscow, we hear the symphony of coughs from men infected with TB – bass, baritone and tenor. We feel the increased humidity that comes from “many pairs of lungs exhaling” in a small space. We smell what Farmer refers to in Haiti as “the fifth food group” – food presented to them by the poor Haitians they visited – that were “meat filled pastries that smelled like sweat”. By engaging the reader’s senses to experience what he experienced, Kidder draws his audience into the midst of the action and demonstrate the misery that exists in the midst of these circumstances and places.
Kidder also uses robust descriptions of scenes to give context to the history and culture of the places he visits with Farmer. In this sense, he allows the reader the chance to “look around” the place before bringing them face to face with the task of understanding the complex realities they’re about to face. In Cuba, for instance, he contrasts the housing projects and old haciendas with the slums and huts of Haiti. Then, he reminds the reader of the care Cubans receive (medical and otherwise) under communism and shows Farmer’s appreciation of Cuba’s example of a poor country’s ability to provide equitable and adequate medical care for all of its citizens.
2. He organizes the story in a way that tells the reader where they’re headed and keeps them engaged for the long haul.
Kidder divides the narrative into five distinct parts and tells stories within stories to explain how one chapter of Farmer’s life provides the foundation for the next. He starts with the introduction of “Dokté Paul”, then takes us to “The Tin Roofs of Cange” and the clinic there that is the main artery that feeds the drive for all other projects around the world. In “Médicos Aventureros,” he moves on to the fight to treat poor Peruvians with multi-drug resistant TB, followed by “A Light Month for Travel” where we see Farmer take on governments, academics and non-profits in defense of the poor. In “O for the P” (Options for the Poor) he gives a glimpse of where Partners in Health is and where they’re headed as they work with other organizations.
He frequently gives a bird’s-eye view of an issue, shows how Farmer and his crew worked to solve it, then links the solution to other outcomes. In doing this, he gives context to the complexities of particular issues. For instance, he paints a picture of the misery of poverty in Cange, Haiti, then tells how the people there were forced to flee their farmland when their valley was flooded. He links the children who were constantly battling diarrheal disease and dying because they drank bacteria-infested water to their new location, where they drink stagnant (and dirty) water to avoid the steep eight-hundred foot hike down a hillside to get fresh water. He builds a case, showing cause and effect. Then, Kidder shares that a group of Haitian and American engineers hooked spigots to an underground river that provides clean drinking water for the community. As a result, infant deaths decline.
At times, Kidder also chooses to narrate one of Farmer’s many confrontations to expose the first-world myths behind the arguments surrounding an issue. For instance, during a conference in Cuba where officials and scholars met to discuss the treatment and eradication of TB and AIDS, Farmer debates those who exaggerate the power of poor women to protect themselves from the diseases. He explains that women working in the larger cities in Haiti cohabitate with truck drivers and soldiers because they have steady jobs in a country with rampant unemployment. The men are on the road a lot, though, and are likely to have a woman in many different ports. As Farmer narrates Haiti and Kidder narrates Farmer, we understand that the rise of infections in women is linked to poverty as well.
3. Kidder uses supporting characters – including himself – to build a multi-dimensional portrait of Paul Farmer and his cause.
From page one, Kidder weaves together Farmer’s many personal and professional relationships and uses them to give context to his character. He draws on old college friends, coworkers, benefactors, adversaries, his ex-lover and simple admirers of his work to help the reader understand his complexities. The critics are heard as well, who Kidder says seem happy to point out what they consider a chink in Farmer’s armor –that his obsession with his quest separates him from his wife and daughter.
Kidder also gives close-up shots of Farmer’s character through the perspectives of those who know him best – his co-workers, Ophelia Dahl and Jim Kim. Dahl confirms that Farmer is in fact insecure about his efforts and seeks approval from those closest to him regarding his work with the poor. While discussing one of Farmer’s rare rants at Kim’s expense, Dahl says that she feels it’s healthy for Farmer to have this place to vent his frustrations – where it cannot jeopardize Partners in Health or care for the poor. In the end, the two men walk out of the restaurant where the conversation took place with their arms around each other.
Our understanding of Farmer deepens through Kidder’s observation and recounting of his quirks. He paints Farmer as an upbeat, caring, passionate individual, but he also hones in on the minute details of his mannerisms – how he looks away, “as if disconnecting to reconnect fully” when addressing his patients, for example. In another instance, we almost feel the steely glare Farmer gives Kidder when he asks how his feelings about Cuba will be portrayed in the book.
The accumulation of smaller details makes the interactions personal, as though we are experiencing them firsthand. For instance, we understand his sense of using any and all resources available to help the poor when he steals a microscope from Harvard to take to Haiti and calls it “redistributive justice” that helps them not go to hell. As Kidder illustrates the hectic schedule that Farmer keeps and multi-directional manner in which his brain functions, we understand why his staff decompresses by crying after “hurricane Farmer” comes through, creates chaos, and then leaves.
In the end, though, it’s all about the reporting.
The main reason why this book is so good lies with the extensive reporting that Kidder has done to be able to present Farmer’s story with this much depth. As his storytelling draws to a close, it’s not an exaggeration to say that the reader had touched on the lives of at least 100 people. Kidder describes multiple flights to foreign countries he’s taken with Farmer or Kim, countless communications via email or telephone, and near-heart attack inducing treks across Haiti’s arid terrain.
This is what is needed to effectively tell stories within stories. The writer has to be there to describe what is seen, smelled, heard or felt. They have to understand the complexities that are prevalent in human relationships. They have to observe, ask questions, and then ask more. On top of this, it takes time to infiltrate the lives of others to the point that you get at the essence of who they are and what drives them. It’s evident that Kidder paid the price.