Mountains Beyond Mountains Final Reflections by Wyn Sullivan

Something I struggled with a lot this summer was the enormous magnitude and amount of problem that exist in our world. Not only in global health, but relating to poverty and inequality as well. I had finished Mountains Beyond Mountains at the very beginning of summer before I left for South Africa. Today I picked it back up for the first time since to glance through the pages and review what I had highlighted. I was amazed at how much I could relate the problems in Haiti to those I had seen in South Africa. It reminded me that issues with global health are truly universal; as Jenna mentioned in her post we sometimes forget that similar problems exist even in the United States. I feel that a lot of people choose to ignore these problems because its easier not to recognize and deny them rather than confront.

As I said, I was overwhelmed with the problems I saw in South Africa. Their government is a corrupt mess, the school system a joke, and the healthcare disfunctional. For example, we took two HIV positive children to the clinic to get their blood drawn. Despite appointments, we waited outside in the windy rain for 3 hours. When the nurse practitioner (one doctor comes once a week on Thursdays) took the childrens' blood, not only was she gloveless, but she also simply wiped up spurted blood with a kleenex off the ground. And this is in the most "developed" country in Africa. How do you fix problems like these in countries that we are so unfamiliar with? Especially in areas where cultural myths tell HIV positive men that if they rape a virgin they will no longer be positive? Or where people won't be tested for HIV because of the social stigma?

But there's hope. Lou Nanni told me once to focus on people rather than the big issues. Paul Farmer is a great example of this being done. He did not go into Haiti wanting establish an entire hospital, but started going from person to person. By looking at individuals, listening, and aiding with their problems, progress can be made. I think that we can all agree Paul Farmer is wonderful and has done great work in Haiti. There are obviously still a lot of areas in the world with inadequate healthcare. We need more Paul Farmers. Organizations such as Globemed give me hope that more Paul Farmers are on their way. As Globemed focuses on grassroots work, the different partnerships really listen and work with the individuals solving problems on a situational basis. I believe that this approach will work, and the example that people such as Paul Farmer set keeps me from getting caught up in the pessimism that will otherwise take over when looking at some of these global issues.

Mountains Beyond Mountains Chs 25-Afterword Reflection by Rachel Chisausky

As I reread these chapters, I was struck by the theme of finding spots of joy in even the darkest situations. Serena sums it up pretty well when she says “you gotta rejoice a little along the way,” even while they were trying to fix the broken down ambulance. Farmer too finds joy in the little things—his fish pond, the walk and visit with Alcante— in the midst of working in an unjustly deprived and dismal environment. He says that he learned to stop getting angry when he transitioned from the US—a world where a major problem is having excess—to poor and needy Haiti; he learned to change the anger into a sense of hope for a dream of equality. I think this is a good lesson for all of us. When we get angry or despairing about the place we are in, be it stressful classes or the MCAT, or a broader sense of anger about the injustices and waste in our world, we too need to find the little things that bring us joy. Though by comparison to those living in Haiti, we have life pretty good, there are still things that can get us down. The best thing we can do is focus on the things that lift us up, and channel that energy  into fixing whatever it is that makes us upset or angry. I was also struck by Farmer’s comments regarding the cost of the Medevac flight; when talking about other ways the $20,000 could have been spent, he points out that even a young doctor often makes about 5 times what the flight cost was—why not talk about other ways that money could be spent? Farmer has a very acute awareness of the disparity in the world, and it seems that he looks at everything through that lens. That raises several questions for us, now and in our futures. When living in a place like Notre Dame, where poverty is not a sight that many of us see every day, I hope that we keep the stories from Mountains Beyond Mountains in the back of our minds; when we appreciate the nice things around us, I hope that we also recognize what that money could have done. (For instance, I hope that the sight of a sprinkler system calls to mind those can’t even afford clean drinking water.) I hope that we carry this awareness into our futures too; With several of us probably planning on going into the medical field, and all of us coming out of a good school, there’s a good chance some of us will be making a substantial salary. If we find ourselves in that position, I hope that we all remember those struggling simply to survive, and find a balance with our lives. Although it is important to live a life that will make you happy, I hope that we all work in our own ways to promote the cause of global health, and the greater cause of social justice—be it like Farmer working in the field, Tom White financing, or Kidder raising awareness of the disparity and potential for change in the world. I think Kidder’s final quote, the comparison of the sound of drums to the sound of ‘so many heart beating through a single stethoscope,’ accurately sums up the philosophy that ‘the only real nation is humanity,’ and I hope we carry that philosophy with us forever.  

Mountains Beyond Mountains Chs 21-24 Reflection by Mike Diaz

The first time I read Mountains Beyond Mountains there was one particular line in the book that made a serious impact on me and is a major reason I wanted to write this reflection. It came when Paul Farmer was describing why he respected Dr. Pérez of Cuba as much as he does. Dr. Farmer says, “He believes in social justice medicine” (207). The reason this struck me is because I believe this description fits Farmer as well as it does Dr. Pérez. In one sentence, this is the essence of Farmer and I believe that if more people could be defined this way there would be far less health inequality in the world. I think this is a profound complement to Dr. Pérez and I certainly hope to be summarized this way some day.

These four chapters to me are some of the most important of the book because they truly show the sacrifices Farmer makes to pursue his “preferential option for the poor” while at the same time highlighting how he does it his own way. I think one of the most important lines to take away from the book comes from Jim Kim when he says, “Paul is a model of what should be done. He’s not a model for how it has to be done” (244). We cannot all be Paul Farmer, however, we can hold similar values and priorities and work in our own way to fight for them.

These chapters describe the intense travel that Farmer has to undergo to juggle the various project’s PIH has taken on and it is difficult not to be overwhelmed just imagining having to take trips like this. The thing that makes Farmer so special, in my opinion, is that his heart is always in Haiti and he is longing to return there. This is the engine that keeps his wheels turning and this seems like one of the key messages of the book. Find a cause you believe in, but more importantly find something you love to push you through the most difficult times. For Farmer this is Haiti and his clinical work, and, as he says to Kidder on page 237, he would be nothing without this. This part of the book highlights how large PIH has become and how that has forced it to evolve, but at its core it is still the organization the Farmer and Ophelia Dahl started so many years back.

Finding something as motivating as Farmer’s work in Haiti may be an impossible goal, but I believe that search is the most important part of being young. This is the best time for us to search out and try to discover what can empower us to accomplish feats as amazing as what Paul Farmer has achieved. This book to me shows just how much is possible when someone truly loves their work and believes in the good one person can create.

Mountains Beyond Mountains Chs 17-20 Reflection by Morgan Benson

Purpose. Young people especially have been attracted to Mountains Beyond Mountains because of the genuine and intense sense of purpose Paul Farmer displays for his work.

Our generation is more socially, environmentally, and politically conscious than ever. We want to know where our food comes from. We want to use recycled products. We find artists that produce independent music. It’s a little simplistic, but I believe all of these little choices are rooted in our desire for authenticity in our lives in a largely profit-driven culture. Many in our generation instead show a motivation to dedicate their lives to work that is purpose-driven.

Paul Farmer and his colleagues have built an organization with a uniquely purpose-driven character. In this section of the book, we see some of the sacrifices Paul Farmer has made for his work. We see him living a hectic life of constant travel and work to build up their MDR-TB program in Peru. We see him in the hospital because of his refusal to address his own health symptoms before they became too severe. We see him struggling with living a life of continually seeing sickness and death. Referring to the health conditions in Haiti, he once says, “Sometimes I get so f*ing sick of it, babies dying….” But amidst all of these trials, we learn more about his spirit.

Ophelia Dahl tells us how Paul has never been depressed. I think the man just has too much faith in what his work can accomplish. He sees what PIH can do amidst all of the challenges and becoming depressed just doesn’t make sense in some way to him.

We also learn more about Jim Kim and his path to PIH. After taking on a few different causes and becoming somewhat disillusioned, he meets Paul Farmer and finds a real passion for health and social justice, eventually co-founding PIH. Among others, his skills in making drugs affordable to treat the poor become extremely valuable. He has since become the President of the World Bank, and judging by this portrait and Farmer’s belief that “you won’t betray the poor” working in policy, he will continue to use his skills well there.

Just like Jim Kim long ago, many people have been inspired by the PIH’s mission of social justice and a preferential option for the poor. This section of the book takes us further into how Farmer and Kim use their sense of purpose to work incredibly hard with their individual skills to expand PIH’s care. GlobeMed was similarly founded with the goal to work for the health of the poor around the world, and I am proud to see this passion and sense of purpose in my fellow GlobeMed’ers at Notre Dame.

By learning from these two men and the founding of Partners in Health, we further our own understanding of global health and social justice and prepare better for our next year of GlobeMed. Does anyone agree? How does a sense of purpose relate to your desire to become involved in GlobeMed? Do you see this in yourself or our generation?

Mountains Beyond Mountains Chs 13-16 Reflection by Jenna Gill-Wiehl

Throughout the first half of my internship with Partners In Health, I have had the amazing opportunity to speak with and learn from some amazing people. Re-reading chapters 13-16 reminded me of some of the wisdom they imparted, and I wanted to share it with you all here.

The first lesson is that those interested in “global” health can sometimes forget that the United States is part of that global community, and that there are very real and difficult problems regarding access to care within our own nation. For instance, the book points out that “in Boston’s Mission Hill neighborhood, right next to the Brigham [and incidentally close to where I am living this summer], for instance, infant mortality is higher than in Cuba.” Boston’s PACT program works with clinics in Boston and the US to strengthen a model of accompaniment and care provision for the sick and vulnerable.

We must not forget about the poor and the sick in our own community, even if poverty is often “relative” in the United States. People occasionally look at communities with absolute poverty around the world and comment that those people are much worse off than people who are relatively poor in the US. The Executive Director of the Equal Justice Initiative and PIH Board Member, Brian Stevenson,  challenged the PIH interns to think of how hard it must be to be poor in the wealthiest nation in the world. Absolute poverty is of course devastating and an enormous issue. But too often, I believe, people (myself included) often look past the suffering in our own communities.

At a meeting today with PIH’s Boston based program, the Prevention and Access to Care and Treatment (PACT) program, we discussed some barriers to care within Boston, a city where nearly everyone has health insurance and that is home to some of the best medical facilities in the world (Massachusetts General Hospital, the Brigham and Women’s Hospital, etc.). Some of these barriers to care include poverty, homelessness, racism, abuse, language and literacy. The PACT program uses Community Health Workers to empower their patients and accompany them to care. As GlobeMedders, we must remember that our global health community includes the United States and as Paul Farmer would say, "the only real nation is humanity." When we say health is a human right we mean that health is a human right for everyone, everywhere, and we must take the necessary steps to make this belief a reality by learning about the different issues and advocating for the poor, the sick and the vulnerable both in the US and abroad. 

Mountains Beyond Mountains Chs 9-12 Reflection by Julia McSorley

By this point in the book, I think it’s safe to say that we have all seen how amazing of a human being Paul Farmer is.  As I am continuously astonished with the turn of each page, I can’t help but wonder how he is able to continually give all that he is over to others. The extent to which he dedicates himself is truly inspiring. There is one phrase that keeps coming to mind as I reflect on this. To quote the New Radicals, “You only get what you give.”  Paul Farmer is an extreme example of what it means to fully give your self over to others. With his credentials he could have easily been living a life that many dream of, in a mansion on the beach with a Ferrari parked in the driveway. But instead of choosing these luxuries, Farmer continues to work in harsh, frustrating, and dangerous conditions as he strives to aid the Haitians. He doesn’t do it for fame or fortune; rather he does it because it is the right thing to do.

This internal drive is necessary to have in order to make a difference in a world with so much suffering and injustice, and I believe this drive can be rooted in one’s faith. Farmer’s experiences with global health had confirmed his beliefs. Even after being exposed to the horrors of disease across the world, Farmer claims, “ there was still a place to look for God, and that was in the suffering of the poor.” Although there are many different kinds, having faith is something that people of all backgrounds and all levels in life can share, which in my mind is truly amazing. This commonality reminds us that although we are all different and although we all come from different places, we are all here together in this world and it is our duty to help others.

This seems to be a cliché moral that we have been told since we were children. It is even shown in the University of Notre Dame’s mission statement as it states the goal, “To create a sense of human solidarity and concern for the common good that will bear fruit as learning becomes service to justice.” Its prominence is because of its importance. If we on this planet cannot look out for our fellow man, than what is the point? At the risk of getting to cheesy on you all I will say, you must empty yourself in order to feel full. By helping others we receive the greatest reward there is and that is something that cannot be shown by a mansion or a Ferrari, but rather something that is felt in our hearts. This is the reason I believe Paul Farmer lives the way he does, because he understands the importance of living for others.

Mountains Beyond Mountains Chs 6-7 Reflection by Kinzie Schulz

           To understand a person I think you really have to look at how they grew up. Paul’s father was a man of ideas and constantly moved his family around to suit his new “business endeavors”. It was one idea after another, and although most of them seemed to blow up in their face, “no one ever got seriously injured”. One of the more disastrous plans came after Paul’s father up and bought a boat one day and decided they were all going to make their money living on the ocean while selling fish for a living (in retrospect, it might have been helpful if he knew a thing or two about navigation or really anything about fishing). The boat ended up being disposed of in the only manner appropriate, a “Viking funeral”. While things never really turned out as planned, I respect Paul’s father for trying, for never doing anything “half-ass”, and for not being afraid to take risks. In that way Paul is a lot like his father. He takes risks everyday in doing what he does and most people I think would say it isn’t worth it. He barely gets to see his family because he is traveling so much of the time and he is basically broke because any money he makes goes right into helping his cause.

His dedication to each patient is amazing and is shown in the way he acts, speaks, and how lives his life constantly making sacrifices for others. Seriously I wish I could be him. If one’s goal is to be a doctor they should aim to emulate the essence of Paul Farmer, honest dedication to each patient. If you’re going do your job, do it right. He cares so much that things are done right that he walked six hours in the heat to make sure his patient was coming in for his TB treatment. His response to how ridiculous that may have seemed was “…but you can never invest too much in making sure this stuff works”. I’m not surprised some of his patients think he is a god. After reading this book I almost agree!

The book doesn’t just challenge its reader just to help others, to risk more, or to be more dedicated in one’s endeavors, it also sheds light on the undeniable connection between the health and happiness of its citizens and the stability or corruption of its government. The dictators in Haiti have long been controlled by the interest of the US government who don’t always have the Haitian’s best interest in mind. Kidder tells us how Paul is very passionate about the dam that was built. The people were made to believe this dam was a gift when in reality it was made to help agriculture down stream and ruined the lives of many who lived up stream. The quality of life of many Haitians was diminished by this project, yet nothing was done about it. The rulers in Haiti are often dictators who use “donations” to help the wealthy stay wealthy and to make sure those in power stay in power. It seems outrageous but that’s the way the world is. Too some, these issues may be overwhelming and disheartening. How can we solve this big of a problem just one patient at a time? How can we effect change in the government? Helping one patient at a time may seem like an arduous process that won’t even make a dent in healing the amount of people suffering or in poverty. In this case thought we are dealing with people, people who have families and hopes and dreams and the effects of truly helping one person, no short cuts taken, cannot be measured.