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UPDATED: 3/30/20 - 1:28 p.m.

"Mountains Beyond Mountains"

mountains.gifGuiding Questions
These questions are designed to help guide you through the common reading as well as to assist you in preparing for a class discussion about the book during your Orientation session in August.

Part I: Dokte Paul

  • Why does Kidder start his book describing his relationship with Paul Farmer, and what is the nature of that relationship? What positive and negative aspects of Farmer does Kidder chose to present to the reader?
  • Does Kidder help the reader "find an out" in terms of Farmer's moral example? (See pp. 21-23.)
  • Describe Zanmi Lasante — where is it, what is it like, why does it exist, who does it serve? Contrast Farmer's life there with the one he leads while in Boston.
  • How does Farmer deal with Haitians' history, culture, and supernatural beliefs? (See the last paragraph of p. 44.) Why is the "back story" important to the book?
  • What are the most challenging problems for Farmer outside of Cange?

II: The Tin Roofs of Cange

  • Tracy Kidder spends a lot of time describing Paul Farmer's upbringing. What clues in that upbringing help us understand Farmer? How did Farmer eventually become fascinated with Haiti?
  • What is Farmer's relationship with Ophelia, and why is it important?
  • Farmer "found his life's work ... through experiencing Haiti" (p. 78) How did he do that? What events, what beliefs, what experiences led him there?
  • Describe Liberation Theology and Farmer's understanding of it as a guide for his work.
  • Why did Farmer start his work in Haiti while still a medical student? What role did Tom White play in assisting him?
  • Despite Farmer's tendency to ignore political events in the course of his work, how did Duvalier's and Aristide's regimes affect his ability to work in Haiti? What happened after the junta that deposed Aristide and in the tumult that followed?
  • Who is Jim Kim, and what is his relationship to Farmer? His role in Farmer's work?

III. Medicos Aventureros

  • What is the "epi-divide" and how does the incidence of TB fall along that divide?
  • Jack Roussin and Jim Kim travel to Peru to establish "a" Zanmi Lasante. Why was Farmer's response to their efforts fairly ambivalent? Why does it take Roussin's death from TB and the strain in Carabayllo before Farmer becomes involved?
  • What did Farmer discover about "amplification"? When did people outside Peru become interested in the problems associated with TB, and why?
  • How did Farmer convince others that MDR-TB needed attention — and money — to fight it? What was the significance of the personal toll this work took on Farmer? Was he more or less likely to take risks? What about working with the DOTs program?
  • Why Russia? (It is not a 3rd World country.) Does PF, Jim Kim, et al. ascribe to the idea that we "should provide the greatest good for the greatest number"?
  • What aspects of Kim's background led him to be committed to PIH? What surprised you about him? Is he really "the twin son of a different mother"? (p. 175)
  • How was it necessary for PIH to court the drug companies in order to make a difference in treating TB? Why was it necessary?
  • What are WHO and Drs. Without Borders?

Part IV: A Light Month for Travel

  • What is the purpose of Tracy Kidder's travelogue of Paul Farmer (first 15 pp. or so)? What does Kidder want us to know about Farmer's schedule? Why does Farmer keep that schedule (see p. 191)?
  • Does Farmer really "relish the break from Haiti" by going to Cuba? How does his travels illustrate that inequality is at root of infectious disease?
  • Why is the Cuba episode important to Kidder's portrait of Farmer, especially in terms of politics? What is the difference between "managing poverty" and "managing wealth"?
  • Should AIDS patients be quarantined?
  • What strains the relationship between Kidder and Farmer as they travel?
  • Is Farmer's relationship with Didi and Catherine truly " ... a chink in his moral armor"? (See p. 212.)
  • For whom does Farmer have an "H of G"?
  • Describe how Farmer manages to interconnect disparate parts of his life, as well as all life in general.
  • Why did Farmer go to Russia? What was his hope? Why was there a TB epidemic in Russia (again, it's not considered to be a 3rd World country)?
  • What political/cultural issues impeded Farmer's attempts to court WHO and the World Bank? How well did he do convincing people that Russian prisoners deserve care?

Part V: O for the P

  • What positive/negative impact did the Gates grant have on testing TB in Peru? How did PIH change as a result of the grant?
  • "What PIH-ers should take from Paul wasn't a manual for their lives but the proofs he'd created that seemingly intractable problems could be solved." (p. 244) Does this quote accurately reflect the general mood at PIH?
  • What was the point of Jim's travel to Tomsk and why did Kidder accompany him? Why did Farmer follow — or follow up — on them?
  • Why does Farmer sometimes jeopardize funding by making injudicious comments, such as the one on pp. 253-254? How does that comment reflect Farmer's attitude toward money in general, and "politicking" for money to continue his work?
  • Why did Farmer bring John to Boston despite all the trouble and the exorbitant costs involved? (Use Serena's response to a similar questions [p. 270] as a guide.) Was the whole endeavor a "lesson in futility"? (p. 279)
  • Why does Kidder trust Farmer on the journey to Casse?
  • What is the second level of triage? How does it affect Farmer's work and psychological state? Why and how does Farmer handle "not being on a victory team"? (p. 288)
  • What is the ultimate point of "O for the P"? (p. 290)
  • What will Farmer do scutwork?
  • Kidder asserts that Farmer is a little crazy. Why? Is Farmer a little crazy?