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Mountains Beyond Mountains
The Quest of Paul Farmer, A Man Who Would Cure the World

by

Tracy Kidder
2003
     
    MonkeyNotes Study Guide by Diane Clapsaddle

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Reprinted with permission from TheBestNotes.com Copyright  2007, All Rights Reserved 
Distribution without the written consent of TheBestNotes.com is strictly prohibited.

KEY LITERARY ELEMENTS
SETTING
Boston and Cambridge, Massachusetts; Cange, Mirebalais, and Port-au-Prince, Haiti; Lima, Peru;…… 

CHARACTER LIST
MAJOR CHARACTERS
Paul Farmer - Obviously the heart of the book, Farmer is an amazing individual whose shoes can be filled, but who can never be imitated. He has devoted his life to what he calls the long defeat. The odds of Haiti ever completely changing from a poor country are astronomical, but Farmer believes he must try to win.

Tracy Kidder - He is the author of the book, but ever-present in it. He documents all the experiences he has with Paul Farmer from 1994 through 2003 while researching the other years of his work in Haiti and around the world.

Ophelia Dahl - The daughter of the actress Patricia Neal and the writer Roald Dahl, Ophelia is a great success in her own right. She begins to work with Paul in Haiti, falls in love with him, and then continues her work with him as his great and abiding friend. She is the one who makes the managerial side of Partners In Health work.

Jim Yong Kim - A Korean-American doctor, he becomes entranced by the work Paul is doing in Haiti. He works alongside him for several years and then begins his own clinics to try to control……. 

MINOR CHARACTERS
Didi Bertrand - She is Farmer’s wife and mother of his daughter Catherine. She lives in Paris and studies for own degree and bears up under the disadvantage of having a husband whom she seldom sees.

Jean-Bertrand Aristide - He is the former priest who became the president of Haiti. He is admired by Farmer and is his friend. His intentions are to pull Haiti out of poverty.

Jorge Pérez - He is the Cuban doctor who is head of the health services there. Farmer sees him and his program as a great model for how health care can be made available even for the poor.

Soros - His foundation helps obtain money for the Russian anti-TB program.

John - He is the little boy who dies even though the doctors and care givers at Zanmi Lasante do…… 

CONFLICT
Protagonist - The protagonist is Paul Farmer, the most amazing doctor who works the long defeat his entire life, meaning he works incessantly to eradicate poverty and give decent health care to…… 

Antagonists - The greatest antagonist in this book is poverty and the inherent epidemics that come with it. Of course, the people who turn their backs on poverty are also the antagonists as are…… 

Climax - The climax occurs when Tracy Kidder finally realizes the true definition of Paul Farmer’s character: he is a man who is more interested in trying to win over the long defeat, even…… 

Outcome - Many of the goals Paul has set for himself come about, including the adoption of new prescriptions for MDR-TB by the World Health Organization (WHO). However, again, the outcome is still uncertain, because there is still so much for people like Paul Farmer to do. If the…...

SHORT PLOT / CHAPTER SUMMARY (Synopsis)
Tracy Kidder travels with, and chronicles the life and work of Dr. Paul Farmer.  Farmer's mission is to serve the poor in countries like Haiti, Peru, and Russia. It runs from approximately 1982 to 2003.  Farmer's crusade is…… 

THEMES
The first and most important theme is: the poor deserve decent health care and living conditions. This is the message that Farmer promotes his whole life from the individual patient to the greatest politicians of all the countries of the world.

Another theme involves the idea of the long defeat. This refers to Farmer’s realization that……. 

MOOD
The mood is often troubling and dark, but there are so many lights of hope along the way that reader can’t help but feel uplifted by the end.

BIOGRAPHY OF TRACY KIDDER
Tracy Kidder was born in New York City on November 12, 1945.  He graduated from Harvard in 1967.  He served as a 1st Lieutenant in the Army in Vietnam from 1967 - 1969 for which he received a Bronze Star.  After the war, he earned a Masters of Fine Arts degree from The University of Iowa.  He began writing for the Atlantic Monthly magazine in 1973 and has served as a contributing editor since 1981.  In his relationship…….

ACRONYMS / ABBREVIATIONS USED IN THE BOOK
WHO - World Health Organization -The United Nations public health agency.  It monitors disease outbreaks and assesses the performance of health systems around the world.  Established in 1948 and based in Geneva, Switzerland.
AMC - Area of Moral Clarity - What ought to be done, morally, is clear, however the logistics and details are often more muddled and difficult 
O for the P - preferential option for the poor. Coming from Catholic social teaching, this concept expresses a special concern in distributive justice for poor and vulnerable persons. The "poor" includes but is….. 

CHAPTER SUMMARIES WITH NOTES AND ANALYSIS
PART I – Doktè Paul
CHAPTER 1
Summary
This chapter explains how the author came to meet Dr. Paul Edward Farmer. Two weeks before Christmas 1994, in a market town in the central plateau of Haiti called Mirebalais, the author is sitting with an American Special Forces captain named Jon Carroll at a Haitian army outpost. He is in Haiti to report on American soldiers, 20,000 of which had been sent to reinstate the country’s democratically elected government and to strip away power from the military junta that had deposed it and ruled cruelly for three years. With only eight men, Captain Carroll is temporarily in charge of approximately 150,000 Haitians spread across one thousand square miles. Political violence has all but disappeared except for one particularly grisly murder: a few weeks back, American soldiers had fished the headless corpse of the assistant mayor of the town from the river. A rural sheriff named Nerva Juste, a frightening figure to most of the people of the area, had been arrested by Captain Carroll, but was released for lack of evidence or witnesses. The release of Juste was a source of great frustration to Captain Carroll, but because the US government had determined that they would not be in the business of “nation building,” he was given no tools to properly govern the area he now controlled.

As the chapter begins, Captain Carroll is advised that he has five visitors: four Haitians with one American friend. The American steps forward to explain that his name is Paul Farmer, and he is a doctor working in a local hospital. Captain Carroll asks Farmer if he has any medical needs and that he himself has even bought medicines when needed. However, Farmer’s concern is who cut off the head of the assistant mayor. Carroll answers that he doesn’t know for sure, but Farmer says that in that small area it is very hard not to know the answer. The two men then have a somewhat circuitous conversation with Farmer expressing his concern that the American government’s plans for fixing Haiti would aid business interests but do nothing to relieve the suffering of the poor. He says he is on the side of the poor but it is still unclear which side the American soldiers are on, especially in light of Nerva Juste’s release. The author realizes that Farmer knows Haiti better than Carroll does, and he’s trying to impart the fact that the Haitians are losing confidence in the Captain. However, Carroll becomes riled at Farmer’s criticisms and raises his voice to say that when he has enough evidence he’ll slam the man, but until he does, he’s not going to stoop to the level of those who make summary arrests. Farmer argues that it makes no sense to apply principles of constitutional law to a country that has no functioning legal system. So they come to a stalemate – one is a “redneck” arguing for due process while the other is a champion of human rights arguing for preventative detention. 

The author stays with the soldiers for several weeks and then meets up with Farmer again on the flight home. Kidder proceeds to have an in-depth conversation with Farmer about the murder of the assistant mayor in which the doctor explains that he had come to Captain Carroll to warn him. The Haitians in the area were upset with Carroll’s decision about Nerva Juste and had challenged the doctor to stop and talk to the soldier. Ironically, as they were passing the army compound, the got a flat tire and Farmer had commented that “you have to listen to messages from angels.”

Kidder also gets Farmer to tell him about his life. The doctor is 35 and graduated from Harvard Medical School and also has a Ph.D in anthropology. He works in Boston for four months of the year, living in a church rectory in a poor neighborhood. The rest of the year he works without pay in Haiti, doctoring peasants who had lost their land to a hydroelectric dam. He had sneaked back into Haiti when the junta was in power by paying a small bribe. 

After the plane lands, Kidder speaks to Farmer again in a small coffee shop and a few weeks later, he takes him to dinner in Boston, hoping the doctor could help him make sense of what he is writing about Haiti. Kidder is very impressed with Farmer’s enthusiasm about the island nation and how he clearly enjoys living among the poor. However, after their dinner, Kidder loses touch with the doctor. In the interim, he comes to take on the same the belief as the soldier that there’s not much they can do to alleviate the extreme poverty in Haiti, which appears in what he writes about the country. It’s only when he thinks about Farmer that he comes to have a different view of the island. He knows that this view will be hard to share, because it implies a definition of a term like “doing one’s best.” In the meantime, Kidder sends monetary donations to which Farmer sends a handwritten thank-you note each time. Then, the author hears that Farmer is working in international health, notably with tuberculosis, but they don’t meet again until 1999 when Kidder calls the doctor and Farmer names the place.

Notes
This entire opening chapter is foreshadowing of the kind of man Kidder is going to tell the reader about – Dr. Paul Farmer, a true humanitarian. His willing to do his best among the poor and downtrodden everywhere is about to unfold to the reader.

CHAPTER 2
Summary
The setting of this chapter is Boston’s Brigham and Women’s Hospital whose great works and fame make people feel stilled in its presence. Kidder is gathered with Dr. Farmer and his team in radiology where they are discussing the cases for the day. Dr. Farmer is now 40 years old and dresses, like the “big-shot” he is, in formal attire. He still spends most of his time in Haiti, but he is also a very important professor of both medicine and medical anthropology at Harvard Medical School as well as being an attending physician on Brigham’s senior staff. They are discussing a patient who has recently been treated for a parasite in the brain. Farmer elicits opinions of his staff about whether to continue treatment for infection. He listens carefully, but it is evident that he is in charge. He calls a female parasitologist, an old, close colleague, whom he calls “pumpkin.” He tells her they are going to treat the patient. This is part of a typical ordinary day for Farmer and his staff. They have dealt with six cases all of which are somewhat of a puzzle, until the last patient who they are concerned may have TB as a result of being HIV positive. They head upstairs to see the patient, and along the way, Kidder is impressed by Farmer’s demeanor: he speaks to everyone in a personal manner and stops at various places to do small office duties and help other physicians. 

Kidder is further impressed by how Farmer deals with the patient, named Joe. Joe is a drug addict and often doesn’t take his medication or eat properly. Farmer curls right on the bed to the point that Kidder thinks he’s going to climb in with the man. He is very close and personal with the guy to show how much he cares. The patient tells him he want to have a home to go to where he can have a six-pack of beer a day and someone to make sure he eats and takes his medicine. On the outside, he is too distracted by finding drugs and a warm place to sleep to take care of himself. Farmer stares at Joe’s face intently as if he and his patient are the only ones in the world, and he promises Joe he will do everything he can to fulfill his wish. A few days later, on a message board outside the door of Brigham’s social work department is the message: “Joe OUT: cold, their drugs, ½ gal. vodka; IN: warm, our drugs, 6 pack Bud.” Beneath this message are the words, “Why do I know Paul Farmer wrote this?” A homeless shelter is found, but they forbid alcohol, understandably, which doesn’t deter Farmer from pleading his patient’s case. 

On Christmas, when he is on duty, Farmer wraps a six pack of Bud as a present for Joe, and when they leave the patient, Kidder overhears him say, “That guy’s a fuckin’ saint.” When Kidder asks him how he reacts to these kinds of comments, the doctor says that he doesn’t mind that they say that, it’s just that he feels it’s inaccurate, and it makes him think he has to work harder to live up to the label. Kidder feels his own inner disturbance to this comment. It isn’t that the words seem immodest to him; it’s that he feels he’s in the presence of a very different person, whose ambitions he hasn’t yet begun to fathom.

Farmer finishes his service at Brigham and returns to Haiti on New Year’s Day. He sends Kidder a copy of his latest book, Infections and Inequalities, in which he makes connections between poverty and disease. In it, Farmer can hardly contain his anger at how the necessary drugs don’t make it to the patients. He isn’t at all like the teaching doctor at Brigham. He shouts on every page. Kidder e-mails him that he loves the book and is going to read his previous ones as well – his oeuvre (body of work). Farmer tells him that those books are not his oeuvre. To see his oeuvre, Kidder has to go to Haiti. 

Notes
This chapter reinforces the type of doctor Farmer is. To Kidder, he is like a split personality: he is a calm, caring laid-back doctor who goes the extra mile for his patients. In his book, he is an angry physician, shouting out the needs of his patients and how the poor suffer more, because they’re poor and don’t have access to necessary care. Kidder seems intrigued and even somewhat disturbed about what he will see in Paul Farmer in the future.

CHAPTER 3
Summary
Kidder, the author, has arrived in Haiti to see Farmer’s oeuvre. He is met at the Port-au-Prince airport by a four-wheel-drive pickup and rides on a two-lane paved road until he comes to the other side of the Plaine du Cul-de-Sac. There, the truck moves steadily upward, while pitching and rolling, along a road that seems little more than a dry riverbed. Along the way, he sees many arid mountains and villages of wooden huts, trucks of various sizes and a lot of foot traffic, beggars, ox carts being pulled by men, few trees, and no electricity after the town of Péligre. The trip is only 35 miles long, but lasts three hours. Finally, kidder’s truck pulls up to a tall concrete wall where a sign reads, “Zanmi Lasante,” or Partners In Health. It is a very dramatic sight in the all but treeless, baked brown landscape. There are tall trees beside courtyards, walkways, and walls, an ambulatory clinic and a women’s clinic, a general hospital, a large Anglican church, a school, a kitchen which prepares meals for 2000 people a day, and a brand new building to treat tuberculosis. Inside, the building has tiled floors, clean white walls, and paintings by Haitian artists. 
The morning after Kidder arrives, he goes on the first of many times with Farmer on his rounds. It begins at dawn and there are many, many people waiting to see him. A large number are there just to ask Farmer to help them in ways that are not really medical or urgent, so he searches the crowd for people in real need. One is a young woman with her hand in a towel. She has waited fifteen days before seeking medical care for a severe wound and now she is has gangrene. He is frustrated that even minor injuries go untended and then more severe consequences are the result. The woman will probably lose her hand. 

Kidder explains to the reader that when he arrived at Zanmi Lasante, he came to what seemed to him the end of the earth. It is the poorest part of the one of the poorest nations in the world, but he feels he has encountered a miracle. The people make the equivalent of one dollar a day or less, the country has lost most of its trees and a great deal of its soil, it has one of the worst health statistics in the Western world, and yet in one of the most impoverished regions of the world is this lovely, walled citadel called Zanmi Lasante. Other clinics treat patients there, but none are as well-equipped, and the patients do not have to pay at Farmer’s clinic like in the others. His Haitian colleagues had told Farmer that the patients must pay user fees of about eighty cents a day. However, Farmer has his own rule: every patient must pay the eighty cents, except for women, children, the destitute, and anyone who us seriously ill. So everyone has to pay except for almost everyone!. And no one is allowed to be turned away.

In addition to the excellent medical care the clinic provides, it also had built schools, houses, sanitation systems and water systems in the catchment area. What’s more, in a country where the greatest killer is TB, there has not been one death from it in Farmer’s catchment area since 1988. The money for Zanmi Lasante is funneled through the public health charity called Partners In Health with headquarters in Boston. The bills are small by American standards, so that Kidder’s local hospital in Massachusetts treats about 175,000 patients with an annual operating budget of $60 million, while Zanmi Lasante treats the same number of patients for about $1.5 million. Much of what they receive is from donated drugs and charitable contributions. 

Farmer himself contributes a great deal to Zanmi Lasante, also. He had received from the MacArthur Foundation a so-called genius grant of $220,000. He had donated the entire sum to Partners In Heath for a research branch for the organization. He personally makes about $125,000 a year from Harvard and the Brigham, but all his paychecks for honorariums or royalties also go to Partners In Health. Now he is married to a Haitian woman named Didi Bertrand and has a daughter born in 1998. They moved from the basement of Partners In Heath’s headquarters and live in a small apartment in Eliot House at Harvard when they are in America. While they are in Haiti, they stay at the clinic. However, these days Farmer doesn’t see much of his family, because Didi is finishing her studies in anthropology in Paris. When told he should spend more time in Paris, Farmer says, “But I don’t have any patients there.” So he spends four months in Boston and the rest of the time in Haiti and has traveled to so many places where doctors are needed that he has traveled more than three million miles by airplane. He has a small house similar to a ti kay that peasants live in only with an indoor bathroom (without hot water). Whenever Kidder looks into Farmer’s little house, he is amazed to see that his bed remains unused. Farmer claims that he sleeps about four hours a day, but later he confesses that he just can’t sleep, because there’s always someone who’s not receiving treatment when he does. 
Once, Kidder wonders aloud what compensation Farmer receives for all his sacrifices. Farmer, with an edge to his voice, responds, “I feel ambivalent about selling my services in a world where some can’t buy them. You can feel ambivalent about that, because you should feel ambivalent. Comma.” This is Kidder’s first experience with Farmer’s use of the word comma at the end of a sentence. It stands for the word that would follow the comma – asshole. Kidder understands that Farmer isn’t calling him an asshole, but instead is referring to third parties who feel comfortable with the current distribution of money and medicine in the world. And implication is that you aren’t one of those. Are you?

Kidder follows Farmer into his office where Farmer says that now the objective is to stay put. The patients then come to him: an elderly man being treated for pulmonary TB who is blind, but wears glasses. He had said he wanted them, so Farmer saw to it that he received them; a younger man called Lazarus by Farmer who had been wasting away from AIDS and TB and had gone from 90 pounds to 150 in Farmer’s care; a woman who looked healthy and well, but only a few months before, her father had been saving to buy her a coffin; a lovely-looking young woman being treated for drug-resistant TB and now is in the midst of a sickle-cell crisis; a man with gastritis in late middle age which Farmer explains could mean thirty years old since 25% of Haitians die before they reach the age of forty; a sixteen-year-old boy too weak to walk because of an ulcer; and a very small elderly-looking woman  who had developed TB of the spine before Farmer could treat her. Farmer is especially solicitous of her needs and calls her “mother.” Then a very pregnant woman enters cheerily calling all the men in the clinic her husbands. She is infected with HIV and has been exposed to TB. 

While Farmer deals with this last patient, Kidder examines the yellow legal pad lists taped on the wall. There is a task to be completed written on every line of each of three pages. When he gets a task done, he checks a box he has drawn beside it. This seems to give the doctor inordinate pleasure when he sees he’s getting a lot done. There are sixty imperatives on the list such as sending sputum samples to Boston. One tantalizing item reads, “Sorcery consult.” This refers to the deep belief in the Haitian culture that someone can be made ill through sorcery. It is called “maji” and all Haitian doctors know how to deal with it. Because Farmer has such a gift for healing, the people think he is a god and that he works with both hands – science and magic. Farmer is embarrassed and amused by these kinds of consults, but on a serious note, he explains that the beliefs of the people evolved in the absence of effective medicine, so they have developed an alternative cause for illnesses they don’t understand. Of course, the allegation of sorcery itself can cause problems, like the boy whose mother refuses to speak with him, because she believes he used “maji” to kill his brother. 

All these interpretive discourses he has with Kidder Farmer calls “narrating Haiti.” Normally, the doctor can be silent during his rounds or at the least, reticent about benign conversation, so Kidder eggs him on in order to get him to “narrate Haiti,” which brings forth his drawing of a moral about the suffering of the Haitian poor as well as the world’s poor. He often pauses for a reaction, “You feelin’ me?” As for Kidder himself, he finds he can’t muster a sufficient response internally. He feels sorry for so many Haitian children, who often die of something as common as measles, but he knows he can never feel sorry enough to satisfy Farmer. It sometimes makes him feel annoyed with Farmer. 

Farmer teaches his students that to be a good clinician, you must never let a patient know that you have problems, too, or that you’re in a hurry. He says that the rewards are so great for simple things. Of course, this means that he seldom leaves his office before dark. A young man named Ti Ofa comes in as a chronic infectious patient. Because the clinic doesn’t have the equipment to measure viral loads and CD4 counts, Farmer knows only from long experience that Ti Ofa is in the endgame of his AIDS infection. Even though it is exorbitantly expensive and no doubt a waste of resources, Farmer has started patients like Ti Ofa on new antiviral drugs. The man is embarrassed by his situation, but accepts the drugs and promises to take them faithfully. He tells Farmer that just talking to him makes him feel better. 
The end of the day brings more rounds, this time of the Children’s Pavilion where there are babies with kwashiorkor, a form of starvation. Farmer has recently lost a baby to meningitis and another to tetanus. He croons softly to a baby girl named Michela who he refuses to give up on even though she is bloated with pleural effusion. The last stop is the TB hospital where the patients are sitting on the beds in one room watching a soccer game on TV. He jokes and teases them, which cheers him up. He points out to Kidder that they’re failing on 71 levels, but not on one or two.  The day ends on Farmer’s little patio lit by battery power. He puts a pile of medical studies on his lap to read, but decides he’s not into that and instead takes Kidder along, while he surveys the plant life he has nurtured over the years. The, he goes back to his studies for awhile. Even that is interrupted when he is called back to the clinic for a moaning thirteen-year-old who has arrived by donkey ambulance. He must give her a spinal tap and when he inserts the needle she cries out in Creole that it hurts and she is hungry. Farmer is amazed and “narrates Haiti” again, “Only in Haiti would a child cry out that she’s hungry during a spinal tap.

Notes
This chapter shows the reader how Farmer spends his days and how dedicated he is to each and every patient. They love him and call him a god, bring him gifts like pigs or chickens. However, none of these accolades are what motivates this man. It is the thought that there is some patient in need that keeps him going…….. 

OVERALL ANALYSES
CHARACTER ANALYSIS
Paul Farmer - It would be difficult to analyze this great man in just a paragraph when the whole book was written to show what he has achieved in his life. However, there are some important aspects of his character to remember. First, he believes he can win the long defeat, his way of saying that he can overcome impossible odds to save the poor of the world. Second, he believes he can give up time with his…. 

Tracy Kidder - He is the author of this book, but he is also one of its main characters, because it is he who must document what he sees by living and working with Paul Farmer. He is a bit of realist and a pessimist who constantly wonders why Farmer continues his work in the face of almost certain….. 

Ophelia Dahl - Being the daughter of famous people, you might expect Ophelia Dahl to have been perfectly content to live her life among the wealthy. But her family faced a great deal of adversity as well, and so it is not unusual that she found herself in Haiti helping Paul Farmer. She didn’t like it….. 

Jim Yong Kim - He is the Korean-American doctor who grew up to be a good athlete, valedictorian of his class, and a more than competent doctor. He falls in love with the work that Farmer is doing in Haiti and like him, devotes much of life working among and caring for the poor. Eventually, he sees…… 

PLOT STRUCTURE ANALYSIS
The novel is divided into twenty-six chapters beginning with the first time Kidder met Farmer in 1994 when the United States had invaded Haiti to place Aristide back in power. Then, he……. 

THEMES - THEME ANALYSIS
The poor deserve decent health care and living conditions
The first theme – the poor deserve decent health care and living conditions – is the very essence of this book. The entire documentation of the work of Paul Farmer reflects this idea, one which will probably never be completely attained, but which is well worth the fight to attain it. Farmer learns in his work that it starts with the individual patient and ends with the wealthy individual who chooses to close his…. 

The Long Defeat 
Kidder comes to realize that Farmer has spent his entire life trying to win the long defeat. This means that the doctor knows that his goal of bringing medicine and better living conditions to all the poor is probably not attainable, but trying and wanting to win are everything. Farmer is……
 
The fortunate of the world turning their backs on the poor and needy 
The theme of the fortunate of the world turning their backs on the poor and needy is evident throughout the book. It is the one aspect of life that angers Paul to the point that he has to…… 

AUTHOR’S STYLE
Tracy Kidder is very truthful and forthcoming in his attempt to document the work of Paul Farmer. There is no need for him to gloss over the man’s character in any way, because the…...

RISING ACTION
The rising action begins when Tracy Kidder meets Paul Farmer while he embedded with…… 

FALLING ACTION
The reader learns at the end that Farmer is ultimately a clinician who very much loves working with and changing the lives of his individual patients. We see this in his eleven hour trek over the…… 

POINT OF VIEW
The point of view is first person, told from Kidder’s viewpoint. This allows the reader to personally experience how Kidder himself learns and grows from his experiences with Farmer at….. 

OTHER ELEMENTS	
FORESHADOWING
There are several literary devices that pop up at various times in the story. One of the most prevalent ones is foreshadowing which frequently presents clues of something that will happen later in the novel. Some examples of foreshadowing include:
1.	Farmer and an American sergeant have a somewhat circuitous conversation with Farmer expressing his concern that the American government’s plans for fixing Haiti would aid business interests but do nothing to relieve the suffering of the poor. This foreshadows that Farmer’s life work is fighting for the poor.
2.	The entire opening chapter is foreshadowing the kind of man Kidder is going to ……

IRONY
Another important element is irony – when something happens, or is seen, or is heard that we may know, but the characters do not, or that appears opposite of what is expected. Some examples of irony include:
1.	Farmer argues with the American sergeant that it makes no sense to apply principles of constitutional law to a country that has no functioning legal system. So they come to a stalemate – one is a “redneck” arguing for due process while the other is a champion of human rights arguing for preventative detention.
2.	Farmer explains that he had come to Captain Carroll to warn him. The Haitians in the area were upset with Carroll’s decision about Nerva Juste and had challenged the doctor to stop and talk to…… 

MOTIFS
Another important element is a motif which is a recurring element used to develop a literary work. There is one major motif in this book:
1.	Farmer is portrayed as a kind of priest of a belief system he calls liberation theology. That is, he….. 

QUOTATIONS - IMPORTANT QUOTES AND ANALYSIS
The following quotations are important at various points of the story (Random House, New York, 2003):

1.	“That guy’s a fuckin’ saint.”
 (pg. 16; This comment is made by a homeless man named Joe in Boston who only wants to take his AIDS medication and drink a six-pack of beer every day. Farmer gets him the beer.)

2.	“I feel ambivalent about selling my services in a world where some can’t buy them. You can feel ambivalent about that, because you should feel ambivalent. Comma.” 
(pg. 24; Farmer said this when Kidder asked him if he shouldn’t be…… 

SYMBOLISM / MOTIFS / METAPHORS / IMAGERY / SYMBOLS
Other elements that are present in this novel include symbols and metaphors. Symbols are the use of some unrelated idea to represent something else. Metaphors are direct comparisons made between characters and ideas. There many symbols and metaphors used by the author such as:
1.	Boston’s Brigham and Women’s Hospital symbolizes outside help for the poor.
2.	Kidder, the author, has arrived in Haiti to see Farmer’s oeuvre. He is met at the Port-au-Prince airport by a four-wheel-drive pickup and rides on a two-lane paved road until he comes to the other side of the Plaine du Cul-de-Sac. There, the truck moves steadily upward, while pitching and rolling, along a road that seems little more than a dry riverbed. Along the way, he sees many arid mountains…… 

Another element that is very dominant in this novel is imagery – the employment of figures of speech, vivid descriptions, or mental pictures in writing or speech. Much of the imagery in this book comes from the language Farmer uses. Some examples include:
1.	Farmer’s use of the word comma at the end of a sentence. It stands for the word that would follow the comma – asshole.  Kidder understands that Farmer isn’t calling him an asshole, but instead is referring to third parties who feel comfortable with the current distribution of money and…… 
			
IMPORTANT / KEY FACTS SUMMARY
•	Title: Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World
•	Author: Tracy Kidder
•	Date Published: 2003
Meaning of the Title: It refers to the main character’s determination to bring health and happiness to the poor and comes from the Haitian proverb, Beyond Mountains There Are….. 

VOCABULARY LIST
Part I:  Dokté Paul
ambulatory (adj.):  of, relating to, or adapted for walking; capable of walking; not bedridden
ambivalence (n.):  the coexistence of opposing attitudes or feelings, such as love and hate, toward a person, an object, or an idea; uncertainty or indecisiveness as to which course to follow
annals (n.):  a chronological record of the events of successive years 
anthropology (n):  the scientific study of the origin, the behavior, and the physical, social, and cultural development of human beings
august (adj.):  inspiring awe or admiration; majestic; venerable for reasons of age or high rank.
austere (adj.):  severe or stern in disposition or appearance; somber and grave
balmy (adj.):  soothing; mild and pleasant
beatification (n):  the act of appearing to be angelic, exalted, or blessed
bemusement (n):  bewilderment or confusion; the state of being engrossed in thought
bourgeois (n):  a person belonging to the middle class
bureaucrat (n.):  an official who is rigidly devoted to the details of administrative procedure
candor (n.):  frankness or sincerity of expression; openness; freedom from prejudice; impartiality
causality (n.):  the principle of or relationship between cause and effect
circuitous (adj.):  being or taking a roundabout, lengthy course….

STUDY QUESTIONS - MULTIPLE CHOICE QUIZ
1.	Kidder first meets Paul Farmer 
a.)	at a church in Cange.
b.)	at an American army base.
c.)	at a meeting about TB in Russia.
2.	Paul’s childhood was unique because
a.)	he lived in church.
b.)	he lived on a bus,
c.)	he lived in a trailer…….

ANSWER KEY
1.) b.  2.) b.  3.) b.  4.) a.  5.) c.  6.) a.  7.) b. 	8.) c.  9.) b.  10.) c.  11.) a  12.) a.  13.) b.  14.) c.  15.) c.

ESSAY TOPICS - BOOK REPORT IDEAS
1.	Describe the program that Paul sets up in Cange which he calls Zanmi Lasante.
Describe the belief system that Paul calls liberation theology. How is like a priest of this belief system…...

END OF SAMPLE MONKEYNOTES EXCERPTS

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