What Paul Farmer Book Should You Read?

With the untimely, unbelievable, and unfair death of Paul Farmer, those dedicated to carrying out his charge to us have no better resource to which to refer than his books. Here we suggest three Paul Farmer books, plus . . .

Mountains Beyond Mountains

Mountains Beyond Mountains (2003) is, of course, not by Paul Farmer. Rather, it is the biography of Paul Farmer written by Tracy Kidder. Published when Farmer was 44 years old, it recounts Farmer’s childhood and young adulthood. Subtitled The Quest of Dr. Paul Farmer, A Man Who Would Cure the World, it is an easy read and serves as an introduction to the man. Kidder traveled together with Farmer around the globe, to Haiti, Peru, and Russia for a number of years. We hear the voices of Farmer, Jim Yong Kim, and Ophelia Dahl, who together founded Partners in Health (PIH). In Mountains Beyond Mountains, they are the young upstarts in global health. PIH, they agreed, had one crucial guiding principle: everyone in the organization needed to practice kindness to others.

We learn about how Farmer started working in Haiti while still a medical and anthropology student, how he chose to work in a squatter settlement in the Central Highlands, and how he built a hospital where there had never been one. Kidder accompanies Farmer on a day-long hike via mountains beyond mountains to home visit a single patient who had failed to appear for a scheduled TB treatment appointment. We see Farmer and Kim smuggling second-line tuberculosis medications from Harvard hospitals to the slums of Lima, Peru.

Farmer’s admirable personal characteristics are limned: his total commitment to patients, his exacting medical standards, his ability to cut through obfuscating ideologies and bureaucratic red tape, his charisma. While medical students reading Mountains Beyond Mountains are impressed by all of this, some comment that he can be faulted for not giving attention to family, an aspect of his life that later changed, as he now leaves behind a wife with three children. You soon recognize that there was only one Paul Farmer, and no one else can do all the things that he did, but the book reminds you that you might do one or two things that he did.

AIDS and Accusation

AIDS and Accusation (1992), was Paul Farmer’s first book, a reworking of his anthropology PhD thesis. An ethnographic account of HIV/AIDS among his patients in the highlands of Haiti, we see him take the “geographically wide and historically deep” approach that he often championed. Thus, AIDS and Accusation recounts the history and political economy of Haiti, which he developed further in The Uses of Haiti, 1994. Farmer reminds us that Haiti is firmly in the U.S.-dominated Latin American orbit. The modern history of Haiti is one of colonial subjugation leading to chronic underdevelopment. Following the French revolution, the Republic of Haiti became free in 1804. The U.S. started violating Haiti’s waters in the mid-nineteenth century, and the U.S. occupied Haiti from 1915 to 1934. During the reign of the Duvaliers, Haiti was further integrated into the U.S. economy. AIDS and Accusation describes how a dam in the Central Highlands, built with USAID funds by U.S. contractors brought neither water nor electricity to the people who formerly lived in the valley. Rather, they became the impoverished squatters that Farmer came to serve. Contrary to assertions early in the  epidemic that HIV/AIDS had been introduced into the U.S. from Haiti, Farmer suggests that HIV was probably introduced into Haiti via North American sex tourists or Haitians returning from North America. A more plausible explanation is that it was introduced into by French-speaking Haitian civil servants in the post-colonial Congo, who contracted HIV there and brought it home to Haiti (Jacques Pepin, The Origins of AIDS, 2011). Farmer refused to accept that HIV-AIDs could be treated only in wealthy, developed countries, and he concretely demonstrated that impoverished patients in resource-poor settings could also be treated successfully, an argument that he has made more recently for multi-drug resistant TB, Ebola, and even cancer. That all human beings deserve the best possible medical care became one of Farmer’s key mantras.

Pathologies of Power

In Pathologies of Power (2004), Farmer charts new directions for medicine in areas of human rights, ethics, and our responses to suffering. He urges us to re-examine the borders of what we usually consider to be “medical ethics.”  He persuasively argues that there is no medical ethical issue larger than the fact that the poor, the over two billion people in the world who live on less than two dollars a day, receive little or no medical care at all. While the struggles of such people might be geographically remote from where many of us practice medicine, in an increasingly globalized world, with its burgeoning interactions and integration, it is less and less tenable to say, “That’s not my problem.” Even if we choose not to learn about them, their suffering goes on.  All of Farmer’s work is based on the simple premises that it is poverty that makes you sick, and that all humans must be included “under the rubric ‘human.’”

While most of Farmer’s previous writings had been based on his experiences living and working in the highlands of Haiti, in Pathologies of Power, he enlarged his scope to include other areas of the world, such as Chiapas, Mexico, and prisons in Siberia, where he insists that prisoners with multidrug-resistant (MDR) TB receive treatments that will cure them. No, such therapy is not cheap, but neither was there any justifiable reason for why second and third-line drugs for TB were so expensive.  Through negotiation, through demonstrations that MDR TB could be successfully treated in places such as the slums of Lima, Peru, the prices of these medications have been considerably reduced. As an infectious disease specialist, Farmer concentrates on HIV and TB – but he also points out, for example, that much maternal mortality around the world would be preventable through the availability of proper maternity care and cesarean sections.  Again, why should such resources be devoted to the care of the poor? Indeed, because they’re poor, and therefore, more deserving. When this book was written, tuberculosis was one of the leading infectious causes of death worldwide, despite effective drugs known to cure it. Now, in 2022, what is one of the leading infectious causes of death worldwide? Tuberculosis.

Given that medicine has made such scientific advances, will they be delivered or denied to those who need them most? Most people around the world do not have the right to a healthy life. On what basis, then, should care to the poor be delivered: through charity, through development, or through social justice?  Drawing upon liberation theology, Farmer favors social justice, that view that the poor are not poor because of individual shortcomings but because they are victims of structural violence, the large-scale social forces that create and enforce their poverty. In summary, Farmer challenges us to rethink what has now become the fundamental basis of the practice of medicine, that the best care is reserved for those who can afford it. Would it that there were a hundred Paul Farmers to take first-class medicine to the poor of the world. Since there was only one, however, it is now up to the rest of us.

Fevers, Feuds, and Diamonds

In Fevers, Feuds, and Diamonds: Ebola And the Ravages of History (2021),Farmer applies the principles of social medicine to examine how the colonial history of West Africa turned it into a medical desert. In the way that AIDS and Accusation delves into the history of Haiti, Fevers, Feuds, and Diamonds delves into the history of the slave trade, colonial rule in West Africa, the political economy of extractive capitalism, and the internecine conflicts they engendered. He also returns to the ethnographic method of reconstructing life histories of individuals who intersect with the Ebola epidemic. These stories, which sometimes took two years to complete, add enormously to the story the book tells.

Recounting how colonial medicine focused on control over care, Farmer notes that much of the international response to Ebola in West Africa was also inordinately focused on control over care. When those affected with Ebola were isolated in “Ebola Treatment Units” with nothing but self-administered oral rehydration solutions, the case fatality ratio was 71%. When Americans were evacuated and treated in ICUs with central lines and intravenous fluids, there was 0% case fatality. Farmer concludes that the lesson to learn from Ebola in West Africa is that we must focus on care as well as control. In one of his last charges for us, he urges us to work toward the appropriate provision of staff, stuff, space, and systems to care properly for the sick.


A more extensive list of the Top 10 Books Written by Dr. Paul Farmer has been posted recently on the Partners In Health website.

In the week before his death, Farmer spoke twice in two days, remotely from Rwanda, with us in Hawaiʻi. The talks are available on-line.

Fevers, Feuds, and Diamonds: Ebola in West Africa (February 16, 2022)

Who Lives, Who Dies (February 17, 2022)

When we received the news on the following Monday (February 21), we refused to believe it. I (Seiji) said that I am going to go back to bed and wake up from this bad dream. Or maybe there was a glitch in the Matrix and we just ended up in a bad alternate universe. We’re somehow going to claw our way back to a less bad universe.

As the day wore on, news outlets began posting obituaries – and I realized that I wasn’t going to wake up from this version of reality. After I had my cry, I decided that those of us who were inspired by him are now charged with carrying out #PaulsPromise.

Seiji Yamada is a family physician practicing and teaching in Hawai‘i. Gregory Maskarinec is an anthropologist.