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Compare and Contrast: Mountains Beyond Mountains

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Submitted By maddiemay8
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In Mountains Beyond Mountains, Tracy Kidder describes a new sister organization that joined Partners in Health (PIH), Socios en Salud operating in Peru. PIH’s contrasting methods of maintaining Zanmi Lasante in Haiti and Socios made their expansion difficult, but greatly helped the new populations they served. Haiti and Peru have different political struggles which affect the potential of healthcare PIH can offer. Haiti’s government was overthrown by the Haitian army, resulting in a lot of violent political protest. Many were severely injured, which caused Zanmi Lasante’s focus to shift. Instead of working to cure those with tuberculosis, Zanmi Lasante had to nurse those victimized by the Haitian army. Not only did injuries delay Zanmi Lasante’s work , the Haitian army blacklisted PIH founder Paul Farmer for a few months. Likewise, a civil war in Peru caused the new government to place strict regulations regarding when Socios en Salud could care for people. Patients had to complete Peru’s custodial care before being surrendered to Socios. After the government let Socios care for their treatment failures, they laid heavy taxes on them. Each Socios patient costed PIH $15,000-$20,000 in contrast to Zanmi Lasante’s $150-$200. Socios could not help as many patients with tuberculosis because of the added cost, and focus shift to those injured. These problems demonstrate how crucial Paul Farmer’s leadership is to PIH.
The most valuable qualities a leader can demonstrate is humility, skill, and passion. Farmer has all three, explaining why Partners in Health would crumble without him. Both Kim and Farmer have skill, they both attended renowned universities for their medical degrees. It’s arguable that Dr. Farmer has more skill because of his degree in anthropology partnered with his medical degree. Farmer also demonstrates humility, which Jim Kim lacks. Kim aspired to be given as much esteem Farmer was as the leader of Partners in Health, so he established Socios en Salud. After Socios was established, KIm was overwhelmed, and Famer began giving him daily advice, saying “remember, serving the poor in Carabayllo is more important than soothing your own ego” (Kidder, 131). Farmer stayed humble and calmed Kim’s ego while being considered a saint by his Haitian patients. However, Farmer could not overcome his passion for his work, even when the stress and commitment caused health issues for him. Once Socios en Salud opened, Farmer was even more consumed with work. He was constantly traveling to and from Zanmi Lasante and Socios en Salud. In his spare time between flights his guilty conscience reminded him of those less fortunate than him, and sick people haunted him. “Everyone told me something like this was going to happen” (Kidder, 151) Farmer recalled once he was diagnosed with Hepatitis A. Hepatitis A is rarely fatal as long as it is treated quickly. However, Dr. Farmer could not pull himself away from his work and fell very ill. He spent two weeks in Brigham Hospital. Doctors worried he was going to need a liver transplant. Even when he was in the hospital, he had to call Socios en Salud and Zanmi Lasante to give drug procurements. PIH would not survive without Farmer’s skill and humility; his passion is demonstrated with his illness and interactions with patients. Dr. Farmer’s extensive humanitarian work brings him lots of joy. His career in medicine and anthropology is more than a job for him, it is his life. His love for his work with PIH is shown by how he interacts with patients. When an older woman comes to the Zanmi Lasante clinic, “Farmer stands when sheenters, greeting her as mami mwen ‘my mother.’ He bends down, practically kneeling, and she kisses him on one cheek, then the other” (Kidder, 26). Mami mwen is sick with Pott’s disease, but she went too long without treatment and can never be cured. She comes to see Farmer for company. A sick patient going to the doctor for company is unheard of. Farmer’s patients are his friends and family. He doesn’t sleep with a good conscience knowing there are people sick and sleeping on dirt floors while he is healthy and in a bed. Haiti’s Zanmi Lasante treated patients of all ages; Peru’s Socios en Salud had a children’s hospital which caused a sway of doctor patient relationships. Prior to Jim Kim establishing Socios en Salud, the World Health Organization (WHO) instilled care in Peru for those with tuberculosis. Once Socios opened people flocked there, they knew it had the best care. The government responded by requiring all patients to go through WHO’s DOTS program; each patient had to complete tuberculosis care twice, if they were still sick after they were released to Socios en Salud’s care. This affected Socios’s relationships with patients because they had limited time with them. After completing WHO’s DOTS program, patients that were still ill were in critical condition. Socios had to act fast to cure patients, and in a lot of cases, their care came too late. As a result, Peru had a much higher patient mortality rate than Haiti. Of the patients that did benefit from Socios en Salud’s late care, they were limited on time. They had less time receiving care from the Socios doctors than those receiving care with the Zanmi Lasante doctors; so there was less time to cultivate relationships. The doctors were as nice and compassionate as in Haiti. When patients’ parents thanked Dr. Farmer for his compassionate care he responded “for me, it is a privelage” (Kidder, 158). PIH’s expansion in the 1990’s allowed the organization to help more people, but stretched personnel and strained resources. Socios en Salud and Zanmi Lasante work to provide healthcare to those in need, specifically those suffering from tuberculosis. The heavy taxes Peru placed on Socios limited the amount of patients they could help and resources they could attain for each patient; but those in need of some healthcare got it.

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