Jessica Reynolds

First Question:
Paul Farmer has a talent for connecting with people whose backgrounds are seemingly

different than his own. I feel this stems from his upbringing and the dynamics of his family life.

Paul Farmer and his siblings were raised in an unconventional home that did not tolerate social

injustices within their unit, and Paul’s father (the Warden) did not like facades put on by others;

only humility would do as an appropriate disposition within those family dynamics. For

example, during the time Farmer attended Duke, he returned home for a visit wearing costly

apparel. He acted as if he could only wear a certain standard of clothing and the Warden

tactfully asserted that Paul would still behave as the rest of them; no matter what he was wearing,

he would be doing chores like the rest of them. This foundation gave Paul Farmer a humble

beginning, one that he could draw from for the rest of his life’s experiences (Kidder, 2004).

Also, Paul Farmer is sure to get on the same level with the person he is speaking with and

maintains eye contact. He speaks to others in a nonjudgmental manner that cultivates openness

and feelings of safety for conversations to freely flow. These nonverbal talents of communication

that Paul Farmer uses are explained in the book when he sits on the bed beside an HIV-positive

man while doing rounds in Brigham. He converses with him just as an old friend would, even

making jokes about how marijuana would be a less dangerous alternative, and Joe, the patient,

feels a connection with Farmer. Joe knew that he was being heard and not judged because he was

a homeless drug user (Kidder, 2004)

Second Question:

The epi-divide is the categorization of people that die from age-related illnesses, and

those that have early ages of mortality, dying from preventable causes. Oftentimes, this is the

difference between those that have access to healthcare and those that do not. This division was

manifested in Haiti by those that have access to TB treatments, and those that do not. The
unfortunate side of that division usually fell upon females with black or brown skin and almost

always affected the poor (Kidder, 2004).

Concerned with TB in Haiti, Farmer designed a study as a response to a woman’s

interpretation of her contraction of TB, and the cause of the disease being attributed to sorcery.

Through the study, Farmer discovered that his patients believed in science, and they understood

the disease as a process, even though they practiced Voodoo. They also understood that proper

medicine could cure the illness. The revelation came when the woman Farmer had interviewed

expressed that her TB infection was a result of sorcery and that someone had cursed her, sending

the disease upon her (Kidder, 2004). This was an important concept for Farmer, as well as for the

rest of us; to understand that we are complicated beings, and our beliefs are not simple. This

discovery has a broad application, especially in melting pot countries such as the United States.

Individuals should not have their beliefs easily dismissed because it mimics a misunderstanding

of science. For some, science is a manifestation of a higher power, and faith in a deity can be

confirmed through the miracles of science. C.S. Lewis said, “…most dogs cannot understand

pointing. You point to a bit of food on the floor; the dog, instead of looking at the floor, sniffs at

your finger. A finger is a finger to him, and that is all. His world is all fact and no meaning”

(Lewis, 2001, p.114-15). To understand only science is like a dog’s perspective of only

understanding the finger, but to believe in a deeper meaning behind the science, is to understand

that finger is pointing in a direction.

Third Question:

In Mountains Beyond Mountains (2004), Farmer is understandably dissatisfied with the

way money and medicine are distributed throughout the world. The book has reinforced my

understanding of health disparities but has also made a connection for me about distribution

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insufficiency regarding poverty, ethnicities, and nationalities. Light has been shed on the specific

inequalities of Haiti and the preferential treatment affluent countries are privileged to. In my

opinion, the distribution of monetary and medical resources is what differentiates people from

the haves and the have-nots. Those that are fortunate enough to have access to healthcare are

oftentimes oblivious of this privilege, taking it for granted. I must agree with Paul Farmer, that

the distribution of healthcare-related necessities is an injustice in our global society (Kidder,

2004).

The awareness of structural violence among the public, and the impact it has on

disadvantaged groups, would be what I would change if I could. As a nurse, understanding

structural violence, organizational racism, the characteristics of these injustices, and

understanding the impact it has on certain groups, is the first step in changing disparities.

Advocating for my patients’ needs serves individuals and sitting on boards that create policies

that impact the people in the communities where I live, helps many individuals in the

community, and initiates the journey for change.

Moral obligations are derived from a moral compass. Because of personal awareness of

what is right and what is wrong, I feel that change is needed concerning healthcare access across

the globe. Money isn’t everything, but not having it is. With that said, I do not feel as concerned

with the distribution of wealth as I am with access to healthcare. I understand these two generally

go hand in hand, but I also understand that the suffering of the poor is a lack of consideration

from those that hold wealth. A community that will function at its highest is one where they have

the same goals, objectives, and see with the ‘same eye’ and feel as ‘one heart’. Understanding

that when your neighbors are suffering, will undoubtedly create suffering in your own life, is an

awareness. To help your neighbor by lifting the burdens that are placed upon their shoulders is

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an attribute of a highly functioning mentality and society. This does not require wealth, per se,

but it does require consideration. Politics and economics reflect the people’s concerns. The

people are the ones (especially in representative democracies) who hold the power, and the

government will act on those desires. If the majority does not care for the problems of those in

poverty, the government will do nothing to help. This means that if we want a change, we must

be the ones to do it first. With that said, not all countries can have policies and governments that

reflect the desires of their citizens; I believe that this is when other nations have a moral

obligation to intervene on behalf of those voiceless people.

No matter the location, the influence that Mountains Beyond Mountains (2004) has on my

nursing practice helps me to recognize that education does not equal emotional intelligence, and

that manners are not equivalent to grace. As I grow in my career, I look back at some of the

physicians that would volunteer to go to Tanzania and set up a clinic. Some practitioners never

went, but others would go, only to come back with a piece of their hearts left in Africa. I had my

favorite providers, and hindsight has helped me to realize that a line of eager compassion could

be drawn that singles out the very physicians I had favored. I aspire to be like these physicians,

not just superficially sympathetic, but one that others discern as approachable; characteristics

that stem from a compassionate empathy that bubbles from the depths of my soul.

Fourth Question:

There are several issues and assumptions about Farmer’s intentions throughout the book,

and many of them echo what is heard in America. Cynicism assuredly existed from a white man

coming to Haiti to help solve black problems, but Farmer won the community over by staying

consistent with his efforts, proving that he was genuine. Haiti becoming dependent upon the U.S.

and the charitable efforts of PIH in cultivating that dependency was a topic of conversation

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between Farmer, Ophelia, and Jim Kim. On another applicable occasion, Farmer addressed an

audience in Cuba about the assumptions regarding women and HIV infection rates. He boils

down the infectious issue as economically derived, and poverty driven. He asserted the

unemployment rate directly affects the prevalence of infectious disease, and that help is given in

the form of employment and economic nurturing. Throughout the text, Farmer reiterates that

poverty is the culprit for most diseases in Haiti, and is responsible for all preventable diseases

(Kidder, 2004).

My experience as a nurse cannot compare to Paul Farmer’s life of selflessly serving the

underserved people of Haiti. But on a much smaller scale, I can relate. While working in

infectious disease, I saw some of those disparities firsthand. Many of our patients were homeless

and current or former drug users. When I first started, I did not fit in as a white, heterosexual

female, serving a population of predominantly black, homosexual males. There was a presence

of cynicism that could be felt, but through my consistent efforts, patients witnessed that I tried to

deliver compassionate and dignified care.

One situation comes to mind, where I had to administer a penicillin injection to a woman

because she had contracted syphilis. As carefully as I could, I administered the injection,

knowing that it is not an easy needle to accept. I always feel uneasy about those injections; the

size of the needle required, combined with the amount of solution to be delivered, especially if

the recipient is underweight, was concerning for me. After the woman received her injection, she

proceeded to thank me for treating her with kindness. She stated that the last nurse told her that

she knew what she was doing, and the injection was a minimal consequence for her actions. She

had caught syphilis from her husband who had cheated on her, but even without that background

knowledge, I had not treated her any differently than I would have any other patient. I do recall

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my feelings when she explained what another had assumed about her, and I will never forget the

pain I saw in her eyes, and the injustice I beheld that day.

In the future, I will continue my professional journey with the same genuine approach. I

will do the job because that is what is needed, not because I have something to gain or because I

want praise for my efforts. Essentially, I will echo the same sentiment and joy Paul Farmer felt

while in Haiti; I am the best version of myself when I am helping others. Indeed, “[t]hat’s when I

feel most alive…when I’m helping people” (Kidder, 2004, p. 295).

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 Jessica Reynolds

References:

Kidder, T. (2004). Mountains beyond mountains. Random House.

Lewis, C.S. (2001). The Weight of Glory. Harper One.