Tracy Kidder’s

Mountains Beyond Mountains is the U.-wide shared reading for the fall
semester at Syracuse. Because I will be teaching freshmen in the fall, I
picked up a complimentary copy from the Writing Program
office
about ten days ago, figuring I’d read it sooner rather than later to get some
sense of how it might merge in with the teaching I’ll be doing in late August. I
haven’t worked that part out yet because I haven’t received my formal course
assignment (slight chance that it will be a Wellness Learning Community
section). Still, it’s never too early to begin thinking about such things.
Basically, the book is Kidder’s journalistic portrait of the life-work of Dr.
Paul Farmer, a physician specializing in TB who is also trained as an
anthropologist and who has deep convictions about treating infectious disease
where it hits hardest–among the poor. A NYT Bestseller, the book trails
Farmer from his start-up work in Haiti, which grew into Partners In Health, to
related efforts to treat MDR (multiple drug resistant) TB in a region of Peru
(eventually the entire country) and also in the prison system in Russia. Farmer
is depicted as ingenious and unshakably committed to his work; he responds to
ceaseless demands with a conventions-be-damned attitude toward medical treatment
and cost efficacy when it comes to TB treatments.

I had considered posting about the book earlier, noting the few
check-marks I’ve put in the margins next to the bits I want to find again–bits
about Farmer’s language games (ending assertions about commonplace attitudes
toward the poor with the word comma to imply the unspoken word to follow:
asshole; personifying infections diseases and closing his rants with
Love, ID.; or his neologisms and PIH-speak: "[t]o commit ‘a seven-three’ was
to use seven words where three would, and a ‘ninety-nine one hundred’ was
quitting on a nearly completed job" (217). Or the bit about "hermeneutics of
generosity" (215), where ethos blends with the believing game.

The TB-infected
passenger who hopped aboard a flight to Atlanta generated more noise than I would have
expected in light of reading Kidder’s book. I’m no TB expert (not even
close), but Kidder’s book gives a reasonably straight-forward account of the
differences among the virus’s drug resistances. In fact, Farmer is notable
in the subject-of-a-book sort of way in part because he is credited with getting
at the complexities of TB’s multiply resistant manifestations. The
breakthroughs in Peru involved his realization that certain first-line
treatments of the disease were, in effect, teaching the virus to resist certain
drugs. Treatment success rates were so low because the medical
establishment hadn’t yet figured out that their treatments were smartening up
the virus. The treatments were proliferating strands of the virus that
were less likely to be remedied through conventional and decades-old practices.

This week’s news, however, involves a case of XDR TB or extensively drug
resistant tuberculosis, for which there is only a 30-pecent cure-rate (so says
CNN). I can’t remember any discussion of XDR TB in Mountains Beyond
Mountains (my biggest complaint about the book is that it doesn’t have an
index), but as these events play out, as passengers who held seats on the plane get tested, and
as we watch the airlines scramble to resolve the medicalization of air space
(not only for flying and border-crossing, but for breathing), I am thinking
about this splash of news as a kind of mini-sequel to Kidder’s book, an extra
chapter in what is, for me, a new awareness of the complex set of issues knotted
together where medical research, germ circulation, epidemiology, border-keeping, and
health care privacy come together.