PP290-4 Integrated notes on Paul Farmer
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Mountains Beyond Mountains
By Tracy Kidder
1. What is Paul Farmer’s definition of the problem, and how does the
problem change over time?
Definition of 
problem 

How 
definition
changes 
Economic injustice/inequity; disparity in wealth allocation
Inequalities in healthcare; quality healthcare is a right
Rejection of denial
Expands problem from Haiti to include poverty/poor healthcare in
other parts of the world
Problem ultimately becomes the fault of entire system
2. What is Paul Farmer’s strategy and how does it change over time?
Strategy 






How 
strategy 
changes 


Practicing physician and trying to make broad changes at the same
time (individual and sytem)
Used boldness, creativity, expertise, morals, outrage
A voice for the poor; build a constituency and fight for them
Confrontational; apply heat to overcome people’s denial; evokes
strong response
Leadership by example; take on challenging projects to demonstrate
it can be done
Cultivated relationships and educated those who could help him
strategize and grow the organization
Overpromising in order make people pay or give
Does not seem strategic but more organic
Entrepreneurial approach – tackle new problems as they come
Constantly reframing the issue and broader and at a higher level
(village, town, country, global)
Continually expands audience that benefits from his work
Start from work on the ground, staying well connected in Boston
and starting Partners in Health, then growing to become global
3. What do we understand about Paul Farmer’s personality drug?
Personality 
drug 
Humber-than-thou; proud to be the most humble
Martyrdom, messiah-hood (ironic that his drive to serve the poor is
PP290-4 Integrated notes on Paul Farmer
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


Effect of 
personality 
drug 

ultimately a self-serving ambition)
Outrage with optimism
Mania, deprivation, workaholism
Love and adoration from people
Adds to his credibility by putting himself on the line every day
Runs the risk of marginalizing himself from mainstream
Failing to develop leadership within PIH; lack of sustainability for
organization
No family life
4. What is Paul Farmer’s overall effectiveness and what can we learn
about our own leadership in terms of positives and negatives?
Overall 
effectiveness 


Positive 
lessons




Negative 
lessons



Amount of desire for change will determine success
Dedication, single-mindedness, focus drew followers
Extremely effective in drawing attention to problems and raising
money/resources
Successfully applied heat to overcome denial and raise expectations
Good leaders will be surrounded by people who make up for their
deficiencies
Change involves an element of risk
Put our knowledge and sense of right and wrong to use; give voice
to people who don’t have one
Be mindful of when to apply heat to generate outrage
Constant reframing benefits cause
Can one be an effective leader if you lose the love and respect of
your own family?
May be marginalized by being too honest and applying too much
heat
Beware of personality drugs that may hinder our effectiveness and
develop strategies to deal with them
How do you focus on "what could be" while still operating in the
real world of scarce resources?