The Process — Mountains Beyond Mountains

Solving the problem of MDR-TB is circuitous at heart. In order to address the growing costs of treating drug-resistent TB, there must be measures taken to lower costs of second-line drugs. In theory, this can be done by finding generic drug manufacturers and asking these parties to produce cheaper medicines. But in practice, drug manufacturers are only willing to produce cheaper generics if there is the demand to justify their investment. In order to create this demand, PIH hoped to collaborate with WHO to modify the processes used to treat tuberculosis (see previous post). From the perspective of WHO, changing treatment processes for MDR-TB are only economically feasible if the costs incurred by second-line drugs is significantly reduced. And then return to “there must be measures taken to lower the costs of second-line drugs.”

I’ve come to realize that this process is something we’re all familiar with. We start a project hoping for the best out of people — that everyone does their fair share and everything goes as planned… but then things start to go wrong. Deadlines are missed and project proposals are rejected. Publishers don’t like our book, and scientific journals aren’t compelled by our research. The truly successful, however, are persistent — they have plans, and backup plans, and even backups of backup plans. In the case of PIH, plan B involved coordinating the efforts of nonprofit organizations. Paul Farmer and Jin Kim managed to raise several million dollars to combat drug-resistent TB, and created demand for cheaper drugs through their successes.

Regardless of what projects we work on, we will always be the most passionate about growing our brainchildren. So we shouldn’t rely on any World Health Organizations, or drug manufacturers, or even nonprofits, to get us where we want to go. That’s for us to pursue on our own.

On Gumption — Mountains Beyond Mountains

I’ve been diligently chipping away at Mountains Beyond Mountains, but in the interim I’ve also been reading Zen and the Art of Motorcycle Maintenance, a gem by Robert Persig.

Persig discusses the idea of “gumption” in the latter half of his book. In summary, gumption is motivation, diligence, and persistence all bundled into one word. It’s the driving force behind our focus when times get rough. When we suddenly encounter a bug we can’t fix, or an argument we can’t seem to win, strong gumption will win us that extra 1%. Weak gumption, on the other hand, leads to frustration, burnout, and boredom.

I can’t help but wonder how Pel Farmer keeps a steady supply of gumption… He stares tuberculosis in the eyes in areas where people are much too poor to help themselves. The world’s leading political health specialists have turned against Farmer, pronouncing resources are wasted on MDR-TB patients (multi-drug resistent TB patients). Even worse, the then-current standards in place to combat TB only stymie the treatment of MDR-TB. Standard treatment for TB called for a second round of two first-line drugs — drugs designed to treat two common types of TB-bacilli. But repeated treatment with identical drugs encourages the evolution of other drug-resistant bacteria. Even the dominant political stakeholders refuse to amend their treatment procedures to reflect the evolution of the illnesses they are trying to address.

Farmer and his PIH project are the only salmon swimming against the currents of medical professionals, government institutions, and billions of bacteria. But in the face of all of this, Farmer still dedicates himself to his cause, dumping hundreds of thousands of dollars into a program he helped create. He flies to and from Boston, where he is still doing his clinical rounds as a resident, starts a family, and battles Hepatitis A. Farmer never wavers, and never burns out.

His job is harder than most, but he sticks with it. It’s a cliche, but that’s something everyone can admire and learn from.

A Thought on Our Strengths — Mountains Beyond Mountains

Several of my friends and I had an interesting conversation over last weekend about the merits of socioeconomic affirmative action. The topic of the conversation stemmed naturally from that of affirmative action. But let’s try our best to stay away from discussing the pros and cons of either of these for now…

I personally believe that family backgrounds are an important factor in building the work ethics of students today. In view of Paul Farmer, I noticed that there were certain qualities he gained as a child that have persisted to the present day (his incredibly strong work ethic and ability to work anywhere). These personality traits aided Farmer in obtaining a strong education at both Duke and Harvard, and have contributed to his successes with his hospital in Haiti. But on the other hand, Farmer is the most academically successful of his siblings, one of which pursued a career in athletics (seemingly the opposite of academia).

As people from all walks of life, all races and all all socioeconomic statuses, how do we develop the skills necessary to unlock our true potentials?

The Idea of Professions — Mountains Beyond Mountains

There are two things I want to discuss from reading Mountains Beyond Mountains: the first is Paul Farmer, and the second is Paul Farmer being a doctor.

Last week I discussed briefly my interpretation of the concept of burn-out. It’s what happens when we work too hard, too fast, for too long, after we’ve bit off a little more than we can chew. We fall into that weird, half-depressed, half-tired state where things seem out of proportion and just a little impossible. But what if we’re Paul Farmer, and the “bit off a little more we can chew” is the poorest part of one of the most impoverished countries in the world? Every day, we work from sun-up until sun-up, at least more than four months a year. We fly between our $125,000 dollar professorships at Harvard Medical school and our home in Haiti, dialing our wife and daughter along the way. And when we’re doing none of those things, we’re the primary practitioner on call for any infectious-disease-related case at a very hectic Boston hospital.

By the way, we’re also broke, because all of our $125,000 paycheck goes to our kids, our mom’s mortgage, and our hospital in Haiti that serves hundreds of thousands of patients every year.

All of this makes me realize that I might have been a little wrong about the concept of burn-out — maybe sometimes there’s no such thing as working too hard, for too long. I’m not sure what to make out of the case of Paul Farmer yet, but it seems to me like there’s an incredible discipline that drives Dr. Farmer. It’s something I admire, and he’s forever going to be a role model to me.

The case of Dr.Farmer (being a doctor) has also helped me realize that the generalizations I’ve made about careers and professions are deeply flawed. I believe that many university students, myself included, categorize people in a general way. There are the businessmen and women, the engineers, the history/english/poly-sci majors, and the doctors. I don’t mean to be crude in my generalizations; as someone who falls into the “engineer” category, I resent this generalization, but am partly shaped by it nonetheless.

As a student studying Computer Science, I’ve often heard the idea that C.S. will help me break down bigger problems into smaller, more manageable ones. I’ve also heard that a good programmer knows how to compartmentalize, and divvy tasks between himself and his peers. Some say that developers have a keen ability to explain and discern difficult technical literature (who knows who came up with this one). All of these claims extend the concept that oftentimes engineers are like wild-cards — they can be played anywhere, in any profession.

Dr. Farmer’s patient interactions have led me to believe that the same is true for highly attentive doctors. His extreme discipline, deep passion, and uncanny ability to relate to both his patients and his acquaintances suggest he would be an incredible fit in any career. While the material knowledge Farmer has mastered is different from the business expertise of Tony Hsieh, I believe the concepts are completely cross-compatible. I feel that, had Farmer chosen a different path, he would have been just as capable, and just as passionate as he is currently about Haiti.

Thoughts?