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One by One by One: Making a Small Difference Amid a Billion Problems
In the spirit of Tracy Kidder's Mountains Beyond Mountains, and joining the ranks of works by Bryan Stevenson, Matthew Desmond, Abraham Verghese and Oliver Sacks, the inspiring story of a young American neurologist's struggle to make a difference in Haiti by treating one patient at a time--a story of social justice, clashing cultures, and what it means to treat strangers as members of our family.Dr. Aaron Berkowitz had just finished his neurology training when he was sent to Haiti on his first assignment with Partners In Health. There, he meets Janel, a 23-year-old man with the largest brain tumor Berkowitz or any of his neurosurgeon colleagues at Harvard Medical School have ever seen. Determined to live up to Partners In Health's mission statement "to bring the benefits of modern medical science to those most in need," Berkowitz tries to save Janel's life by bringing him back to Boston for a 12-hour surgery. In One by One by One, Berkowitz traces what he learns and grapples with as a young doctor trying to bridge the gap between one of the world's richest countries and one of the world's poorest to make the first big save of his medical career.As Janel and Berkowitz travel back and forth between the high-tech neurosurgical operating rooms of Harvard's hospitals and Janel's dirt-floored hut in rural Haiti, they face countless heart-wrenching twists and turns. Janel remains comatose for months after his surgery. It's not clear he will recover enough to return to Haiti and be able to survive there. So he goes for a second brain surgery, a third, a fourth. Berkowitz brings the reader to the front lines of global humanitarian work as he struggles to overcome the challenges that arise when well-meaning intentions give rise to unintended consequences, when cultures and belief systems clash, and when it's not clear what the right thing to do is, let alone the right way to do it. One by One by One is a gripping account of the triumphs, tragedies, and confusing spaces in between as an idealistic young doctor learns the hard but necessary lessons of living by the Haitian proverb tout moun se moun--every person is a person.
342 pages, Kindle Edition
First published June 2, 2020
57 people are currently reading
603 people want to read
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Displaying 1 - 30 of 36 reviews
December 26, 2023
This book has all components of an amazing non fiction audiobook: great narrator, topic that is humanly important, eye-opening but not preachy, and easy to follow along no matter how much do you know about the topic.
I have been actively seeking moments of peace in my everyday chaos to listen to authors' experiences and thoughts about voluntourism, inequality, poverty, accessibility, prejudice, and much more.
The reason I couldn't give this book 5 stars is a small but persistent feeling of unease I had. While the author is very competent, intelligent, experienced, kind, well-intentioned, and surrounded with even more experienced doctors, at times, he seems so oblivious to possible consequences of his actions. I am not sure if that was added to the book just to give it more twists or what is going on, but it stopped me from hitting that 5 stars button.
I have been actively seeking moments of peace in my everyday chaos to listen to authors' experiences and thoughts about voluntourism, inequality, poverty, accessibility, prejudice, and much more.
The reason I couldn't give this book 5 stars is a small but persistent feeling of unease I had. While the author is very competent, intelligent, experienced, kind, well-intentioned, and surrounded with even more experienced doctors, at times, he seems so oblivious to possible consequences of his actions. I am not sure if that was added to the book just to give it more twists or what is going on, but it stopped me from hitting that 5 stars button.
January 4, 2025
10/10 made me like medicine again LMAO Uworld can’t beat me down‼️ in Paul farmer’s (everyone’s fav global health superstar) words: it breaks your heart and then puts it back together in the end. Wonderfully written, lots of introspection questioning the role of the physician, and how to advance global health systems while also providing preferential care to the poor snd underserved
April 14, 2021
I'm an admirer of PIH and the work it does, and so when this book came up as a potential common read for my university, I was excited to read it - especially since Mountain Beyond Mountains was a common read several years before, and I thought it excellent. For me, though, this book left me more discomfited than inspired. I have been a patient for a good portion of my life, and seeing how doctors talk about some of their patients when they're not around is... unpleasant. Which was the point, in some ways, but it was not unpacked enough to make me feel anything other than slightly ill about it all.
I didn't like the Janel was supposedly the focus of this book, and yet he disappears from the narrative almost entirely at the mid-point and only comes back in the end as miraculously cured - and no follow-up info provided on what, exactly, happened. It's like Paul Farmer arrives and BAM! Janel is fixed, by Dr. Farmer's presence alone! Dr. Berkowitz may not have been there to see the development of Janel's case, but why was there no info on what questions he asked Janel or Janel's mother about how his recovery happened? It felt like Janel was a convenient narrative tool at the end - initially a patient in his own right, but then turned into a tool to put a nice, narrative conclusion to the memoir. I was very uncomfortable with that.
There are certainly good parts of the book - the reiteration of the general philosophies of organizations like PIH, that work to provide excellent health care to anyone, regardless of geography, poverty, or logistics, and how important it is for people to be treated kindly and fairly in that regard; the short, but impactful, examination of wealth disparities and their connection to health outcomes; the connection of colonialism and slavery to present conditions in Haiti, etc. But I can get those from other books, and have, and so these positives alone are not enough to have me recommend it as a common read for my uni. I still respect and admire the work of PIH and other affiliated folks, but this book didn't send me.
I didn't like the Janel was supposedly the focus of this book, and yet he disappears from the narrative almost entirely at the mid-point and only comes back in the end as miraculously cured - and no follow-up info provided on what, exactly, happened. It's like Paul Farmer arrives and BAM! Janel is fixed, by Dr. Farmer's presence alone! Dr. Berkowitz may not have been there to see the development of Janel's case, but why was there no info on what questions he asked Janel or Janel's mother about how his recovery happened? It felt like Janel was a convenient narrative tool at the end - initially a patient in his own right, but then turned into a tool to put a nice, narrative conclusion to the memoir. I was very uncomfortable with that.
There are certainly good parts of the book - the reiteration of the general philosophies of organizations like PIH, that work to provide excellent health care to anyone, regardless of geography, poverty, or logistics, and how important it is for people to be treated kindly and fairly in that regard; the short, but impactful, examination of wealth disparities and their connection to health outcomes; the connection of colonialism and slavery to present conditions in Haiti, etc. But I can get those from other books, and have, and so these positives alone are not enough to have me recommend it as a common read for my uni. I still respect and admire the work of PIH and other affiliated folks, but this book didn't send me.
October 13, 2023
as a neurology resident, I found this to be such an inspiring, engaging, and well-written read. this book serves as a reminder that every patient, regardless of where they are born, has the right to be cared for as a human being and not as a statistic. thank you Dr. Berkowitz for being an amazing doctor, advocate, and role model - you are a true legend in the fields of neurology and global health 🧠🌎
June 5, 2022
As a proponent of Effective Altruism - the story for spending hundred of thousands of dollars to fly one brain tumor patient from Haiti to Boston for survey, physical therapy, and chemo treatment is superbly cost ineffective.
As a human being with a soft spot for warm and fuzzy stories about solving inequality in global health, there is a desire to sell my soul for Partners in Health.
At the end of the day, there is no right answer. Berkowitz acknowledge the shortcoming & cost ineffectiveness of bringing 3+ patients into the US for fully funded surgeries. But also, human lives are human lives. Do you ignore a drowning kid to instead spend that time making money to donate to save 10+ lives?
This book helped to create greater perspective & meaning behind the words: healthcare inequity. If I ever have cancer or a brain tumor, I can easily walk to the nearest urgent care/hospital knowing that there are resources & knowledge for a promising plan for treatment. We cannot say the same for many many people in the world.
Quotes:
stupid death - "a tragically unnecessary death in a poor country rom a condition that would have never been fatal in a rich country
"Paul Farmer would say it's not about being unlucky to have been born in one place and lucky to have been born in another. He would explain that it has nothing to do with luck at all but rather with the forces of history, economics, and politics that create and continue to deepen such inequities."
As a human being with a soft spot for warm and fuzzy stories about solving inequality in global health, there is a desire to sell my soul for Partners in Health.
At the end of the day, there is no right answer. Berkowitz acknowledge the shortcoming & cost ineffectiveness of bringing 3+ patients into the US for fully funded surgeries. But also, human lives are human lives. Do you ignore a drowning kid to instead spend that time making money to donate to save 10+ lives?
This book helped to create greater perspective & meaning behind the words: healthcare inequity. If I ever have cancer or a brain tumor, I can easily walk to the nearest urgent care/hospital knowing that there are resources & knowledge for a promising plan for treatment. We cannot say the same for many many people in the world.
Quotes:
stupid death - "a tragically unnecessary death in a poor country rom a condition that would have never been fatal in a rich country
"Paul Farmer would say it's not about being unlucky to have been born in one place and lucky to have been born in another. He would explain that it has nothing to do with luck at all but rather with the forces of history, economics, and politics that create and continue to deepen such inequities."
June 12, 2020
*Thank you to Net Galley and Harper Collins for the advance copy*
Read this book.
A few weeks out of the year Dr. Berkowitz, a neurologist at Boston's Brigham and Women's Hospital, travels to Haiti with Partners in Health, the NGO founded by Dr. Paul Farmer (Mountains Beyond Mountains), to help the medical team based in Haiti diagnosis and create a treatment plan for their neurology patients. In Haiti, Dr. Berkowitz meets Jamel, a wheel-chair dependent twenty three year old man living with a brain tumor. After conferencing Janel's case with a neurosurgeon back in Boston, they make the decision to bring Jamel to the US for surgery. In this book, Dr. Berkowitz, takes us through every step in the process of arranging medical care in the United States for his patients traveling from Haiti.
This book is about Janel's journey; how he came to the United States, responded to medical interventions, and his socioeconomic challenges in Haiti. But it is also about Dr. Berkowitz's journey as a newly practicing neurologist balancing responsibilities in the US and Haiti, realizing the limitations of health care in resource poor areas, and working to change it.
I may be biased because I live in Boston and I focused on global health work as part of my MPH. While completing my capstone in Ghana, I saw first hand how medical care is delivered in resource poor settings so I was already aware some of the limitations Dr. Berkowitz faced with treating patients in Haiti. It was interesting to read how those limitations were addressed from the perspective of an American physician. He describes surgical procedures in detail from the initial incision to how the tumors affected a patient's functioning, but he also has this ability to connect with the patient's he treats (he speaks Haitian Creole) and describes them in vivid detail.
Dr. Berkowitz is impressive. I feel like I gained a good sense of the work Partners in Health is doing in Haiti and other resource poor countries to treat patients with complex medical needs. This does not read like a medical text or patient case study. Dr. Berkowitz has provided a window into Haitians and their culture. He draws comparisons between the inequality that would relate to those living in a developed country, like the United States. It's an engaging, heartwarming, and educational read. Highly recommend!
Read this book.
A few weeks out of the year Dr. Berkowitz, a neurologist at Boston's Brigham and Women's Hospital, travels to Haiti with Partners in Health, the NGO founded by Dr. Paul Farmer (Mountains Beyond Mountains), to help the medical team based in Haiti diagnosis and create a treatment plan for their neurology patients. In Haiti, Dr. Berkowitz meets Jamel, a wheel-chair dependent twenty three year old man living with a brain tumor. After conferencing Janel's case with a neurosurgeon back in Boston, they make the decision to bring Jamel to the US for surgery. In this book, Dr. Berkowitz, takes us through every step in the process of arranging medical care in the United States for his patients traveling from Haiti.
This book is about Janel's journey; how he came to the United States, responded to medical interventions, and his socioeconomic challenges in Haiti. But it is also about Dr. Berkowitz's journey as a newly practicing neurologist balancing responsibilities in the US and Haiti, realizing the limitations of health care in resource poor areas, and working to change it.
I may be biased because I live in Boston and I focused on global health work as part of my MPH. While completing my capstone in Ghana, I saw first hand how medical care is delivered in resource poor settings so I was already aware some of the limitations Dr. Berkowitz faced with treating patients in Haiti. It was interesting to read how those limitations were addressed from the perspective of an American physician. He describes surgical procedures in detail from the initial incision to how the tumors affected a patient's functioning, but he also has this ability to connect with the patient's he treats (he speaks Haitian Creole) and describes them in vivid detail.
Dr. Berkowitz is impressive. I feel like I gained a good sense of the work Partners in Health is doing in Haiti and other resource poor countries to treat patients with complex medical needs. This does not read like a medical text or patient case study. Dr. Berkowitz has provided a window into Haitians and their culture. He draws comparisons between the inequality that would relate to those living in a developed country, like the United States. It's an engaging, heartwarming, and educational read. Highly recommend!
August 8, 2021
I really enjoyed this book.
Dr. Berkowitz's descriptions of Haiti evoked memories of my medical trips to the Dominican Republic and Peru. While my trips were brief short-term missions, his struggles resonated with me: walking the tightrope between resources and need; the debate between helping more people generally vs. investing much into a single patient; thinking through the long-term ramifications of aid.
As the Chief Medical Officer of a community health center serving the uninsured, we face many of the same struggles. Some of our patients cannot afford even the basics of their care, even with our 340b (subsidized) pharmacy. How do they choose between paying rent, buying food, and buying medicine? Preventive care is an unaffordable luxury for many. We are battling the social determinants of health, which loom as large as their medical conditions -- all within miles of excellent, high level medical care. It might as well be thousands of miles away.
Our clinic has had some amazing success in reaching out to the neediest. However, providing robust primary care comes with a consequence -- we are diagnosing disease that needs care beyond our scope. Finding speciality care and treatment at a price our patients can afford is like scaling an increasingly slippery wall. What good is it to reveal disease that cannot be treated?
I was challenged by Dr. Berkowitz's description of "failure of imagination," and his quote of Dr. Paul Farmer - "If you believe it is impossible, it will be." We continue to reach out to find ways to serve our patients' needs -- and that means continuing to believe the impossible is possible.
Everyone is equally deserving of care. "Tout moun se moun." Every person is a person.
Dr. Berkowitz's descriptions of Haiti evoked memories of my medical trips to the Dominican Republic and Peru. While my trips were brief short-term missions, his struggles resonated with me: walking the tightrope between resources and need; the debate between helping more people generally vs. investing much into a single patient; thinking through the long-term ramifications of aid.
As the Chief Medical Officer of a community health center serving the uninsured, we face many of the same struggles. Some of our patients cannot afford even the basics of their care, even with our 340b (subsidized) pharmacy. How do they choose between paying rent, buying food, and buying medicine? Preventive care is an unaffordable luxury for many. We are battling the social determinants of health, which loom as large as their medical conditions -- all within miles of excellent, high level medical care. It might as well be thousands of miles away.
Our clinic has had some amazing success in reaching out to the neediest. However, providing robust primary care comes with a consequence -- we are diagnosing disease that needs care beyond our scope. Finding speciality care and treatment at a price our patients can afford is like scaling an increasingly slippery wall. What good is it to reveal disease that cannot be treated?
I was challenged by Dr. Berkowitz's description of "failure of imagination," and his quote of Dr. Paul Farmer - "If you believe it is impossible, it will be." We continue to reach out to find ways to serve our patients' needs -- and that means continuing to believe the impossible is possible.
Everyone is equally deserving of care. "Tout moun se moun." Every person is a person.
March 21, 2021
This is a memoir by the author, who is a neurologist at Brigham and Women's Hospital in Boston and a regular volunteer with a non-governmental organization called Partners in Health. He started by going to Haiti for two weeks a year and later more frequently. His task was to train doctors at a small rural hospital in Mirebalis outside of Port-au-Prince in the practice of neurology. Haiti has a population of 10 million - and has one neurologist and a single CT scanner, no MRI at the beginning of this story. More than half the population lives on less than two dollars a day. As a point of reference, Dr. Berkowitz's hospital alone in Boston has more than 100 neurologists on staff, with lots of fancy equipment to help in diagnosis and treatment of brain problems. This book is the story of things that are hopeful by trying to help one person at a time and depressing by what it says about the level of health care in poor countries. It is worth reading as a reminder of how incredibly lucky we are to live in the USA, and how brave and cheerful people with nothing manage to be. The message is that we can all do something, by doing good with one person at a time.
January 9, 2023
For my first book of this year, I wanted- needed- something that would restore some faith in humanity, and this book definitely met that need.
Personally, the pandemic only brought to light the inequities people face that many of us don’t even see or think about, and I’ve spent so much time “doom scrolling” wishing I had the means to help people with these problems that well, shouldn’t be problems in a first world country. Reading this book, I felt like Dr. Aaron felt much the same about these patients in Haiti so I related to his emotions on some level.
The beauty of this book is that it’s realistic. Dr. Berkowitz doesn’t just tell us the success stories like Davidson’s, he also tells us the tragic failure of Francky. And somewhere in between is Janel, whose stories I think captures the essence of the work described throughout this book: we do what we can to help those who need it and we try our best but it may not always work out the way we envisioned it. At the end of the day, doing what is right at the time (providing free surgery) is the the right thing to do because the intention (saving someone’s life) is noble.
Personally, the pandemic only brought to light the inequities people face that many of us don’t even see or think about, and I’ve spent so much time “doom scrolling” wishing I had the means to help people with these problems that well, shouldn’t be problems in a first world country. Reading this book, I felt like Dr. Aaron felt much the same about these patients in Haiti so I related to his emotions on some level.
The beauty of this book is that it’s realistic. Dr. Berkowitz doesn’t just tell us the success stories like Davidson’s, he also tells us the tragic failure of Francky. And somewhere in between is Janel, whose stories I think captures the essence of the work described throughout this book: we do what we can to help those who need it and we try our best but it may not always work out the way we envisioned it. At the end of the day, doing what is right at the time (providing free surgery) is the the right thing to do because the intention (saving someone’s life) is noble.
This entire review has been hidden because of spoilers.
July 6, 2021
Great read. Great questions to ask ourselves. Are we doing more harm by helping people in Haiti or doing more good? In the end I do believe in the mission of PIH. Not an easy, cut and dry, simplistic approach to care with actual patients but to see the entire up and downs of bringing patients here to the US from Haiti with hopes that our medical services and community can help them. And that’s the easy part! What happens when they go home and need care? What happens if there are complications from surgery or medication afterwards? And a completely different question - How can I have as much faith as the people in Haiti?
Incredible book with incredible people.
Highly recommend this book!
Incredible book with incredible people.
Highly recommend this book!
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May 15, 2025“I say before we criticize the people who actually come down here to try to help, we should criticize the people who don’t” -Jack the plumber
“‘The two most important days of your life are the day you are born, and the day you find out why’” -Mark Twain
“I’d been brash in the face of every concern so far, blinded by my belief that I was acting as a strong advocate for my patient against resistance in the system”
“I had been reluctant to give up, but was it because of all he’d been through or because of all we’d been through?”
“Proceed on principle, struggle to a solution, address obstacles as they arise”
“‘The two most important days of your life are the day you are born, and the day you find out why’” -Mark Twain
“I’d been brash in the face of every concern so far, blinded by my belief that I was acting as a strong advocate for my patient against resistance in the system”
“I had been reluctant to give up, but was it because of all he’d been through or because of all we’d been through?”
“Proceed on principle, struggle to a solution, address obstacles as they arise”
June 17, 2021
Another enjoyable memoir by a physician who has worked hard to make a difference in the world. I appreciated his consistent confessions that he was often not sure that he was doing the right thing when trying to help people in poverty. I'm sure a lot of us have trouble knowing if we're doing the right thing when we reach out to try to help someone, so I liked his perspective on that. I also appreciated that in spite of those reservations, he still just moved forward and tried his best to help some people.
July 30, 2021
I think that this book is so moving even for people who are not in medicine but as I physician, I found it especially moving. The inequities of healthcare are so devastating abs hard to stomach. The cases in Haiti that are presented here are amazing and inspired me to really look into spending more time with the underserved in medicine. At the same time, although I have no aspirations nor the ability in being a leader in global change, it did make me take pride in the small differences I am able provide to my patients….one case at a time.
January 7, 2024
I personally have been to Haiti and to this hospital mentioned in this book. I’m in awe of the determination and advocating that this doctor went through and the internal struggle of doing what’s right and when to know when it’s wrong.
His perspective is refreshing and gives insight into the medical community, which to average people, at times seems distant and heartless.
I’m a social worker and I will be bringing these thoughts from this book into the service I do with my clients. It’s a MUST read. And good for your heart.
His perspective is refreshing and gives insight into the medical community, which to average people, at times seems distant and heartless.
I’m a social worker and I will be bringing these thoughts from this book into the service I do with my clients. It’s a MUST read. And good for your heart.
August 15, 2020
Aaron Berkowitz is a young neurologist who works with the Partners in Health organization in Haiti. His work and experiences are moving as he struggles with the concept of whether it's right to use limited resources to help one patient whose need is huge and urgent or should resources be used to help as many as possible instead. It's a very real problem agencies must deal with as they try to make a difference in the lives of the poorest people.
June 13, 2022
I read a few sentences, a paragraph or two and the introduction in the front cover. It didn't make me feel any emotion or empathy for the people in the book. It seemed dramatized and some parts unethical. However, these comments should be taken with a grain of salt considering that I haven't read the whole book and I'm not a doctor. The writing was well structured. The story line became, at times, too focused on the dialogue.
June 2, 2021
I really enjoyed this book about a Boston doctor who spends weeks in Haiti helping with medical patients. His organization is the one written about in the brilliant book Mountains Beyond Mountains, and I loved the stories in this one. My one tiny complaint is that the title/subtitle/cover made me think it was going to be a self-help type book, when really it is a memoir
April 16, 2022
I am very glad I read it. It is the story of some people in Haiti the author has had the privilege of serving through his work in Partners in Health. It was a good read. I thought it could use some editing (could have been shorter), but the story is well told. And the issues he raises are complex and interesting. It was well worth reading.
October 15, 2022
This was a really good book. It really opened by eyes to all the complications people who need surgery face in third world countries. The stories about different patients treated by Dr. Berkowitz were moving and emotional. This book was not too difficult at all to read and I really enjoyed reading it!
December 19, 2021
“They always say in development work that you have to teach people to fish, not just give them a fish, or it isn’t sustainable. But do you know what, dear Aaron? Sometimes you just have to give them a fish! We can’t wait for it to be sustainable. In the meantime, they must eat!”
April 19, 2022
This really warmed my heart and gave me perspective on how PIH.org can and will continue with Dr. Farmer. Doctors like Aaron Berkowitz have already shouldered the mantle and are working with a preferential option for the poor in healthcare as a life work. How I appreciate that. 🙏
January 11, 2021
A passion to serve, that all lives matter, and to acknowledge that voice in our heads that asks “am I doing the right thing? What more can I do?”
Thank you
Thank you
March 26, 2021
Beautifully written tales of inequity. Truly inspiring.
July 4, 2021
A heartwarming memoir written by an American neurologist who volunteered in a Haitian hospital. Made me rethink about all of the privileges that some might experience in a functioning medical system.
October 4, 2021
Holt-Delhi Nonfiction Book Discussion Group title October 2021.
December 8, 2021
Loved this. It really shows the complexity of decision making in the author's mission work. No right answers.
January 3, 2022
Well written inspiring story.
June 8, 2022
Missing something...
September 10, 2022
I was so draw in I read this book in 3 days. A lot to think about in terms of world problems and our obligation to one another in this world.
October 20, 2022
What an unexpectedly refreshing book! I expected a "how to" self help-y book. What I got is a moving, motivating, thoughtful story about a neurologist in Boston who, through small, meaningful advances, through strategic connections, with the support of cheerleaders, and an occasional dose of good luck makes a difference in the lives of others. I was inspired and I think you will be too.
Displaying 1 - 30 of 36 reviews