Saturday, November 26, 2005
The book starts off on describing how the author and Dr. Paul Farmer meet. The author was in Haiti to report on American soldiers, who were there to restore the Haiti government. Dr. Farmer and the caption of the army met up about a beheading, and this is where the author meets Dr. Farmer. The author then leaves Haiti to return home, and he sees Dr. Farmer on the plane. The two of them talked for a long time, and then later went to dinner. They kept in touch, and wrote letters to one another.
Five years passed by, and the author meets Dr. Farmer again at Brigham and Women’s hospital in Boston. Dr. Farmer and his team of other young doctors were discussing the issue of weather or not to treat a patient. Dr. Farmer worked for the HIV Central, and specialized in Infectious Disease. After the talks they decided to treat the patient, and then they went to work. The author went with Dr. Farmer to look at Joe’s X-rays. It was thought that Joe had been diagnosed with TB. The tw o of them then went into Joe’s hospital room to have a talk with him. The doctor requested that he start eating a little bit more because he had already lost 26 pounds. Joe requested that he wanted to have a special HIV home that he could go to. Dr. Farmer liked the idea, so they sent Joe to a shelter and Dr. Farmer said his goodbyes to the author and was off back to Haiti.
Chapter 3 by Allyson B.
In chapter 3 we get our first glimpse of Zanmi Lasante and what it’s all about. It beginss with Kidder on his way to Zanmi Lasante for the first time. He is being picked up at the Port-au-Prince airport in a “sturdy four-wheel-drive pickup”. As he is on his way he describes the landscape such as mountains and villages of wooden huts, beggars here and there, and so on. When Kidder arrives to Zanmi Lasante he describes it as a “fortress on its mountainside, a large complex of concrete buildings, half covered with tropical greenery.” He continues on to describe the inside as it appears, which is nothing like the rest of the outside city. Everything here in the hospital is new and well resourced. The next morning Kidder follows farmer has he does his morning rounds. Tons and tons of people are waiting outside of Zanmi Lasante to see a doctor or nurse. Most of them ask for Dokte Paul. Farmer comes out in the typical Haitian clothing-black jeans and a t-shirt. Everyone asks for him but he makes his way through the crowd looking for people in the most urgent need. Kidder then goes on to describe the accomplishments of Zanmi Lasante such as water systems and communal sanitation, schools and houses. Zanmi Lasante gets most of its money from a small public charity called Partners in Health and other individuals such as Tom White. Kidder then goes on to tell a little about Paul Farmer’s personal life; how he has a wife, Didi, and a daughter who live in Paris. Farmer is so busy with Zanmi Lasante and the Haitians that he’s home with his family only 4 months out of the year. Kidder then describes and talks about Farmer’s interaction with his patients. We can see that he is a very compassionate and loving man. He calls the older men “father” and women “mother”. Farmer through it all doesn’t sleep much and never has time to his self. He is always thinking about his patients and the next person he will help cure. Kidder also brings up the topic of sorcery for the first time. We later in the book see that sorcery is a big part of Haitian life. The basics presented in chapter 3 are that since the Haitians do not have money the rely on sorcery as an explanation fro diseases and death. The chapter ends with another day in the life Paul Farmer comes to a close and him and Kidder are on there way back to the Farmer’s little home. Of course before they can make it home a young girl is rushed in on a donkey ambulance. She has meningitis and the Haitian doctors do not issue a spinal tap so Farmer does it himself. We come to realize at the end that Farmer, even when we think the day is over, it isn’t. His work never ends. He is in a constant day to day fight against the disease of Haiti.
Chapter 4 by Franni
There was a staff debate including the Zanmi Lasante’s community
health center. It was at this debate when workers agreed that the
poorest patients suffer the most, especially because of malnutrition.
The Contradiction between faith and medicine is presented through out the chapter. Farmer wants doctors and nurses to imbed themselves with the patient they are treating, for example TB patients. So, each patient received “directly observed therapy” which consisted of a community health worker. In return, the worker would receive equivalent to five American dollars and benefits from the Zanmi Lasante. This plan seemed to be working well.
Highway 3 regards the US’ use of Haitian land to benefit others. The chapter goes into his travel around the dam. Both sides of the damn were different from one another. Farmer was quite popular around these areas. As him and his traveler finally travel back, he realizes that Farmer did not want to educate the world but transform it.
Pages 47 - 58 by Justin
This section of the book isn't all that eventful. It just describes Farmer's childhood and his mother and father. It begins by saying Farmer was born in Massachusettes. The father relocated the family to the South because the father was informed that he'd make a much better living. They stayed there for a few years a did quite well. Farmer says it was the first and last time (for a while) that his mother owned both a house and a dishwasher. The family then relocated again because the father didn't think that Mississippi was a safe place to grow up at the time (racial tensions in the South). So they relocated to a bayou in Florida where they lived in a bus that the father bought in a public auction. They lived on a campground in the bus for a while until the bus flipped off the interstate. The family then lived in tents until the bus was repeared. And finally, the father bought a boat on which they lived for a very long time (Farmer got through college I believe) and then it is stated that Farmer's father died in 1984 of a possible heart attack.
59-75 by Kyle
In this chapters , they discuss Farmers years at Duke University.He went to Paris to study, where he lived with a French family. He would go and watch political demonstrations.He studied many religious/science documents while in college.He was very fond of Haitians and Haitis history. He did a lot of volunteer work. He moved to a town called Mirebalais where he worked at the Eye Care Haiti.Years later he reiceved a letter from a woman he wanted to marry. She said she couldnt marry him because his willingness to deticate his life to the poor and his compassion was not in her interest. The rest of the chapter discusses how the met in the village they worked at and how they feel for each other.
88-103 by Allison K.
Paul Farmer expanded and refined the health census that he began in 1983. There was a
census done in the rural part of India, and he used it as a manual. Water, underground river, was
the main source of drinking water that is until it burst. Engineers came up with plan to make
water run through pipes, and infant deaths began dropping. They learned the importance of
water and health. They used building records to see how the new system was working, using the
census as help. Paul Farmer starts thinking about health. Tom White generously donates money
to feed the poor people in Haiti, in order for them to build a bread oven. Paul went to medical
school in Boston. A public charity in Boston, Partners In Health, was created as an organization
that would help support the growing system around Cange.
104-121 by Brooke
Farmer returned to Cange in a wheelchair in December 1988. There had been
several shootings and the government had become corrupt. Farmer went to the top of a hill where he looked out and thought about all the people that had died from the many diseases that were prevalent around the area. Kidder then begins to talk about Farmer’s absence from Harvard. His absence at Harvard ended up helping Farmer in the long run. By the time he was thirty-five he had dealt with more varies of illness then many American doctors do in their lifetime. Every time Farmer traveled back to Cange he was stopped at several check points where he was often verbally harassed and his medical supplies were often taken from him. Farmer was confused as to why the military disliked him because he had not played a big role in Haitian politics. He assumed that they were mad because every time one of his patients were sent to jail he would go to try and get them out. He also thought that maybe the wrong people had seen him with Aristide, a priest who publicly spoke out against the Haitian military and government. Aristide angered Farmer when he declared his candidacy for the president. Although, soon after he found himself rooting for Aristide because he know that the Haitian people demanded that he run. Aristide won in a landslide against the other twelve candidates. Farmer thought to himself that the real victors in the election were the Haitian people because Aristide was a president for the people. On Farmer’s next few trips around Haiti he wasn’t forced to stop and any checkpoints and wasn’t harassed by the military. However, that didn’t last for long. When Farmer tried to return to Cange after a trip to Boston he was shocked to find that all the flights there had been canceled. It turns out that Aristide had been deposed. Also the new authorities, the junta, had put his name on a list of people who were not allowed in. Finally he was able to return by bribing a Haitian army colonel. One day when Farmer was in his clinic working a woman came in and said that the army had beaten up her husband and left him for dead. It turns out that one of the men had heard Chouchou, the man who was assaulted, making a negative remark about the Haitian roads and he was later followed and beaten. Also, when he tried to return home he was beaten and left for dead. Farmer then realized how bad it had gotten over there. Farmer worked hard to get the word out in America about the problems and corrupt system in Haiti. There was talk in the United States for a while that they might send troops to put Aristide back into power. Up until the time that Aristide was put back into power in mid-October 1994, Farmer spent his time lecturing to anyone who would listen about the problems in Haiti. The government was corrupt and there were more diseases and people dying than ever before. Farmer returned to his clinic right when Aristide was put back into power.
126-141 by Alison M.
TB had vanished from the rich parts of the countries but not from the poor parts. Farmer had been working in Haiti and noticed that AIDS and TB effected each other and made the latent other one active. Many patients were infected with the strand of TB that was restistant to all of the first-line drugs. Farmer created Partners in Health and made Father Jack Roussin one of the board advisors. Jack Roussin went to a small town called Carabayllo and then Jim Kim wanted to work there. He wanted to do the work that Paul Farmer had done and finally got Farmer's approval. Farmer would travel back and forth between the Brigham and Carabayllo trying to cure patients. Ten of the patients he tried to cure had underwent treatment with the World Health Organization and a program the called DOTS, directly observed treatment short-course chemotherapy. Many of the strands of TB had went from one- or two-drug resistant strands to four- or five-drug resistant strands.
142-158 by Thao
Beginning of the chapter, the author explains that Peru has established their TB program called WHO in 1991. Farmer and Jim Kim found out that there will be an increasing number of people who are in the slum of MDR. And treating for than a handful of people, they knew it would a handful. While back when Farmer experienced his first case of MDR, he went to Michael Iseman for advice. He was working in one of the best TB centers called the National Jewish in Denver. Iseman and his colleagues had said that the cure rate was only abut 60 percent and cost up to $250,000 (in an very complicated case). To treat this, they needed to use second-line drugs which needed to be imported which means a lot more expensive. These drugs are very rare. All these drugs were weak and had side effects that and affect a patient for two years. Paul, Jim, and Ophelia talk again and again in various places. Then they decided to try on ten patients first. Paul nor Jim had a license to practice in Peru, but they knew a nun that is friends with the director of TB to let Paul and Jim intercede. However, they still had to get permission for each patient they treated. Paul Farmer and Sonya Shin, a young Harvard doctor, ask permission to treat David Carbajal, but permission was denied. Shin had to watch this patient die. Farmer wrote a letter to the TB managers about this, and then they replied that he is just a foreign doctor behaving inappropriately. Then, Farmer decided to go to Higher authorities. He was invited to give a speech in Chicago on TB. Farmer speech was mainly about that they should treat sick people if they had the technology to do it. Then one moderator considered his speech as "provocative." They think he is so into the patients that Farmer is not looking at the big picture.
The chapter started off with Farmer getting married to Didi Bertrand. Then the author go on stated that Peru was taxing the resources. It came up to fifteen to twenty thousand to treat a patient. The number of patients kept on growing. One day the president of Brigham told Hiatt, Paul and Jim were his favorite students, that Paul and Jim owe the Brigham hospital ninety-two thousand dollars. Before Paul and Jim would leave Peru, they go to the pharmacy and sweet talk them into giving them all the medicines. Farmer was traveling back and forth country to country. When Farmer had to give his speech in Chicago, he noticed he wasn't feeling well himself. He had nausea, vomiting, and night sweats, and then he realized that he had MDR himself. His wife told him to go see a doctor, but he said that he wants to do his monthly service in Brigham first. Then he realized his urine was dark, and he had hepatitis A from eating tainted fish in Lima. However, Farmer is still more concerned of all the other people's lives then his own. The MDR was making progress. Farmer had an appointment at the Children's Hospital. He had to treat his first child. Farmer proposed an "empiric" regimen. They were unsure at first, but then this child was dying so why not try it. Turns out the child was doing very well. The child mother went to Farmer and thanked him for her son. Farmer replied back to her saying that it was a privilege for him.
chapter 18 and 19 by brittany r.
April 1998) In the beginning of chapter 18, we learn that Howard Hiatt put together a meeting at the American Academy of Arts and Sciences in Boston to present early results from the small MDR treatment project in Peru. Farmer got a lot of top ranking TB experts to come to the meeting. There was much debate during the meeting about the funding of MDR-TB treatment and if it was really working. Jim Kim had an opening speech the following day at the meeting and the crowd asked him why a little organization like PIH had taken such a costly and difficult task in Peru. He responded and ended with a quote from Margaret Mead, "Never underestimate the ability of a small group of committed individuals to change the world...Indeed, they are the only ones who ever have."Chapter 19We learn that a committee has been formed to study the feasibility of DOTS-plus programs from the meeting in the previous chapter. For this program to ! work for such poor countries though, it had to be funded and therefore had to pass a test (cost effectiveness analysis). WHO declared MDR treatment largely ineffective, but on the basis of any substantial trials. But Jim Kim is determined and wants to drive down the prices by 90-95%. We learn more about Jim Kim and where he's from, Korea. He had done some studies there and had learned that often the price is high for drugs because only one company makes it. he told Howard Hiatt about the "price gouging", and decided that Jim should go to WHO to encourage drug companies to produce more second-line antibiotics. But WHO backed out leaving JIM to convene a meeting by himself in Boston. Through his meeting, he got IDA (International Dispensary Association) to do 'everything we can to lower prices by exploring generic manufactures." They created a committee called "green light committee" to control second-line drugs. Lima, Jim and Paul become more distant and in ! 2002 Ophelia wrote to Paul and Jim asking for more money (she's still in charge of the Budget). They devised a plan called "a dissembly strategy" and Jim put a giant proposal together. He met up with Paul in Moscow and they discussed how much they were going to ask for from "big shot donors" and agreed on 45 MILLION DOLLARS!
182-196 by Wes
Tracy tells us that Farmer was now forty and that his reputation had grown. He was about to become tenured at Harvard. Some people were saying that he redefined the field of anthropology. Farmer was often invited to lecture and medical schools around the world. Farmer didn’t let his fame get to him; he continued to see patients one-on-one in Haiti.
Farmer received about seventy five emails a day in early 2000 which he answered the majority of. The emails were filled with questions or requests for medical help and even questions from favorite medical students.
Ophelia defined it succinctly: “wherever he is, he’s missing from somewhere.” Tracy tagged along for what Farmer called a light month of travel.
Tracy and Farmer left Zanmi Lasante for the airport headed down national highway 3 in Haiti. Tracy describes sight of malnourished children walking barefoot carrying water and a thin man riding a starving donkey. Tracy thought of the Bible verse Matthew twenty-five. “Inasmuch as you have done to the least of these my brethren, you have done it unto me.” They went on to visit a man in prison accused of murder who Farmer had found a lawyer for then continued to the airport. On the plain Farmer describes the death a young girl the night before that he had tried to prevent. Tracy remarked on Farmer’s sleepless nights, hundred hour work weeks and incessant travel to which farmer said, “The problem is, if I don’t work this hard, someone will die who doesn’t have to.”
The Miami airport was Farmer’s main hub, while he was there he described it as either a Miami day or a Miami day plus. A Miami day plus involved sleeping overnight in the airport hotel. Farmer traveled with his computer and a suitcase with only three shirts for two weeks. The rest was filled with medicine and gifts for his guests. Farmer also did the Haitians favors like picking things up for them in the country like small appliances or delivering things for them. Tracy and Farmer were heading to Cuba which Farmer was looking forward to because he said, “No dead babies for a while.”
196-210 by Michael
On page 196, Doctor Farmer wakes up in Cuba. He is in Cuba to try and raise money for antiretroviral drugs. At the Aids conference he met a woman who might be able to help. She was the head of the United Nation’s project on HIV/AIDS in the Caribbean. Doctor Farmer then wanted to get doctors indigenous to Cange so that they wouldn’t leave when they were trained. Doctor Paul and his Cange staff found two local youths and sent them to Cuba to be trained in the brand new medical center there. Doctor Farmer caught the attention of two very important dignitaries when he gave a speech at the conference. One was the man who discovered AIDS and the other was the French ambassador to Cuba. Doctor Farmer stated in his speech that he ran an experiment involving two hundred women. Half were infected with AIDS and the other not infected. The experiment concluded that the women were being infected by the soldiers and truck drivers of the country. During this segment of the book, Doctor Farmer would work on his new book, Pathologies of Power. It contained a chapter where he compares the two ways in which AIDS had been managed on the island of Cuba. One was the quarantine of Haitians by the Americans at Guantanamo Bay. The other was a quarantine of Cubans by the Cuban government. The place where the Cuban quarantine was held is now a place where AIDS infected people can go and live with other Aids infected people. It is somewhat like quarantine, but it’s voluntary. When Farmer arrived back in Havana, Perez and him took a tour of the new hospital and visited some of the patients there. That was a hobby that both Perez and Doctor Farmer both enjoyed. Cuba was a vacation for Doctor Farmer because he did not receive any emails, so he was not obligated to respond to any of them until he returned to Cange. Farmer and Kidder’s flight was delayed back to the states and they sat in Cuba’s airport for five hours. Finally they arrived in Miami where Farmer realized he had over a thousand emails that needed to be answered. Kidder came down with a bad case of diarrhea and became one of Doctor Farmer’s patients.
He and Farmer go to Paris where they meet Farmer's family. Farmer convinces others to take a much needed vacation while he himself never does. A pregnant woman comes in suffereing from eclampsia. Farmer immediately begins treatering her. The baby is stillborn after being delivered. Then farmer began establishing a piece of private language for their month of travel. Farmer gave a speech to a class and said, "Looking for life, destroying life." He then explained what it meant. Farmer seemed to find the most fundamental part of life was the "erasing" of people, and the "hiding away" of suffering. Farmer goes to Moscow to help get a loan for the World Bank to try and stanch the TB epidemic in Russia. Farmer then flies to New York for an "emergency meeting" with Soros. Farmer believes in the importance of intentions and the power of will.
224-237 by Ty
Farmer visits Moscow’s central prison which is described as being dark and gloomy. He also explains how cold it is in the Moscow prison without a working air conditioner. 80% of the prisoners there have a form of tuberculosis and Dr. Farmer visits with them and the AIDS patients there. He says that it is necessary to separate the AIDS patients with the prisoners infected with TB in order to avoid the prisoners with AIDS from getting TB. Dr. Farmer then explains that if the Russia’s justice system wouldn’t be in such shambles than the prisons wouldn’t be such a hot bed for TB. Farmer then negotiates with Goldfarb on how much money the Russian prison should get from the World Bank loan.
The gates foundation has just given partners in health $45 million to help wipe out MDR-TB in Peru. The grant would last five years, enough time to wipe out 2,000 chronic cases and cure 80 percent. Farmer then begins to worry that others will stop contributing money because of all the press this grant has recieved. So Farmer assured all his contributors their money was still needed.
The chapter goes on to talk about Farmer not trying to be a model to shape your life after, but just an example about what should be done. It also talks about how PIH had become more calm and employees were actually able to leave at 5 some days, where in the old days they would take turns sleeping on the couch.
A foundation in Russia who worked with TB needed the PIH to take over the project, and Paul and Jim agreed. Jim was supposed to go to Russia to take care of managerial chores, and when a month had passed and he still hadn't gone, Farmer was mad and was arguing with Jim about it through Ophelia. Jim and Farmer have a heated discusion at a resturant one night, but leave as friends, and a few weeks later Jim headed to Siberia and Tracy went with him.
When they arrive in Russia, there is a banquet where several Russian generals and Jim get drunk and sing karoke. The next morning Jim leaves and Farmer takes his place. Farmer spends the day checking on patients and giving press conferences. At a banquet that night Farmer speaks and everyone loves him. The next day they flew to paris.
253-268 by Jessica
Farmer was now traveling more than ever. However, the author kept in touch with him by email. He wrote to the author from many different cities before he came back to Boston. While at Brigham, in Boston, a young man comes in with toxic shock. The young man’s parents were worried and did not think their son was going to make it, but Dr. Farmer reassured them that he would be walking out the hospital door at the end of two weeks, and two weeks later the young boy walked out the hospital door.
After visiting Brigham, he returned to Zanmi Lasante, a hospital near the area of Haiti. A doctor from Boston, Dr. Hiatt, was there to see Farmer’s hospital. When Dr. Hiatt returned to Boston, he wrote an article in The New York Times, that said that Zanmi Lasante had moved him more deeply than anything he’d ever seen before, and whatever time he had left on earth, he would spend helping the people at Zanmi Lasante.
Farmer then came up with the Global Fund. The Global Fund was intended to raise billions of dollars to help fight the world’s three great diseases. The fund was not raising as much money as it had intended to raise, but Farmer was happy with any money that was coming in. Farmer and many others were hoping that the United States would help with the raising of funds, but in 2000, the United States rejected the request to help fight the world’s three great diseases in Haiti. Framer said, “I sometimes think that I am going nuts, and that perhaps there is something good about blocking clean water for those preventing the resuscitation of the public health sector in the country most in need of it.” All together the Global Fund raised 14 million dollars.
The 14 million dollars went to many different cases. One such case was John’s, a young man who came to Zanmi Lasante with his mother not knowing what he was suffering from. He had swelling in his neck and his white blood cells were higher than usually seen in TB. Farmer thought about this and suspected that John had some sort of cancer. It would take a long time to diagnose in Haiti, so Farmer tried to work things out with a hospital in Boston. Many hospitals would not accept John’s case because it was very costly and John’s family did not have the money to afford it. Finally after trying many different hospitals, Massachusetts General Hospital decided to take him for free. While he was in the United States it was determined that John had nasopharyngeal carcinoma, a very rare cancer that needed to be treated immediately. John had become very sick and they had planned to bring him back to Haiti on a commercial plane, but the doctors knew that the airline would not allow him on there, and my pages stopped with them trying to decide whether or not they could afford a helicopter to bring him back to Haiti.
It begins at Dawn with Serena and Ti Fifi about to leave for Port-au-Prince to find an ambulance and a medevac flight for a young boy named John. In their frantic search they risk many lives and even describe the special honk you use in Port-au-Prince to let someone know you are coming around the corner on the wrong lane. Without a whole lot of trouble they find a medevac from Port-au-Prince to Boston for $18,540. With Paul in Russia communicating only by e-mail, Serena attempts to contact Paul, letting him know the latest on John situation and the cost of the medevac flight. The problem lies in the large sum of cash it will cost them to fly John to Boston for his free treatment at Mass General. In the end, Paul tells them to go ahead with the medevac. With their flight in order, all that was left was the Ambulance. The end up paying Sam’s Ambulance Service to drive all the way to Crange on Highway three in their old, two wheel drive Ambulance. After a few breakdowns, the ambulance could no longer go on. So, they pay the Ambulance crew to borrow their suction device, which they rewire to work off a cigarette lighter plug. The group left early the next day from the hospital and got John to his medevac flight. Unfortunately, John would die as Massachusetts General Hospital. The point of this chapter is not to show the failure of Paul’s team, but to show how much they care for every person, no matter what the circumstances. If nothing else, they helped a poor young boy be able to pass on in a comfortable surrounding. They even flew his mother up to be at his side.
282-301 by Erin
Tracy tells us that a lot of the staff involved in teaching disease prevention are former patients. A family of five had been treated for MDR and they were all cured and sent home except for one son. He felt responsible for infecting his family and was so filled with guilt that Farmer decided he couldn’t send him away. Farmer hired the young man as a TB “outreach worker.”
A boy named Alcante arrived at Zanmi Lasante’s Children’s Pavilion, with lumps on his neck that were symptomatic of scrofula. “He changed the atmosphere in the Children’s Pavilion and lessened the tightening Farmer felt in his chest as he climbed the stairs to that wing… and I think Alcante came to seem like the guardian angel of the place, or like Farmer’s.” As for any case of a child with scrofula, Farmer assumed Alcante had gotten it from his parents; Farmer had the family sent to Cange to be tested. Several members had TB, including Alcante’s father, who is still in therapy. Farmer was interested in where Alcante lived so Farmer went to his town of Casse.
Ti Jean, Farmer, and Tracy begin the long walk to Casse but stopped a quarter of the way to make a house call. They stopped at a hut with tiny rooms and dirt floors to find an elderly couple sitting together on a straw mat. Farmer suggested that the man had a stroke but would be able to recover. He also checked the woman’s blood pressure while he was there; hers was also high like her husband’s. Farmer treated them, said a few kind words, and then they were on their way.
Tracy then tells us about the term triage after Farmer tells him, “You should compare suffering. Which suffering is worse. It’s called triage.” Triage, in modern medical usage, has two meanings. In situations where doctors, nurses, and tools are limited, one performs triage by attending first to the severely wounded who have the best chance of survival. In well-staffed and well-stocked emergency rooms, however, triage isn’t supposed to imply withholding care from anyone; rather, it’s identifying the patients in gravest danger and giving them priority. Farmer then talks about how he has to do this day in and day out—do one thing over the other and often let some people die. In the case of a little boy named John, Farmer sent him to Boston on a plane (which costs $20,000) before knowing that cancer had invaded his vertebrae—meaning that they “wasted” (to some people) all that money to send a boy back to the US when it could have been spent elsewhere. Farmer says, “If I spent all my time arguing, No, this man needs Canadian crutches and a roof and a floor…if you spend all your time arguing about that stuff, defending yourself, you don’t get your work done…”
Ti Jean, Farmer, and Tracy finally arrive at Casse after several hours of walking. Several kids and other family members pile out of Alcante’s tiny hut. “On a scale of one to ten, this is a one,” says Farmer. Farmer plans to first cure the entire family of TB, then change the conditions that made them vulnerable to it. Tracy tells us that these long hikes to visit one or two patients are what keep Farmer going. Some believe Farmer is wasting his time by hiking all over the country when he could be doing more important things. By not approaching these patients, Farmer feels like he would be choosing who is more important and who has the right to live.
In the after-word, we are told that in 2002, WHO adopted new prescriptions for dealing with MDR-TB, the same as PIH had used in Carabayllo. The prices of second-line antibiotics continued to decline, and the drugs now flowed fairly smoothly through the Green Light Committee to Peru, where about 1,000 chronic patients were either cured or in treatment. The twin pandemics of AIDS and tuberculosis raged on in Africa, Asia, eastern Europe, and Latin America. Mathematical models predicted widening global catastrophe—100 million HIV infections in the world by the year 2010. In the summer of 2002 the expansion of Zanmi Lasante began. Farmer planned to build up the facilities in the central plateau, first of all towns near Cange. He sent teams of doctors and technicians to three towns—one was Lascahobas, which had a nearly empty private hospital and public clinic. Farmer sent in people to work there, along with a generator, a lab, and a full supplies of medicine. Haiti was still doing horribly but a group of Cangeois had drafted a petition to President Aristide asking for electricity; pylons were being erected to carry power to Cange for a few hours a day. A blood bank was also established so that Farmer could serve blood to the central plateau. Also in 2002, Cange saw its first open-heart surgeries performed by teams from the Brigham and South Carolina.
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