Kidder comes to Carabayllo with Farmer. He’s struck by the traffic congestion in the area, and the gloom of the city by day—there’s so much smog that it’s difficult to see more than a few miles. Migrant workers come to Carabayllo from the surrounding countryside, hoping to find shelter, electricity, and clean water.
Carabayllo is something of a safe haven for migrant workers, even if its living conditions seem subpar for an American. Because many people come to Carabayllo from surrounding areas, it’s the ideal location for a good hospital.
In Carabayllo, Farmer and his assistants identify 10 cases of MDR-TB. He obtains samples of TB bacilli in these 10 patients, and flies them back to Boston for testing. Farmer reviews what he knows about multidrug resistance. Sometimes, antibiotics can cause multidrug resistance bacilli if the antibiotics aren’t consumed regularly: the bacilli build up immunities to the treatments. But this can’t be the cause of the MDR in Carabayllo, Farmer knows, as the only clinic that gave out antibiotics “did its job properly.” There must be another cause of the MDR.
Above all else, Farmer is a good scientist, and he’s able to be objective and disinterested when necessary. Following the steps of the scientific method, he identifies the problem and collects as much information as he can about the causes and effects of this problem. By interviewing patients and studying the structure of TB bacilli, Farmer gets closer and closer to isolating the cause of TB mutations.
Farmer develops a hypothesis for the cause of the MDR-TB. The 10 patients must have had a natural resistance to some of the usual TB drugs being distributed in Peru. When this is the case for a patient, taking other TB drugs can actually cause new MDR-TB, rather than wiping out TB. Farmer terms this process “amplification.” As Farmer makes his conclusion, he feels guilty for feeling so excited about such a dismal subject—this feeling, he notes, is the irony of medicine.
It’s important to understand Farmer’s emotions here, because they tell us a lot about Farmer himself. He is enjoying himself in this particular moment, as he’s a scientist solving a complex problem. And yet Farmer is also a moral, sensitive human being who can’t remain wholly objective—he’s proud of himself for solving the problem, but ashamed for feeling good about something that causes so much human suffering. These are the two sides of Farmer’s personality: the brilliant scientist and the compassionate “priest.”
Farmer researches the history of TB treatments in Lima, and realizes that the World Health Organization (WHO) has been inadvertently breeding MDR-TB. Worse, he learns that the WHO recognizes the existence of MDR-TB, and doesn’t think it’s a serious enough problem to treat. Farmer notes the bitter irony: in New York in the 80s, a strain of MDR-TB prompted a billion dollar research program that wiped out MDR-TB in New York. In Peru, by contrast, the same problem prompts no research at all.
Here Kidder complicates his point slightly, and further condemns Western racism and imperialism. While it’s true that big pharmaceutical companies base their decisions to manufacture drugs on the “dollars and cents” of the matter, they also favor American lives over Peruvian lives. The very idea of talking about the “dollars and cents” of a TB research program implies that the lives being saved are somehow cheap and expendable—measurable by cost-efficiency, rather than an inherent and priceless value.