In Peru, there is a “rigorous” anti-TB program, established in 1991. Farmer believes that at the present, faulty drug treatments have caused hundreds of drug-resistant strains of TB and other diseases. Farmer remembers meeting a Denver-based doctor named Michael Iseman, one of the world’s foremost authorities on MDR-TB. Iseman has been treating MDR-TB for years, often for huge sums of money. He has a success rate of only 60 percent, which isn’t very good for a U.S. facility.
Farmer isn’t a specialist in TB, but his time in the medical world has given him an important weapon for wiping out TB in the Third World: he has a huge network of friends and connections who specialize in the diseases he’s trying to eliminate.
Jim Kim and Farmer plan to treat MDR-TB in South America. Jim cynically points out that first world countries might need to pay more attention to the problem, because TB is an airborne disease—in other words, anyone, rich or poor, can get TB, so it’s a danger to the U.S. as well as Peru. In 1996, PIH begins treating TB patients. They hire a team of epidemiologists, including a brilliant doctor named Meche Becerra.
Kim is being cynical, but he’s also making a very important point: the disturbing fact is that the First World is more likely to spend money to wipe out a Third World disease if there’s a reasonable possibility that such a disease could spread to the First World at some point in the future.
In 1997, the PIH team proceeds with treating TB in South America. In Carabayllo, the doctors take on patients suffering from TB. Right away, they find that their research is unpopular in Peru, because it implies that the Peruvian government’s health measures are insufficient. Farmer and his team are derisively nicknamed Médicos adventureros: “adventuring doctors.” The government points out that neither Farmer nor Jim Kim has a legal right to practice medicine in Peru (in reality, these rules are almost never enforced in Peru). As a result, Farmer is forced to stop his treatments mid-way through, resulting in the death of a young man named David Carbajal.
By calling Farmer a mere “adventuring doctor,” the Peruvians imply that he’s somehow more interested in his own fame and success than in curing the disease he’s come to Peru to treat. The Peruvians think Farmer is like a typical spoiled “voluntourist,” who travels to Peru to “help people” but winds up posting about his trip on Facebook instead. This is certainly a valid perspective for locals to have of most visiting volunteers, but we know that in Farmer’s case this implication is very wrong.
Farmer tries to use his political influence to work around the Peruvian government. He makes a speech on TB in Chicago in February. He argues that it’s vital to treat MDR-TB in the third world, even though it’s extremely expensive. Farmer argues that the costs of treating individual cases of MDR-TB pale in comparison with the costs of allowing TB to thrive in the third world—it could spread to the U.S. easily. A few days later, there’s a rumor that someone at Farmer’s talk has called the director of Peru’s national TB program and told him that the program is killing patients.
Farmer is a clever politician and tactician, as well as a good doctor. Even though Farmer doesn’t really care about the costs of treating TB in Peru, he knows that he has to convince his wealthy American colleagues to fund his ventures. For this reason, he implies that the consequences of not treating TB could be dire for the U.S. In other words, he briefly speaks the language of his patrons and measures the value of Peruvian lives in terms of American lives.