In 2000, Kidder is in Haiti, having been invited there by Farmer. He’s driven through Haiti along the National Highway, a road surrounded on all sides by decaying houses and ruined cars. After three hours, the car arrives at Zanmi Lasante, the huge building where Farmer practices medicine and takes care of patients. Zanmi Lasante is something of a miracle to Kidder: a paradise of health and efficiency in the middle of an extremely poor country.
We’re back in Haiti, the antithesis of peaceful, quiet Boston. In the same way that Farmer represents the “third way” between Haiti and America, Zanmi Lasante is a blend of American medicine and day-to-day Haitian life: an oasis in the middle of a desert.
Kidder follows Farmer through a typical day. Farmer wakes early, dressing in jeans and a t-shirt. His co-workers and patients call him “Doktè Paul.” Every day Farmer walks outside Zanmi, where a massive crowd of injured and sick people waits to be treated. Farmer finds the people whose needs are most urgent, and takes them inside immediately.
When reading about Farmer, it’s hard not to think of Jesus Christ walking through the streets, surrounded by lepers desperate to be cured. We can sense that Kidder is awestruck by Farmer’s generosity and brilliance. Farmer may not be a saint, but at first glance he certainly looks like one.
Kidder observes life in Cange, the nearest city to Zanmi Lasante, during his first week. There are hundreds of thousands of peasant farmers in the Cange area. They work in unsanitary conditions, and work long hours. When Zanmi Lasante was first established, Farmer and his colleagues arranged a system whereby patients only had to pay about 80 cents per visit. Under Farmer’s leadership, however, almost nobody pays even this low fee: he’s simply ignored the hospital rules in the interest of helping more people. At Zanmi Lasante, there are schools and houses being built. Hundreds of children are vaccinated every day. The charity that funds Zanmi Lasante, Partners in Health (PIH), was founded by Farmer himself.
We’ve already see that Farmer is something of an iconoclast in the medical world—he has no problem smuggling beer into a homeless shelter, for example. Here, Farmer’s rule breaking is even more extreme: he blatantly violates the “admission policy” for Zanmi Lasante, essentially treating his patients for free. As Kidder describes the Haitian facilities, we have to wonder who’s paying for all this—if the expensive treatments and complex equipment that Farmer uses every day are entirely funded by Farmer’s own charity.
Kidder notes that the average hospital in Massachusetts serves about 175,000 people a year. Although Farmer’s facilities in Haiti serve about the same number, they do so with a tiny fraction of the budget. Farmer continues his work in Haiti thanks to private donations, as well as some of his own money. In 1993, the Macarthur Foundation awarded him a “genius grant” of 220,000 dollars. Despite his relatively high salary from Brigham, Farmer lives in a small house, and he often finds himself in debt due to his generosity in funding his hospital in Haiti.
As we learn more about him, Farmer does seem to be “saint-like” in almost every way. Although he works with huge amounts of money, he never spends this money on himself. He also seems uninterested in saving or being cost-effective (something we will see more of later), as he sometimes uses all of his resources to fund his medical projects in Haiti and the Third World.
Kidder gives more information about Farmer. He’s married to a Haitian woman named Didi Bertrand. They have a daughter, who lived with Didi when she was studying anthropology in Paris. Many of Farmer’s friends note that he didn’t spend much time with his wife and daughter during his daughter’s early years. Farmer explains that he is too busy helping the sick.
This passage sets up a tension in Farmer’s character. Clearly, Farmer is a very good man, devoting his time to the sick and poor to an unmatched extent. And yet he seems to be reluctant—or maybe just too busy—to give too much time or attention to his family: ironically, the form of love that usually comes most easily to people.
Every morning in Haiti, Farmer goes to his offices in Zanmi Lasante. He usually has a couple dozen patients waiting to see him. On the first day Kidder observes him, Farmer meets with an elderly woman with tuberculosis of the spine. She kisses Farmer in gratitude for all he’s done to help her. A peasant tells Kidder, “God gives everyone a gift and his gift is healing.” There are rumors throughout Haiti that Farmer is a magician or a sorcerer.
Seemingly everyone whom Farmer has ever treated regards Farmer as a great, almost supernaturally gifted man. While other accomplished doctors remain isolated from patients, preferring to spend their time conducting research, Farmer takes the opposite approach. We also see here the theme of science, magic, and religion—aspects of healing that are especially intertwined in places like Haiti.
Kidder takes a moment to explain the Haitian attitude toward magic. Many Haitians believe in sorcery—indeed, they sometimes cite sorcery as the reason for their medical problems. One woman explains that her son has “sold” his brother to a sorcerer. Farmer is comfortable talking with patients in terms of magic and sorcery for long stretches of time.
Farmer’s devotion to his patients doesn’t stop with healthcare itself. He’s also spent time learning about Haitian culture so that he can better communicate with the people he treats, and can treat them in a more holistic way that doesn’t seem foreign or invasive to their lifestyle.
In Haiti, Farmer uses new antiretroviral drugs to treat AIDS and HIV. These drugs are still cutting-edge, and Farmer is the only one using them in Haiti. Nevertheless, the drugs are very expensive, meaning that Farmer has had to lean on his connections in Massachusetts frequently.
All these treatments and hospitals aren’t free. Someone needs to pay for them, and the payments mostly come from wealthy people who live back in the U.S. A good book about Farmer’s work must also discuss Farmer’s financial backers, as he would be much less effective without them.
Kidder describes how late one night Farmer rushes to the Zanmi Lasante facilities, where a young girl is suffering from meningitis. Farmer calmly prepares to give the girl a spinal tap in order to determine which drug would be most effective in treating her. As he prepares the spinal tap, the girl whimpers that she’s hungry. Kidder notes that only in Haiti would a child talk of hunger at such a time.
The disparity between life in Boston and life in Haiti is mind-boggling. The little girl who complains of hunger is probably starving—one would have to be exceptionally hungry to think of food even after a spinal tap had made her so nauseous. Kidder’s book aims to familiarize readers with Farmer’s work, but also with the difficulties of life in Haiti—a country that usually receives very little attention.