For the second half of the 80s, Ophelia visits Farmer in Haiti every summer. Although Ophelia treasures her time with Farmer, she finds herself trying to spend as much time as possible in Port-au-Prince, the cleaner and more prosperous part of the country. Farmer finds these visits tiresome—when they’re in Port-au-Prince, Ophelia can tell that he is constantly thinking about getting back to Cange. Once, during a car ride, Ophelia accuses Farmer of being too self-righteous. Farmer immediately stops the car and yells for Ophelia to get out of the car. Ophelia is secretly pleased with herself—she’s finally proved to herself that Farmer has human flaws, and isn’t a saint.
The great irony of Farmer’s life is that while he excels at showing love and compassion for complete strangers (the people most of us would ignore), he’s often bad at expressing his love for the people who know him well (i.e., the kind of love that comes easily to most people). One result is that the people who know Farmer well secretly delight in angering him—anything to prove that he’s “only human.”
In the summer of 1986, Baby Doc is ousted from power. Many in Haiti think that Baby Doc’s departure signals the beginning of a new, more democratic era in the country’s history—but instead, power shifts to the military, and things remain more or less the same. Once, Farmer and Ophelia are in Port-au-Prince when shots break out: the army is breaking up a political demonstration. Ophelia wants to get out of danger as soon as possible, but Farmer insists on going back to help the wounded.
Although Farmer wants to address the root causes of disease in Haiti, there seems to be almost no progress in doing so. On the contrary, the current dictator is merely replaced by another similarly dangerous government force. The more Haiti changes, the more it stays the same. This might make us question Farmer’s mission: if Haiti remains a corrupt, impoverished state, then what good is Farmer’s work?
In 1988, Ophelia comes to live with Farmer in Boston, where Farmer is busy with his clinical rotations. Although Farmer is forced to remain outside of Haiti, he uses his time in Boston to raise money. He founds a charity called Partners in Health, and convinces a rich college roommate, Todd McCormack, to be on the board of advisers. Other PIH members include Jim Yong Kim, another medical student at Harvard. Kim shared Farmer’s ambitions, and despises the American establishment for contributing to institutionalized poverty. Kim worries that building clinics in Haiti will only make Haiti more dependent on Western aid. Only a radical attack on the root causes on Haitian poverty can truly eliminate the country’s problems. Farmer agrees, and insists that he is an ally to anyone trying to challenge institutionalized poverty.
Although Farmer doesn’t approve of the “one percent” lifestyle, he knows that he must depend upon the wealthy for funds. Thus, he has no qualms about using his relationship with his roommates and other college friends to help Haitian patients. Farmer and Kim are realistic about their humanitarian work abroad, but they’re not cynical. It’s all too easy for Americans to believe that charity work never accomplishes anything, and this mindset is often a way for the wealthy and powerful to rationalize the status quo instead of trying to change it. Farmer finds that the opposite is true: it would be barbaric not to try to improve the quality of life in Haiti.
At the end of his clinical rotations, Farmer is preparing to come to Haiti permanently. Then he is hit by a car in Boston, and has to spend weeks in the hospital with a broken leg. In the hospital, he tries to convince Ophelia to come with him to do charity work in Haiti. Ophelia is sure that Farmer loves her, and she knows that she loves him, but she doesn’t want to commit to a life in Haiti, where she knows she’ll never be more important to Farmer than his medical practice is.
This is a revisiting of the episode that later inspires Farmer to work harder, as his broken leg (supposedly) causes the death of a Haitian patient. It’s not a coincidence that this is also the moment when Ophelia realizes that she and Farmer can never be truly close. Ophelia simply can’t compete with Farmer’s patients, and she (like most humans) needs a little selfishness and comfort in her life.
In the early 90s, Farmer proposes to Ophelia, and she turns him down. Hurt, Farmer tells Ophelia that he can’t see her—it would be too painful. For many years afterwards, Ophelia only hears about Farmer through Jim Kim. But gradually, Ophelia works her way into the structure of PIH. Farmer has a lifelong “weakness” for forgiving people. Eventually, he forgives Ophelia for turning him down, and soon, they’re back to their old friendship.
Even though Farmer is extremely busy with his patients, and feels guilty giving attention to anyone who doesn’t seem to immediately need it, he is still subject to his romantic desires, and he wants to get married. Clearly Farmer loves Ophelia, but it’s also clear that he has different ideas about what a marriage should be: Farmer must be aware that he wouldn’t be spending more than a few hours a week with his wife. Ultimately, this kind of marriage is too psychologically taxing for Ophelia to accept.