As the chapter begins, Howard Hiatt is explaining to Kidder that Farmer and Jim Kim have “mobilized the world to accept drug-resistance TB as a soluble problem.” But TB is only part of the problem. Outbreaks of malaria cause millions of death in the developing world, as does the ongoing AIDS crisis. Because of the danger of these threats to world health, Hiatt has long been trying to convince Farmer to devote most of his time to worldwide health strategy, instead of hands-on work in Haiti.
As Farmer gets older and more famous, it becomes increasingly odd that he spends so much of his personal time with patients. This is unusual not only because most famous doctors concentrate on research, but because most famous doctors know that they can accomplish more by focusing on the “big picture.” Farmer, however, continues to focus on individual humans, considering one patient at a time with each case infinitely valuable to him, even as he also works to alleviate suffering on a political and institutional level.
Farmer is now 40 years old. He’s a tenured professor at Harvard, and renowned for “redefining the field” of anthropology. He’s on the boards of countless medical councils around the world, and is regularly invited to lecture on public health. And yet Farmer continues to spend long hours working one-on-one with patients in Haiti. Kidder notices that Farmer receives about 75 emails a day: He’s bombarded with requests for advice from doctors in Brigham, or young ambitious students looking for a letter of recommendation. Despite being very busy, Farmer answers almost all of his emails immediately.
It’s a mark of Farmer’s dedication that he answers all of his emails—fundamentally, he cares about human connection, whether it’s an email response or a patient consultation. To him, spending his life lecturing at Harvard Medical School is almost inconceivable.
To get a sense for how busy Farmer has become, Kidder “tags along” with him for a month in early 2000. He travels to Cange, where he witnesses Farmer working late nights. Then he goes with Farmer to South Carolina for a church event; then Cuba for an AIDS conference; then Moscow for a TB conference; then Paris. Farmer’s travel is almost always paid for by the hosts of these conferences.
The scene is now set for Part Four of this book, in which Kidder will follow Farmer around the world for a typical month in his adult life.
Back in Haiti, Kidder looks at the decrepit roads in Cange. Haitians built the roads under the supervision of the U.S. army in the 1910s, controlled by a system of conscripted labor that dates back to the time of slavery. Kidder and Farmer visit a Haitian prison to inspect the living conditions, and make a variety of other errands. In between errands, Farmer quotes a Bible verse: “Inasmuch as you have done it unto the least of these my brethren, you have done it unto me.”
Kidder contrasts the derelict state of Haiti—a landscape that suggests the enormous difficulty of fighting poverty and misery there—with Farmer’s optimism. Although Farmer acknowledges that it’s very difficult, if not impossible, to eradicate poverty altogether, he also believes that any attempts to do so are not only crucial, but also are part of basic human decency. Any medical work in Haiti is good, even holy, no matter how futile it may seem in the long run. Again we see Farmer using religion insofar as it supports and inspires his work.
The next day, Farmer and Kidder fly to Miami. At the Miami airport, Farmer “catches up” with his friends—he’s spent so much time in the airport that he knows almost everyone there. Farmer and Kidder spend a night at the Miami Airport Hotel, and then wake up at 4 AM and prepare for a flight to Havana, Cuba. Farmer gives Kidder “travel tips”—for instance, he tells Kidder that a packet of peanuts and some Bloody Mary mix make a decent meal on the plane. Farmer shows Kidder a list of errands he’ll need to run in Haiti on behalf of his Haitian friends. Whenever Farmer leaves Haiti, his friends ask him to buy them things in Cuba or the U.S.
In this comic section, we get a sense for how much time Farmer spends traveling: he’s spent so many hours in the Miami airport alone that he knows almost everyone there. This brings up another important point as well. Although Farmer spends many hours every day helping patients, he also spends many hours a day sitting on a plane, not seeing any patients. This is the tradeoff that Farmer faces: ironically, by deciding to travel the world helping patients, he’s agreeing to spend a chunk of his month eating peanuts and drinking Bloody Marys.