Summary
Chapter 10 focuses on two interwoven relationships: Farmer's increasingly troubled romantic relationship with Ophelia, and his emerging relationship with those who would work to help Haiti with him. Tension grew between Paul and Ophelia because of his commitment to the Haitian poor: Farmer often acted like he wanted to do nothing else but help the poor, while Ophelia wanted to help the poor incredibly generously...and sometimes do some other things for herself, and with Paul. This led to disagreements, and in one case to a fight in which Farmer screamed at Ophelia to get out of the car and insulted her. During another trip to Port-au-Prince, in 1986, political violence erupted. There had been a protest, then the couple heard shots from their stopped car and a mob of peasants was suddenly running from them. Ophelia wanted to leave, for safety's sake; Paul wanted to stay, to witness the crimes and help people.

Eventually, in 1988, the couple's stresses came to a head while they were in Cambridge. A car hit Farmer and broke his leg. He would not obey medical orders about taking care of himself, and they fought over this and their life together until, on December 10, Farmer went back to Haiti.

However, while this relationship was deteriorating, Farmer was recruiting people to help him in his mission. With Tom White's support, Farmer started Partners in Health (PIH), with the parallel organization Zammi Lasante in Haiti. He enlisted a classmate from Duke (Todd McCormack) to serve on the board of directors and another anthropology/medical student from Harvard (Jim Yong Kim). The three young men and Ophelia (and sometimes Tom White) talked endlessly about what they should do and how to understand the world. They named their approach "pragmatic solidarity," identified "areas of moral clarity" (AMCs) where right action was clear, and started to act, including building another school near Cange. After their breakup, Ophelia kept away from this group for a time, but she then returned as Paul's friend and colleague, and as an employee of PIH.

Analysis
In Chapter 2, Kidder had recounted an occasion in which Farmer was called a saint. Chapter 10 shows two things. First, it shows just how hard it is for a normal good person, even a deeply committed person, to live with a saint. Years later, Ophelia Dahl's descriptions of her time with Paul are filled with a mix of bitterness, longing, and self-judgment: she eventually came to resent precisely that pure focus that had drawn her to him in the first place. And, at times, that pure focus makes Paul seem foolhardy and markedly irritating; how does it serve the poor best for Farmer to ignore his own health as he does after the accident.
Second, this chapter shows a tension between that pure purpose and the events of the outside world. It shows how a saint is made. These events are political in part: Paul and Ophelia are trapped in Port-au-Prince at the demonstration because the Duvalier had left Haiti. The Haitians expected change, and instead things stayed mostly just as bad. The events are also conceptual as well though: the late night conversations that Kidder must summarize (or else they would go on and on at great and potentially dull length) are the conceptual fuel of Farmer's later mission. Through these arguments, discussions, and bull sessions, he and his friends at PIH discover, create, and articulate their mission. And this leads to a kind of miraculous paradox: in summary, they sound like any group of good-hearted young people who want to change the world. However, most of this talk does not come to anything, while this small core of committed individuals founded an organization to challenge the mechanisms of public health and help people around the world.