Summary
The scale and expense of the MDR issue in Peru made PIH hesitate, forcing them to ask themselves if this was a challenge they should even try to solve. They eventually decided it was, because no one else was doing it and people were dying—and because it would allow them to tackle other public health issues along the way. In August 1996, they started treating TB sufferers in Carabayllo. They combined a team of Peruvian health workers with doctors and medical students from Boston. They ran into problems almost immediately. The Peruvians did not want to visit the homes of MDR patients, they needed money, and Peruvian officials did not want to admit they had such a serious problem. Jim and Paul were not licensed to practice medicine in Peru, and the TB director threatened to force them out of the country.

When they were allowed to keep working on the problem, Socios could only do so after "las normas" (the official clinical procedures or norms) had been tried. This meant Socios entered the treatment process late in the infection, and sometimes it meant watching people die. The Peruvian medical authorities were stuck. Allowing this treatment meant admitting there was a problem and they did not have the funds to implement new treatment regimes nationally. Jaime eventually told Farmer he would have to go over the national government's head. Farmer agreed and went to talk to the International Union Against Tuberculosis and Lung Disease annual meeting in Chicago in February 1997. After planning to give a "wimpy" speech, Farmer gave a fiery one, debunking many "myths" about TB treatment and directly challenging established wisdom.

Analysis
Chapter 15 had in many ways set Farmer and PIH up against the Peruvian authorities, almost in a good-guys-versus-bad-guys situation (or at least, good guys versus bureaucrats). This tone had lasted until the end of Chapter 15, when Kidder had touched on the Peruvian debt crisis, which complicated the matter. Chapter 16 continues that process. It shows many more faces of the situation. The Peruvian workers who do not want to face MDR patients in their homes are afraid for their lives. The Peruvian doctor who labeled Farmer and Kim as "Medicos aventureros" (adventuring doctors) had good reason to suspect the motives of these "gringo" doctors. Were they not part of the same social and economic structure that was oppressing Peru? And they were not even technically licensed to practice medicine in Peru. If a Peruvian did that in America, he would be considered a criminal, and the government would shut him down. Who would want that?

Moreover, there is a complex web of guilt sketched into place around the Peruvian resistance to admitting there is a problem. They know, on some level, that their system was not working—but if these outsiders demonstrate a better way, the costs would cripple other programs. The Peruvian authorities are shown to reason in parallel with the TB specialists in the International Union Against Tuberculosis and Lung Disease. Both groups are doing cost-benefit analyses and deciding against improved treatment for the infected poor, who they must let die. Farmer's work is a challenge both to their calculations and to their value system.