Part IV, Chapter 23 Summary and Analysis
In Chapter 23, Kidder accompanies Farmer to Russia for an international meeting to fund TB treatment there. TB was exploding in the Russian prison system; people were getting TB at a rate of "forty to fifty times higher" than civilians were. Many prisoners—some of whom were in for minor crimes like stealing a loaf of bread—died from TB, while others lived through their sentences only to get out and spread MDR through the general population.
When Farmer visited Russia, a number of international attempts to deal with the Russian TB situation had been made, but they were too small, under-funded, and committed to a DOTS treatment plan. The result was that most of the prisoners were not cured, and in fact, through their partial treatment, had their TB made resistant to at least one of the main drugs used to treat TB. Farmer met with George Soros to ask for the $5 billion needed to treat the Russian epidemic, and Soros arranged a meeting with the White House. Hilary Clinton asked the World Bank to loan the needed money, and the World Bank put together a team to visit Russia and work out the details.
During the trip to Russia, Farmer (along with Kidder) toured the prison in Moscow to get firsthand observations of prisoner conditions with TB. Later, at the meetings with the World Bank, Farmer continually argued for the prisoners, trying to get them the help they needed. He also had the task of managing Alex Goldfarb, the representative of the Russian Ministry of Justice (who ran the prisons). Farmer did not enjoy the international politics, but he charmed, joked, and argued tirelessly on behalf of the poor. Sometimes he argued politics with Goldfarb; sometimes Goldfarb was on his side as they worked together on methodology.
In Chapter 23, Farmer is shown at his most transformed and in some ways his most ideological. Distanced from his actual patients, with whom he can demonstrate his compassion through his actions, Farmer has only words and charisma to make his case. The result is sometimes a kind of good-hearted rant, as when he explains how America is and is not a democracy. At other times, as when Farmer and Goldfarb argue the politics of crime and imprisonment in the chapter's final pages, Farmer sounds profoundly and at times naively radical. The radical nature of his politics is ultimately that of the saint, or even Jesus; when Kidder asks Farmer if he forgives everyone, Farmer's answer is "I guess I do. Do you think that's crazy?"
That Farmer is not crazy is demonstrated by his "small victories" at the international meeting, which gets the Russian prisoners dying of TB the most funding ever for their treatment, despite the internecine sniping. That Farmer holds himself to an almost inhumanly elevated standard is demonstrated by his frailty and fatigue, and by the night he skipped sleep to answer 413 emails.