Part V, Chapter 24 Summary and Analysis
Chapter 24 opens with the Gates Foundation giving PIH $45 million to fight MDR-TB in Peru. This influx of wealth produced new challenges, taxing Jim Kim's capacity and causing Paul to remind previous donors that their funds were still needed. Kidder follows this with a quick description of the PIH offices, where Farmer is held up as the (impossible) model, and with how the organization's growth was forcing changes, some of which, like paying overtime wages, directly contradicted Farmer's wishes.
In addition to Haiti and Peru (and the United States), PIH had expanded into Siberia. This produced a serious rift between Kim and Farmer over Kim's choices (where to focus his time) and actions (including tourism when working for the poor). It blew over, and the two made up.
Kidder accompanied Jim Kim to Siberia. There in the city of Tomsk, at the banquet starting the discussions of how to treat TB there, attendees were separated into two distinct groups—the Russian military on one side, Russian doctors and foreigners on the other—until Kim broke the ice by singing karaoke. Everyone started singing and drinking. Farmer, who had run into visa trouble, arrived the next day.
Kidder sketches Farmer's travels: to Haiti, Paris, Siberia, New York, South Africa, and so on. In each place, Farmer argues for medical help for the poor. The remainder of the chapter sketches a few of Farmer's cases, then focuses on how the PIH programs are starting to serve as a model for other programs, and on Farmer's attempts to raise money and educate people. It ends with Farmer's account of the two voices he heard: one arguing for the meetings he attended, the other calling him to heal Haiti's sick children directly.
The final page of this chapter is, frankly, the only place where the chapter's narrative comes together and makes sense. Before that, while it may be what was actually happening at the time, the organization is a narrative jumble. Too much is included, and too many people are heard from. The very activity makes it hard to track what specifically is accomplished...and that is no doubt Kidder's point. In this chapter, Kidder creates for the reader a textual equivalent of one of Farmer's "little hurricanes," one in which Farmer blows into the PIH offices, then sprints away, leaving everyone dazed and blinking. Just as Farmer is having trouble holding on to his internal compass (as evidenced by the two voices calling him in very different directions), so do the readers. That said, this is what victory for PIH looks like: organizational growth (beyond a sense of community), public discussions (instead of private treatment), and serving as a model rather than as a rebel.