Setting
Zanmi Lasante
Zanmi Lasante is the medical center Dr.
Paul Farmer founded in Haiti. On the way to Zanmi Lasante are mountains and
villages comprised of wooden huts. Beggars can be seen everywhere. Farmer
describes arriving at Zanmi Lasante as a “fortress on its mountainside, a large
complex of concrete buildings, half covered with tropical greenery.” Hundreds
of people crowd around the outside of the buildings everyday seeking medical
treatment. Dr. Farmer begins the day by circulating through the crowd looking
for the worst cases. At the end of the day, when Tracy Kidder and Dr. Farmer
are walking back to Dr. Farmer's small house, a girl with meningitis is
transported on a donkey ambulance and Dr. Farmer does a spinal tap.
A special young boy comes to Zanmi Lasante Childen's Pavillion with lumps on his neck. He is the kind of child that uplifts all of those around him, especially Dr. Farmer. His parents had the same disease, symptoms of scrofula. They are asked to go to Cange to be tested. Dr. Farmer, instead, goes to their home with Ti Jean and Tracy Kidder which is the whole way to Casse, requiring a very long hike by foot. On the way, Dr. Farmer makes a house call at an elderly couple's hut with dirt floors. The man has had a stroke and the woman is sick too. He treats them then resumes the hike to Casse. After several hours of hiking they arrive at Casse where several children and four adults run out of a tiny hut to greet the well-known doctor. This is a typical day for the doctor when living in Haiti and treating patients at Zanmi Lasante. Dr. Farmer loves going to help these patients in their huts. Kidder explains that these visits to the Haitian people's homes kept Dr. Farmer inspired to fight on their behalf.
One special case is a man by the name of John who comes to Zanmi Lasante with his mother, not knowing what he has. His white blood cell count is very high, higher than is usually found in tuberculous. His neck is swollen. Dr. Farmer goes to great lengths to get him to the U.S. be treated. They travel rough roads in an old ambulance that breaks down, and finally resort to using an emergency medivac flight to the States. Dr. Farmer rushes him to many hospitals in Boston who will not accept him. Finally, Massachusetts General Hospital admits John who is diagnosed with nasopharyngeal carcinoma, a rare form of cancer. Eventually he dies because he is already “wasted,” a term that Dr. Farmer despises because it means that the cancer invaded his vertebra. Usually doctors do not go to such extreme lengths to save a patient who is so far gone. Dr. Farmer hates prioritizing patients; he has to decide who lives and who dies, because of the scarce medical resources in Haiti. Dr. Farmer is angry about the treatment situation because in a real triage situation everyone gets treated; it is just that the worst cases are treated first.
Among the poorest people, such as those in Haiti and Peru, many people are not treated at all because they are not among the few chosen to be given medicine. This is what Dr. Farmer fought to eradicate, the unfair medical practices available to poor people worldwide.
Brigham and Women's Hospital
At Bringham Hospital, Dr. Paul Farmer is a specialist in Infectious Disease. He is also associated with the HIV Central. Dr. Farmer has access to all the medical facilities and medicines that a patient needs in Boston. Compared to Haiti, Boston seems like paradise. Patients actually improve because there are...
(This entire section contains 1490 words.)
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adequate supplies of medicine to treat them; and there are ways of containing the disease, such as in AIDS and TB—the two main diseases he worked on during his life.
Working at Brigham and Women's Hospitals in Boston, Dr. Paul Farmer meets Tracy Kidder a second time. (The first time they met in Haiti.) Dr. Farmer and a team of younger doctors discuss whether a patient should be treated. Dr. Farmer and his staff look at the X-rays because they thought he had TB. Tracy Kidder was there observing Dr. Farmer's work. As it turned out, the patient had AIDS and asks to be sent to a special home for AIDs patients, which he was permitted to do.
Dr. Farmer works at Brigham when he is in Boston. He treats a man with toxic shock whose parents believe he will soon die. However, within two weeks, he walks out of the hospital. The work Farmer does in Boston is seen in striking contrast to the work he does in Haiti--all because of the poor facilities and limited availability to medicine.
Peru at Socios en Salud
At the Peru at the Socios en
Salud medical center, funded by PIH (Partners in Health), many people are
dying of (MDR) TB. This is another major medical center highlighted in the
book. It was founded by Dr. Tim Kim and Dr. Farmer. Due to the slum conditions
in Carabayllo, Peru, more people will contract the disease in the future,
which will require second-line drugs to combat the disease.
These medicines are expensive and this project is more
complicated due the mass amounts of drugs needed.
In the beginning, Dr. Farmer and Jim Kim get enough of the drugs to treat ten patients. Because they are not licensed to practice medicine in Peru, they have to get special permission to treat patients. One particular patient, David Carbajal, is suffering greatly and the doctors want to help. The government denies them and he dies. Dr. Farmer writes a letter to the TB managers but they brush him off as an interfering foreign doctor. Dr. Farmer argues with them, saying that if they have the technology, they should utilize it to help people get better.
Dr. Farmer and Jim Kim discover that the policies of treating patients in Peru has led to the spread of the disease. In addition, the policies set forth by the WHO for rationing of drugs makes it almost impossible to eradicate the disease. The patients who require only the cheapest treatment are given the medications; the others are left to die.
Due to the multitude of infected poor people in Peru combined with the flawed social policies for treating them, and the WHO's drug rationing policy, Dr. Farmer has to resume his fight for the poor in the arena of challenging national health policies in Peru and and contributing to the development of new world health policy.
Dr. Farmer contracts (MDR) TB himself and has to receive treatment. At the end of the book, recounting PIH's achievements in the late 1990s, 45 million dollars was donated by the Gates Foundation for this project in Peru.
Cuba's Medical Center
Dr. Farmer goes to tour Cuba's
new medical facility. He admires Cuba's public health treatment plan and hopes
that Haiti can learn from Cuba.
Cuba's new medical center is state of the art, with programs developed specially for containing the AIDS virus in a humane manner. It is a containment center that AIDS patients can go to voluntarily where they receive treatment but not be able to infect the general population. Dr. Farmer visits the containment center and interacts with patients there who appear to be satisfied. Dr. Farmer admires Cuba's health care system where they seem to be able to treat the poor as well as the wealthy patients in a humane way.
1983-2005 in Haiti
Haiti's history and development
has been effected mainly by the extreme debt they have owed to France
ever since their sovereignty. Therefore, they have not been able to
spend money on roads, schools or health care.
Kidder recounts the Duvalier era which contributed to the extreme poverty. The elder Duvalier, known as "Papa Doc," misappropriated millions of dollars in funds, while his son ("Baby Doc") embezzled millions of dollars that were given as foreign aid in the 1980s. Foreign aid was taken away.
Finally, in 1986, when Baby Doc Duvalier was ousted from government, the International Monetary Fund and the World Bank donated money to begin to relieve Haiti's poverty. When Jean Bertrande Aristide assumed the presidency, he tried to institute economic reforms but they were not well received. As of 2005, Haiti owed 1.5 billion dollars in external debt; and 80% of Haitians live in abject poverty.
These historical facts serve as the political and economic background for the book. Dr. Farmer chose to carry out his work in one of the poorest countries in the world, where thirty years of a corrupt dictatorship ruled the land, and the need for public health care was the greatest.
