Soon after Ophelia left Haiti, Paul first saw Cange. He was still searching for a place to do his work when he met up with a Haitian Anglican priest named Fritz Lafontant. He was running a rudimentary one-doctor health clinic in Mirebalais. He also had built schools, organized community councils, and programs for adult literacy in several small towns, including Cange. He went with the priest one day by truck and was struck by the beautiful greenness of Haiti in the spring; that is, until he passed the dam and saw the barren, dry area around it. Most of the dwellings were crude hovels with banana-bark thatched roofs patched with rags to stop the leaking. Farmer was struck by his memories of the tin roofs he'd seen in Mirebalais which were emblems of poverty. The roofs in Cange screamed misery.
Farmer kept traveling through Haiti, hitching rides with whoever would take him. He came down with dysentery, probably from eating foods sold on the street. An American public health expert told him, as he lay in a grubby hospital in Port-au-Prince, that if he got any sicker, she would have to take him back to America. At the same time he was telling her no, his heart was saying yes. After he recovered, his determination to understand what Haiti needed returned, and he continued to travel around the country asking questions of the peasants. He knew that the scholarly texts were wrong. He came to realize by living there that a minor error in one setting of power and privilege could have an enormous impact on the poor in another setting. That could be seen in the Creole pig eradication and the dam at PÃ©ligre.
Farmer also became interested in liberation theology. It was a powerful rebuke to the hiding away of poverty. The peasants didn't follow doctrines that encouraged them to accept their plight in life and anticipate the afterlife. Instead, they believed that the rest of the world was wrong for screwing them over, and that someone, someone just and perhaps omniscient, was keeping score. Religion was the one thing they still had. The peasants also believed that God gives humans everything they need, but he leaves it up to them to divvy up the goods. This is also the tenet of liberation theology which demands that we redress the horrors of poverty in the here and now with service and remediation. This fit Farmer perfectly, because as he said of himself, I'm an action kind of guy. This was further emphasized to him through two events: in one, an American doctor, who loved the Haitians and loved caring for them, was returning to the States, ecstatic to be going home. He said he was an American and that's where he belonged. Farmer wondered about the idea of saying, I am an American; in the second, a woman and her baby died of malaria because there was no blood or money to buy it. Her sister sobbed that it was terrible that you couldn't get a blood transfusion when you were poor. She says, We are all human beings. As a result, he wrote his relatives asking for donations for blood-banking equipment. He happily received a thousand dollars and turned it over to the hospital for the equipment they needed, but he wrote to Ophelia that things hadn't turned out as he had thought: the hospital was not for the poor, because when a blood transfusion was needed, they were still demanding payment in advance. Farmer decided he would build his own hospital.
It was a relief to Paul to discover that there was no clinic at all in Cange. Not because he didn't feel they needed one, but because he knew he couldn't work on one like that of Mirebalais. It was all about the patients and their awful outcomes, and he wanted a clinic that reflected that. He began with a modest health census. Hiring four young Haitians who had at least finished the 7th grade, he sent them to two neighboring villages, going hut-to-hut, tallying up the numbers of families, recent births and deaths, and the apparent causes of morbidity and mortality. It confirmed what Farmer already suspected - the mortality rates were horrific and the deaths of mothers, common events in this squalid area, led to skeins of catastrophes in families, to hunger and prostitution, to disease and other deaths.
Farmer also learned from another experience how cooperation with the beliefs of the people was important to meeting their needs. A woman with malaria was treated by a local hougan, a Voodoo priest, because her father insisted, but after Farmer explained his role in healing, her mother agreed for her to be treated with chloroquine, and she recovered. Farmer reiterated what he learned in an essay entitled The Anthropologist Within. He stated that when he had learned that an ethnographer should observe and not try to change anything within a culture, he knew that this made anthropology impotent. To him, it was a tool rather than a discipline unto itself, a tool for intervention. A doctor-anthropologist who understood the religion would find a way to make the hougan his ally rather than fighting his methods. Furthermore, he knew the people of Cange weren't interested in having their suffering merely scrutinized; they wanted both research and action.
Farmer entered Harvard Medical School in 1984 at the age of twenty-four. However, he didn't linger there just studying and learning. He would take off for Haiti, then showing up at Harvard just in time for lab practicum and exams and avoiding basic lecture courses. Being a commuter like this didn't cause any disapproval from his professors who understood that he was trying to bring medicine to people. Besides, his grades were the best of his class.
When Farmer spends time in Haiti, he formulates his own philosophy about how his love of both medicine and anthropology can become tools to help the people who most sorely need it.