Summary

Paul is given Ophelia's blessing to court and marry someone else. He falls in love with Didi Bertrand, the daughter of the schoolmaster in Cange, and they are married there in 1996 with over 4000 guests - all of the town of Cange included!

In Peru, the patients are beginning to tax PIH's resources. The cases of MDR are growing, and whole families are affected. Paul and Jim's friend in Boston, Howard Hiatt, a very influential physician at Brigham and Harvard, is told that Farmer and Kim owe Brigham $92,000. They have been sweet-talking their way into medications from the hospital pharmacy, in what Hiatt calls their Robin Hood attitude. Fortunately, Tom White comes through with the money. However, even he is worried about their refusal to realize that the money could be finite. He wants to die penniless, but is afraid the two doctors will take all his money before he dies! Nonetheless, he is there with money whenever they need it. The sad part of all this is that they lack institutional support, and the weight of opinion is against them. Furthermore, Peru is putting a strain on all their other projects. Add to all these problems the costs of travel that both men, but especially Farmer, incur not only the cost to the treasury of PIH, but also the cost to Farmer's health.

Farmer hadn't been feeling well when he gave his speech in Chicago, but he feels even worse when he begins a month of service in Boston. At first, he just tells himself he is exhausted because of the schedule he has been keeping. However, when he reviews his symptoms, he fears that he has contracted MDR. He gets a friend in radiology to do an x-ray in secret, and fortunately, it's normal. Didi, his wife, begs him to see a doctor, but he insists he is a doctor and can care for himself. He has the colleagues he's working with give him fluids intravenously, but he just feels worse. One of the infectious disease specialists comes back with the news that he has hepatitis A, against which he had never taken the time to vaccinate himself. He gives up to their pleas to be treated and hospitalizes himself. For a time, his doctors worry that he might need a liver transplant, but eventually, he improves, and then Ophelia sends him and Didi to the South of France for his first vacation in nine years. All's well that ends well, because nine months later, his daughter Catherine is born.

Kidder, the author, wonders at Farmer's recklessness in not protecting himself against disease. However, at some point, he has come to hold Farmer to a higher standard than most people he knows. After he has seen him in action, he is much more able to excuse him.

Finally, the MDR program has begun to make progress, and the Peruvian doctors are beginning to notice. Accordingly, Farmer and Jim are making progress with them. One day, Kidder follows Farmer to an appointment at Children's Hospital in downtown Peru. Because of traffic, they are an hour late, but all is forgiven when Farmer sees little Christian. At the age of three, the little boy had been diagnosed with MDR-TB and was dying in agony when Farmer finally saw him. The boy was on his second regimen according to DOTS and Farmer knew he would die if they didn't break from those protocols. He devised a regimen with second-line drugs which no one knew how to apply to children. Farmer followed an empiric regimen, which was based on his best guesses. He was enormously successful and little Christian is now chubby and healthy.

Farmer is impressed to see Christian healthy, but the case he has come to see is the daughter of one of the Peruvian doctors. Farmer has now learned how to play the game that will allow these doctors to see the truth about how to treat MDR patients. They cannot pronounce a new protocol themselves, but Farmer can. So when he says how the child should be treated, the others are willing to implement his ideas. Christian being there is his most eloquent argument for adding flexibility to the norms. He tells Jim that a few more success stories like Christian's and they will have turned the corner with the Peruvian doctors. As he leaves the hospital, Christian's mother approaches him and says in Spanish, I want to say many thanks. Then, Farmer, with great humility, replies in Spanish as well, For me, it is a privilege.

Notes

This chapter shows the steady, sure changes that Farmer and Jim are making in Peru, but it also reinforces the possibility that Farmer could destroy his own health in trying to improve the health of others. Nonetheless, even Kidder, our author, is so impressed with the kind of man Farmer is that he is willing to excuse how he cares for himself.