Summary

This chapter details Farmer's and Kidder's time in Cuba. Farmer's first commentary about the island of Cuba comes from his view from the plane as it lands: Look! Only ninety miles from Haiti and look! Trees! Crops! It's all so verdant! At the height of the dry season! The same ecology as Haiti's and look! His adopted country and its limitations are never far from his mind.

The Cuban doctor who is running the AIDS conference is a friend of Farmer's named Jorge Pérez. He has sent a car for them, and as they travel to Havana, Kidder sees the large billboard with Ché Geuvera. It reminds him that Farmer is fond of Cuba, not for ideological reasons, but for its health statistics, vetted by WHO and generally regarded as among the most accurate in the world. Since its revolution, Cuba had achieved real control over infectious diseases. Farmer says it is a given for him to admire Cuban medicine. It's a poor country, largely in part because of the American embargo, but the regime had listened to its epidemiologists and had increased health expenditures. In fact, their doctors are so well trained that the country has largely abandoned any idea of exporting its armies, but sends out its doctors instead. Farmer even becomes incensed at comparing Cuba to Scandinavian countries which have learned how to manage their wealth. Cuba has learned how to manage its poverty. He also wasn't a Marxist in any way. It seems to him an undeniably inaccurate philosophy. However, he is more interested in denouncing the faults of capitalism than in cataloguing the failures of socialism. He distrusts all -ologies even his own liberation theology. What happens when the poor stand up behind an ideology to reclaim what is theirs? He says we know already, because we are digging up their bodies in Guatemala. As for Kidder, he finds the sights of Cuba lovely after the deep and destitute vision of Haiti while Farmer can finally sleep, because everyone here has a doctor.

Farmer is looking to Cuba first of all for money to stockpile antiretroviral drugs, enough to treat twenty-five patients with full-blown AIDS in Cange. So he begins his lobbying tactics with Peggy McAvoy, a woman at the conference who is in charge of the United Nations' project on HIV/AIDS. He also hopes to begin creating more doctors willing to stay in Cange and has picked out two local youths to go to medical school in Cuba. Pérez introduces him to the Secretary of Cuba's Council of State, Dr. José Miyar Barreuecos who immediately says of course. Then, he approaches the French ambassador and the keynote speaker, Dr. Luc Montagnier, the man credited with discovering the human immunodeficiency virus. He speaks to them about his dream of a new kind of triangle between France, Cuba, and Haiti, which includes doctors from Cuba and money from France. His ability to speak French so well impresses them, and they agree to help. These may be polite promises, but Farmer believes the more he lobbies people, the more the help will appear, even if later down the road.

Farmer is giving two speeches at the conference. The first has to do with HIV and TB coinfection, and as he says, the second is entitled, Why Life Sucks. The second asks the audience to remember the days when expert opinion had retailed all sorts of nonsense about who caught HIV and why. Those were the days when to be Haitian meant you were part of a risk group. He had designed a study, as a result, about why two particular groups of Haitian women didn't fit the definition of a risk group. They had not been exposed to intramuscular injections, blood transfusions, or intravenous drug use. They practiced what he called serial monogamy, that is they had had sex with no more than two men and only one man at a time. They worked as servants in Port-au-Prince for Haiti's elite and were either cohabiting with truck drivers or soldiers. Farmer had to wonder why these two groups of men? He came to the conclusion that these two groups had steady jobs which attracted the women, but they also traveled or had access to other women rather steadily. This is why these men contracted HIV and passed it on to the two groups of women. After coming to this conclusion, Farmer logged onto Medline on the internet and cross-referenced the terms Aids, women, and poverty and found absolutely no studies meeting those specifications. These ideas he asserts make people uncomfortable, but he warns that they need to deal with these details. He agrees that co-infections of AIDS and TB are important topics to know, but it's also important to understand that poverty is the basis for them both. Farmer says, A woman in Cange said to me, ‘You want to stop HIV in women? Give them jobs.' He receives a long, loud round of applause.

Even though he would like to hang out at the conference, Paul spends most of his down-time in the hotel room working on his laptop. If he begins to doze, he jumps up and shouts at himself to get it together. He is typing grant proposals and writing a counter-editorial questioning the wisdom of treating TB in Russia. He's also working on his next book entitled Pathologies of Power. He tells Kidder that he doesn't approve of quarantine as a means of controlling AIDS. He cites two examples: the one in which Americans quarantined Haitians at Guantanamo Bay and treated them so badly that an American judge ordered them released; and the one in Havana which is conducted at an old hacienda called Santiago de las Vegas. When they visit there, Kidder notices that there are some small problems with the building, but it's far from shabby. Pérez tells them that it came about at the orders of Fidel Castro who told them it was their responsibility to keep AIDS from spreading in Cuba. Each patient has his own set of rooms, like mini-apartments, which Kidder says he finds kind of depressing. He thinks that Paul is just looking for things to praise in Cuba, and he decides to take the opposite view, maybe looking for an argument. However, the statistics speak for themselves: on an island of 11 million people, only 2,669 had tested positive as of the year 2000; the virus had progressed to AIDS in 1,003 of the people infected, and of those, 653 had died; only 5 children caught HIV from their mothers, and they were all doing well; finally, because Cuba had acted quickly to clean up its blood supply, only 10 people had contracted HIV from transfusions. Perhaps the US embargo had protected the island to a great degree, but at the same time, Castro was engaging in a lot of commerce with Africa, which tends to negate that argument. The island nation had just taken the right steps to control the onset of the disease.

Jorge takes Farmer and Kidder to meet the chief forensic pathologist of Cuba who tells them how he and his team had found the body of Ché Guevara in Bolivia and brought it back to Cuba. Of course, some would say that was just a claim, not a reality. He also takes them to dinner at his home, and Kidder sees that, even though he is a doctor, he lives like a lower-middle class citizen in America. To Paul, it is all like a holiday. He can't e-mail out because of internet restrictions in Cuba, and even though he will pay for that later, he is happy to be free of it now. He enjoys the tarnished heirloom atmosphere of Havana, but it does make him feel guilty about Haiti, which he thinks in the 18 years he has worked there, the country has only gotten worse. He thinks Zanmi Lasante is an oasis in the midst of despair in Haiti, but he feels the Cubans would have done a better job.

Farmer marvels at the attentions lavished on him in Cuba. He asks Kidder what he thinks is the reason for all this. Kidder knows he should find an answer that Farmer already thinks he knows, just to keep the peace, but instead he says that he thinks the Cubans like Farmer's published attacks on American policy in Latin America, his frank admiration of Cuban public health and medicine, and his efforts to create connections between Harvard and Cuba. Farmer just stares at him and says he receives the same sort of reception even in Russia, whose wacky health system he hates. So he definitively tells Kidder that it's because of Haiti that he's admired: he serves the poor. Kidder feels like Farmer is now angry, disappointed, and a little hurt, but he doesn't stay angry for long. It's a relief to Kidder to believe he's forgiven. However, at the airport, he takes the opportunity to tell Kidder that if he's going to write about Ché, he should write it from his own opinion, not Farmer's. This is actually his way of warning Kidder about how he should write about Cuba. He insists that he doesn't care how Kidder portrays him, but if he shows him as a sycophantic ally of Cuba, then the Cuban doctors concern for the poor of Haiti will be lost. He also doesn't want Pérez's efforts within the Cuban health system to be ridiculed. Kidder wonders if he's being told that Farmer doesn't want to travel with him anymore. He asks that very question when Farmer begins to talk about their next destination, Russia. Farmer simply scolds him, No, no. It's important. He calls the end of the scolding a dismount, a term used in his family when they became interested in gymnastics during the Olympics. To them and to Farmer, a dismount is the term meaning the end of the conversation.

It's difficult for Kidder to stay angry at Farmer. He does so much for so many and in a usually cheerful attitude. Kidder also knows that there is no question that Cuba has pulled off a great achievement with its health system. He just wonders what the price is in political freedom for its people. However, he also knows that Farmer would frame that question a little differently: what price would most people pay for freedom from illness and death? Farmer would turn Haiti into Cuba in a minute if he could. His hope for Haiti is that someone will revolt for the people who are too ill to do so themselves. They see a large sign on an airplane hanger which reads: Patria es humanidad, the only real nation is humanity. To Farmer it is a lovely saying, but to Kidder, it's just a slogan. They finally catch their plane in Miami to Paris, although Farmer's busyness with shopping and e-mails almost causes them to miss it. Kidder finally tells Farmer that he's having some trouble with diarrhea. Farmer tells him in no uncertain terms that, from now on I want a full report of your bowel movements. Kidder feels oddly reassured.

He finally comes to this conclusion about Farmer: in Farmer's mind, he is fighting all poverty, all illness, all the time. The reward is inward clarity and the price, perpetual anger. Farmer wasn't put on this earth to make anyone feel comfortable, except for those lucky enough to be his patients, and for the moment, Kidder has become one of those and that's what gives a feeling of reassurance.

Notes

Their time in Cuba is interesting for Kidder, but he has a hard time disassociating himself from what he has learned all his life about Cuba by living in America. To Farmer, it's not about the politics, but about the health system. He doesn't care where the compassion for and willingness to help the ill and poor comes from, just as long as it comes.