In July 2000, the Gates Foundation gives Partners In Health and a cohort of other organizations $45 million to wipe out MDR-TB in Peru, virtually everything Jim Kim had asked for. The grant is intended to last five years and Jim plans to cure 80% of the patients, which will then give Peru control of the dread disease, and the world will have proof that countrywide control is possible. Farmer is pleased with the grant but frets that other people who support PIH will think the charity doesn't need their money anymore. As a result, he begins to speak to all his old allies and supporters to tell them in no uncertain terms that they are not dismissed.
The greatest problem for PIH at this point is just paying the bills since foundations tend to narrow the focus of their giving. Also, he still has the problem of obtaining money for drugs for Haiti when every potential giver insists that Haiti fails to meet sustainability criteria. That is, once the disease is under control, the patients cannot afford to pay for drugs to sustain the program. Fortunately, the Soros Foundation, Tom White, and the selling of their headquarters in Boston help sustain the program in Cange. Furthermore, Friends of Harvard Medical School and the Brigham also provide support, and Farmer persuades Harvard to give them office space in a pair of old brick buildings on Huntington Avenue. Of course, this means adding newcomers to the staff which Ophelia is expected to accommodate. On one visit to the new offices, Kidder sees a sign taped to the wall which reads, If Paul is the model, we're golden. Upon looking closer at it, he sees the word golden is on another piece of paper taped over another word which now reads, If Paul is the model, we're f*****. It's not meant to sound as harsh as it does, but merely to emphasize to all staffers that no one can be Paul Farmer, and if the poor have to wait for a lot of people like Paul to come along before they receive good health care, they are totally f*****. The same quirkiness also still remains in the new offices, such as Paul's suitcases lying open all over the floor and everyone running in various directions following his orders, what Ophelia calls little hurricanes. Furthermore, there is still the great frugality of the organization, running on just 5% of its budget, although Ophelia does pay overtime when necessary. She just doesn't tell Paul.
PIH has also expanded its organization into Siberia as a result of Alex Goldfarb. He involved himself in some political problems by helping Boris Berezovsky, a KGB agent, to escape assassination and flee Russia with his Swiss bank accounts. This assures that Goldfarb will be unable to return to Russia for while, and as a result, PIH is needed in Siberia. Paul assigns Jim to the managerial chores of that project. Unfortunately, a month later, Jim has still not gone to Russia, and Paul has a fit in the middle of a Cambridge restaurant. He accuses Jim of only wanting to attend the Bolshoi, and then they argue over the fact that Jim always picked up Paul when he arrived in Haiti, but that Paul had never once picked up Jim. The point is Paul wants Jim there yesterday, and Jim knows he has an important meeting to attend first, and Russia will wait. Ophelia is glad these temper tantrums happen when they are away from patients, and she says that this one is nothing compared to some Paul has had. Outside the restaurant, Paul puts his arm around Jim's shoulder, and Jim does the same to him. Just that quickly, the argument is over.
Kidder flies to Siberia with Jim a few weeks later. The city of Tomsk had once been a thriving one, but now is suffering over and above its MDR-TB problems. In addition, because of Goldfarb's antics with politics, Jim has to find a way to smooth over suspicions that they are foreign spies. Ironically, at the opening banquet of the meetings with the generals who run the prisons, it is karaoke that makes everyone friends. Jim begins by singing My Way, and soon everyone is taking part, including the generals, who drink their friendship toasts to PIH. Jim comments, The night of the singing gulagmeisters. We're not going to see that again soon.
The next morning, Jim leaves, and Paul arrives. The generals already know Farmer, and relationships warm immediately with lots of toasting to each side. The funny side of this evening is the drunken local oligarch, who owns the hotel where they're meeting and oil and gas fields as well. He wanders in and out of the meeting and even proposes his own toasts. When the meeting is breaking up, the oligarch comes out of a side room naked but for a towel around his waist. He is followed by a buxom woman in high heels, looking greatly alarmed. Paul watches them intently, smiling gleefully. He says, The Rooskies are my kind of people.
As they are leaving Tomsk, Kidder asks Paul why he had gone to Paul White for $150,000 to help a few dozen patients when larger amounts of the drugs would soon be on their way. Paul's answer, Project managers can afford to wait for low prices, but not all patients can. Kidder reflects as the flight continues that this approach toward money is completely impractical, and yet it appears to be working.
Paul is traveling more than ever, and Kidder is forced to keep in touch with him by e-mail. Of course, he still returns to Brigham for month long tours of service. It is here that he practices on all sorts of strange cases that seem to really fulfill him. For example, he is brought in on a case of a man with lightning gangrene of the penis, who is being recommended for hospice care. Farmer just says, He's going to walk out of here, and a month later, he does. He also cures a young man with toxic shock who two weeks after Paul sees him is still suffering from a severe fever. Paul tells the caregivers that the next two week won't be a picnic, but the worst is over, and he is right once again. He is even consulted by telephone by someone who is treating a monkey!
Howard Hiatt, who has been lobbying Paul for a long time to give up Haiti and work at employing troops on worldwide campaigns, finally visits Cange, and once he sees Zanmi Lasante, he is full of trying to replicate what Paul has done there. He now understands why Haiti means so much to Paul. In August 2001, Paul publishes an article in Lancet, describing the treatment and prevention program in Cange. As a result, PIH receives nearly 100 requests for advice and information from health consultants and charities on every continent. Paul's reaction to all this is slightly more realistic than those who would praise him, It's embarrassing that piddly little projects like ours should serve as exemplars. It's only because other people haven't been doing their jobs.
The Global Fund is a brand new institution financed by governments and foundations. It wants to raise many billions of dollars annually to fight the world's three great pandemics. By spring of 2002, it has only achieved a fraction of the goal, but has already received applications for grants. It approves one from PIH Haiti to direct a thorough AIDS treatment and prevention program throughout the central plateau. It is hoped that this will serve as a model for projects in Haiti's other districts and in very poor countries. However, in addition to the daunting task this promotes, politics emerges when the United States attempts to block aid to Haiti's government. They have a longstanding and institutional fear of President Aristide, as well as general weariness with Haiti's problems. Paul's response is short, but succinct, Lunacy is what it is. The results are the closing of many other clinics that no longer have the funds to stay open, which then puts an additional burden on Zanmi Lasante. Nonetheless, PIHers manage to implement a program to prevent transmission of AIDS from pregnant mothers to their babies. They'll have to travel by donkey, bike, motorcycle and jeep, but they do what they have to. The Global Fund then releases $14 million for the central plateau, payable over five years and to go mainly for anti-HIV drugs, for hiring Haitian workers, and for fixing up the public clinics that already exist in the region. It's really just enough to get them started, but Farmer weeps with elation. He vows to spend even more time in Haiti, but he still continues traveling everywhere. Once, on his return to Boston, he tells Ophelia that he hears two sets of voices in his ears: the one from the world saying, This meeting's important; and the one from Haiti saying, My child is dying. It seems to Kidder that he doesn't have a plan for his life as much as he has a pattern. He is like a compass, with one leg swinging around the globe and the other planted in Haiti.
This chapter reinforces the realization on the part of the reader that Paul Farmer is not just an amazing man, but one who no one can ever imitate. He spends little time with his family and barely sleeps all in the name of patient care. He serves the world and never stops loving and serving Haiti.