Summary

This chapter begins in December, two months after the medevac flight of John to Boston, and Kidder has returned with Farmer to the other side of the epi divide. As they are driving toward Cange, they see a bumper sticker ahead of them which translates from the Creole to, Lord, a word on all this. It makes Farmer laugh. He tells Kidder that his e-mails are now up to 200 a day, but he's still managing them. He knows something's gotta give, but . . . he's not burning out. Once they arrive at his Ti Kay, and he changes into his Cange clothes, they sit outside on the bower and are joined by Ti Jean, the man who serves as Farmer's chief of staff, because he is his main local male confident. This man wishes that they would fix National Highway 3 so that Zanmi Lasante can receive 100,000 patients, because it is their vocation to receive them. He also believes that people turn themselves into animals for shifty reasons or else sorcerers turn them into animals as punishment. Pail calls it a giant morality play, a commentary on social inequality, almost invariably. Ti Jean notes that Paul's fish pond cost a lot of money, but he approves of it since it makes the doctor happy. If he only saw patients, he might not be happy. He says the doctor is a nestless bird in all his travels, but that since Haiti is his base, it can be called his nest.

Kidder summarizes at this point for the reader the outcomes of many of the patients he has introduced throughout the novel, like Ti Ofa, the young man with AIDS, who wanted to give Farmer a chicken or a pig. Now he has gained eight pounds and is doing much better. A few months back, a little boy named Alcante came into the clinic with scrofula and was given first-line drugs that wiped out his infection. He was the kind of child that takes strangers by the hand, and he was also very beautiful looking. As a result, Farmer kept him at the clinic two weeks longer, calling him a P.O.P. or prisoner of Paul. The rest of his family was eventually brought in, and his father was found to have TB.

So, now that the boy has gone home, Paul is anxious to see how the family truly lives, by taking a hike to his home in a town called Casse. Ti Jean, a pharmacist, and Kidder go along with him, and as usual, Paul doesn't even seem winded on the long trek. Kidder, however, has a few moments of chest pain that Paul decides is only heartburn, but it shows how good a shape Paul is in. They also stop along the way to speak with other patients Farmer has been concerned about. While at the home of an elderly couple, a grandchild appears with his two toys: his thumb in his mouth and a stone tied to a string. Paul laughingly calls it Rocks R Us which suddenly sends them into gales of laughter. When they leave, he comments that they came to see Grandpa, but discovered that Grandma had blood pressure problems, too. According to Farmer, This is a good cast of the net. They came to see Papa and got Grandma, too. Just in time. Before she got run over by a reindeer! More laughter.

Kidder has been trying for awhile to ask Farmer about John, the boy who died of the terrible throat tumor, but has been unable to couch it in just the right way. Now he has his opportunity to question Paul about it when the doctor talks about triage. Kidder asks whether the $20,000 was a huge expense that might have gone for something with a better outcome than death. He assures Farmer he doesn't mean this disrespectfully; he just wonders how he feels. This begins a long explanation that Farmer says he feels pressured to give all the time, but because it takes so long to explain, he just refuses to do it very often. He begins by summing up that he has fought his whole life a long defeat. He says he is doing it, and he brings other people in to do it, but he won't give up, because sometimes he feels like he is winning. He says that all the PIHers want to be on the winning team, but not at the risk of turning their backs on the losers. So they fight the long defeat. He also uses the example of the young attending physician who makes $100,000 a year, five times as much as it cost to bring John to America, and yet it is often people like him who question the use of $20,000 to help just one child. He says he has to limit how much time he puts in explaining all this or it will just suck his soul dry. Eventually, the long walk gets to Kidder who has run of water he can drink, and so Farmer searches a village until he finds oranges and then Cokes to restore his hydration.

Not long after, they all come to Alcante's home, and no sooner does Farmer see the boy's impoverished hut with its old banana bark and rag roof than he knows that money will have to be forthcoming to help this family and stop the tide of TB that is probably incubating in the 10 people who live there. To Farmer it is all so unfair, especially in light of people who live outside of this poverty, who want to give money for better drinking water, but only if the poor show they really want it. So Farmer continues his hikes, saying that if seven hours is too long to walk for two patients, you're saying that their lives matter less than some others', and that the thought that some lives matter less is the root of what's wrong with the world. He says this person is sick and he is a doctor, an idea that taps into the universal anxiety and the ambivalence some of those fortunate ones feels about their place in the world. To Ophelia, his walks are the best part about him, because they are small gestures which do add up. He is a one person with great talents who has come to exert a great force on the world, just because of the craziness, the sheer impracticality, of half of everything he does, including the hike to Casse.

Now, as they are readying to leave for Zanmi Lasante, the sunset makes Farmer realize it won't be safe for Kidder to walk the rest of the way. So, he borrows a young man and his motorcycle to take the pharmacist back to get the truck for the rest of them. They then begin to walk toward the route where the truck will come. Along the way, Ti Jean tells Farmer not to speak to anyone on the road, because they may be demons. That makes Paul comment that a people who believe that you should take medicines and then see a Voodoo priest, use their religion as a means of driving away illness. It gives the sounds of the drums in the distance an entirely different, less frightening, feel for Kidder. Kidder finally reaches the point where he can go no further, and they sit down on the side of the road, waiting for the truck under a star-filled sky unaffected by electric lights, and Kidder thinks the sound of the drums is like the beating of so many hearts under a single stethoscope.

Notes

This final chapter is a kind of summarization where Kidder seems to finally get exactly what Paul Farmer is all about. He is a genius who just happens to believe that he has lived his whole life as a long defeat. He may die and the Haitian people will still be poor and dying in the thousands because of TB and AIDS. However, he will know that he has tried to win and that's what it's all about. He is the single stethoscope under which beat many hearts.

AFTERWARD

Summary

In June of 2002, seven years after Father Jack Roussin's death, WHO adopted new prescriptions for dealing with MDR-TB to which Jim Kim wrote, The world changed yesterday. The prices of second line antibiotics continued to drop, and the Russian Ministry of Health had finally agreed to the terms of the World Bank's loan - $150 million to fight the epidemic throughout the country.

The fear of 100 million HIV infections by the year 2010 had galvanized much of the world in spite of prominent voices, like the United States, that still argued that AIDS could not be defeated in impoverished places.

Jim Kim became the senior advisor to the new director of WHO in 2003 and the example of Zanmi Lasante continued to grow with Cange as the destination for global policy makers and American politicians.

The Global Fund money was delayed, but Farmer chose not to wait, instead using $2 million borrowed from a commercial bank in Boston to begin the program throughout the central plateau. The plan is to beef up the smaller clinics around the area by dispatching teams of Haitian and American doctors and technicians to three towns. It was a nightmare, but within a month, they were up and running.

Haiti was still bleeding away like topsoil and the whole situation was rotten, but according to Farmer, there are still spots of hope. Electricity came to Cange, and they finally have a transfusion post at Zanmi Lasante. As for Zanmi Lasante, they have over two hundred health care workers, a dozen nurses, and twelve doctors. They care for over 3,000 AIDS patients, providing retrovirals to over 350, and they have the equipment and trained personnel to do their own high-tech AIDS diagnostics. Father Lafontant has managed to build another operating room, and they have seen their first open-heart surgeries performed by teams from Brigham and South Carolina. Kidder is attempted to ask Farmer if this is appropriate use of technology - not to hear the answer, just to hear him say it!

Notes

This afterward sums up what Paul has now accomplished in about 20 years in Haiti. The achievements are unbelievable, but Kidder and the reader know that they will not stop him from continuing to try to win.