Kidder follows Paul Farmer, a physician and anthropologist who co-founded Partners In Health and spent his career treating patients in Haiti, Peru, Russia and elsewhere while holding a position at Harvard Medical School. Kidder travelled with Farmer over several years.
Farmer's central argument is that the standard of care available to poor patients should be the same as that available to wealthy ones, and that the public health orthodoxy of cost-effectiveness, which held that treating drug-resistant tuberculosis in poor countries was not economically justified, was a decision to let people die rather than a technical constraint. He demonstrated in Peru that community-based treatment of multi-drug-resistant tuberculosis could work, which changed World Health Organization policy and eventually the price of the drugs.
The operational model Partners In Health built uses community health workers, meaning local people trained and paid to visit patients daily, which addressed the adherence problem that had made treatment appear impossible. Kidder does not present Farmer as easy to emulate. He documents the personal cost, the strain on his family, the twelve-hour walks to visit single patients, and the difficulty other people had working alongside someone who accepted no limits. Farmer's own answer, that the goal is not to be reasonable, is the book's central tension.
Kidder is a sympathetic observer and the book is a portrait rather than an analysis of global health policy. Farmer's position on cost-effectiveness has been argued against by health economists on the grounds that resources spent on expensive treatments come from somewhere. Farmer died in 2022.
Readers interested in how a demonstration project changed global policy, and in what a refusal to accept resource constraints costs the person making it.
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