* Dr Paul Farmer set out twenty years ago to heal the world. He still thinks he can.
# Zanmi Lasante is famous in the Central Plateau, of Haiti, in part for its medical director, Dr Paul Farmer, known as Dokte Paul, or Polo, or, occasionally, Blan Paul. The women in Zanmi Lasante's kitchen call him ti blan mwen-"my little white guy." Peasant farmers like to remember how, during the violent years of the coup that deposed President Aristide, the unarmed Dokte Paul faced down a soldier who tried to enter the complex carrying a gun. One peasant told me, "God gives everyone a gift, and his gift is healing." A former patient once declared, "I believe he is a god." It was also said, in whispers, "He works with both hands"-that is, both with science and with the magic necessary to remove ensorcellments, to many Haitians the deep cause of illnesses. Most of the encomiums seem to embarrass and amuse Farmer. But this last has a painful side. The Haitian belief in illness sent by sorcery thrives on deprivation, on the long absence of effective medicine. Farmer has dozens of voodoo priests among his patients.
# On an evening ... Farmer sat in his office at Zanmi Lasante, dressed in his usual Haiti clothes, black pants and a T-shirt. He was holding aloft a large white plastic bottle. It contained indinavir, one of the new protease inhibitors for treating AIDS-the kind of magic he believes in. A sad-faced young man sat in the chair beside him. Patients never sat on the other side of his desk. He seemed bound to get as close to them as possible.
Farmer is an inch or two over six feet and thin, unusually long-legged and long-armed, and he has an agile way of folding himself into a chair and arranging himself around a patient he is examining ... He is about forty. There is a vigorous quality about his thinness. He has a narrow face and a delicate nose, which comes almost to a point. He peered at his patient through the little round lenses of wire-rimmed glasses.
# The young man was looking at his feet. He wore ragged sneakers. ... The young man had AIDS. Farmer had been treating him with antibacterials, but his condition had worsened. The young man said he was ashamed.
"Anybody can catch this-I told you that already," Farmer said in Creole. He shook the bottle, and the pills inside rattled. He asked the young man if he'd heard of this drug and the other new ones for AIDS. The man hadn't.
Well, Farmer said, the drugs didn't cure AIDS, but they would take away his symptoms and, if he was lucky, let him live for many years as if he'd never caught the virus. Farmer would begin treating him soon. He had only to promise that he would never miss a dose. ... Farmer leaned closer to him. "I don't want you to be discouraged."
The young man looked up. "Just talking to you makes me feel better. Now I know I'll sleep tonight." ... Farmer likes to tell medical students that to be a good clinician you must never let a patient know that you have problems or that you're in a hurry. "And the rewards are so great for just those simple things!" Of course, this means that some patients wait most of a day to see him, and that he rarely leaves his office before stars shiver in the louvred windows. There is a price for everything, especially virtue.
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