Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World

by Tracy Kidder

There was a proper procedure for dealing with resistance. When a patient didn’t get better on standard therapy, a doctor should suspect that the TB was impervious to some drugs in the regimen and should find out which drugs as quickly as possible and substitute others. Giving patients the wrong drugs was both useless and dangerous. It could lead to what infectious disease specialists call “recruitment of further resistance.” The term exactly described the process that Farmer saw in the ten patients’ records. He chose to call the process “amplification,” because that term sounded worse. These ten Peruvians had gone to the doctor sick and emerged, about two years later, sicker, their TB becoming resistant to more and more drugs as it went on eating their lungs. Not because they hadn’t followed doctors’ orders, but precisely because they had. And those orders weren’t simple acts of stupidity or carelessness. They were enshrined as official policy. They came from on high, from the people in charge of Peru’s TB program, who had gotten them from Geneva, from the World Health Organization itself.