A “great epi divide” exists between regions—even neighborhoods—where tuberculosis is nonexistent and those where poverty allows TB and AIDS to flourish (125). Five anti-TB drugs are available, but advanced nations stopped researching in that discipline years ago even as multi-drug resistant (MDR) strains develop among poor, often Black and female patients who could not complete their proper regimens.

Paul Farmer prefers keeping Partners in Health a small foundation, but Jim Yong Kim starts an independent project, Socios en Salud, in Lima’s Carabayllo district with Father Jack Farmer, a charismatic preacher and PIH advisor, to create a replicable healthcare model for slums worldwide. PIH deals with administration conflicts and antagonistic revolutionaries, but Farmer feels that tuberculosis won’t be a problem due to Peru’s WHO-endorsed TB control program. Father Jack, however, contracts TB and dies a month later. His sample shows resistance to five first-line drugs.

Farmer, Kim, and project director Jaime Bayona search for the origins of the MDR strain. They find witnesses and records detailing patients who did not get better from treatment due to contracting an MDR strain or a treatment disruption that enabled the bacteria to develop resistance.