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5

C H APT E R

Tuberculosis

Keys to Success in Peru

Nancy R. Lee

Just recently, a TB patient from a village called Morne Michel hadn’t shown
up for his monthly doctor’s appointment. So—this was one of the rules—
someone had to go and find him. The annals of international health
contain many stories of adequately financed projects that failed because
“noncompliant” patients didn’t take all their medicines. (Paul) Farmer
said, “The only non-compliant people are physicians. If the patient doesn’t
get better, it’s your own fault. Fix it.”
—Kidder, 2004, p. 36

Paul Farmer is a physician, a director at Johns Hopkins, a professor at the Harvard
School of Medicine, an anthropologist, and, according to at least one of his former
patients in Haiti, “he’s a god” (National Public Radio, 2003). Farmer specializes in
infectious disease and has made it his mission to transform health care on a global
scale, focusing on the world’s poorest and sickest communities. (Perhaps that ex-
plains the passion and sense of urgency in this chapter’s opening quote.) In 1987, he
founded a nonprofit organization called Partners in Health, which now treats about
1,000 patients daily for free in the Haitian countryside. They also work to cure tu-
berculosis in Peru, the public health issue and country of focus for this chapter.
The tuberculosis challenge is a natural for social marketing. There are specific be-
haviors to be influenced for audiences downstream as well as upstream. There are
SMART goals (specific, measurable, achievable, relevant, and time-bound) that have
been set for countries by organizations such as the United Nations that established
targets for tuberculosis control included in one of the Millennium Development Goals.