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116 CHAPTER 5 ■ Tuberculosis: Keys to Success in Peru

BOX 5-1 DOTS Therapy

(This brief story expands on the opening chapter quote from Paul Farmer
and highlights a journey he took to visit the patient in Morne Michel.)
The one-way trip to Morne Michel usually took him two hours (on foot).
About three hours after we’d set out, we arrived at the hut of the non-
compliant patient, another shack made of rough-sawn palm wood with a roof
of banana fronds and a cooking fire of the kind Haitians call “three rocks.”
Farmer asked the patient, a young man, if he disliked his TB medicines.
“Are you kidding?” he replied. “I wouldn’t be here without them.”
It turned out that he’d been given confusing instructions the last time he
was in Cange, and he hadn’t received the standard cash stipend. He hadn’t
missed any doses of his TB drugs, however. Good news for Farmer. Mission
accomplished. He’d made sure that the patient’s cure wasn’t being
interrupted....
“Some people would argue this wasn’t worth a five-hour walk,” he said
over his shoulder. “But you can never invest too much in making sure this
stuff works.... The objective is to inculcate in the doctors and nurses the
spirit to dedicate themselves to the patients, and especially to having an
outcome-oriented view on TB.” . . .
We started on again, Farmer saying over his shoulder, “And if it takes
five-hour treks or giving patients milk or nail clippers or raisins, radios,
watches, then do it. We can spend sixty-eight thousand dollars per TB
patient in New York City, but if you start giving watches or radios to patients
here, suddenly the international health community jumps on you for creating
nonsustainable projects. If a patient says, I really need a Bible or nail
clippers, well, for God’s sake!”

Source: Kidder, 2004, pp. 41–42.

low-income patients received food packages as an incentive, and some received
reimbursement for transportation costs to the health clinic and free lodging for
those in need. In addition, the NTCP started a micro-credit loan program to
help patients start a small business and leave disease and poverty behind. For ex-
ample, Socios En Salud (SES), a sister organization of Partners in Health and
one of the largest nongovernmental organization (NGO) healthcare organiza-
tions in Peru, helped women in the community earn an income by providing
membership in a cooperative workshop that participates in crafts fairs in Peru