Farmer sets out to explain the coup of September 1991 and the detention of HIV positive Haitian refugees at Guantánamo by tracing the long relationship between the two oldest republics in the hemisphere. He writes an interpretive history deliberately told from the position of those who lost, arguing that what North American reporters diagnose as Haitian paranoia about Washington's hand turns out, on inspection, to rest on documented events. His method is to pair large scale economic and political forces with the lives of particular people he has known as a physician, so that a nineteenth century pattern of gunboats sent to collect merchants' debts, the steady transfer of Haitian commerce from Britain and France to the United States, and the Duvalier era plasma company that shipped tons of Haitian blood north each month for a few dollars a litre all appear as one continuous history of extraction reaching into the clinic.