Farmer's subject is not Haitian poverty but its manufacture. Following Gutiérrez, who asked that exploitation be studied concretely rather than deplored in general, he runs two investigations at once: a historical account of the economic and political forces that produced the crisis, and close attention to what those forces did to particular Haitians he has known.

The historical half is written deliberately from the losing side, in something close to the register Haitians use about their own past. American journalists have read that register as paranoia — the reflex of finding Washington's hand in everything — and Farmer's reply is that the specific charges, once checked, hold up. So did the peasant claim he first took for metaphor, that the United States trafficked in Haitian blood: under Duvalier, Hemo-Caribbean shipped tons of plasma a month to North American laboratories.

The 1991 coup and the HIV-positive refugees held at Guantánamo frame the whole argument.