A Mighty Purpose

by Adam Fifield

  Finally, they made it through the throng and arrived at the cardiology office in the warren of a packed, teeming bazaar. It was dark, but they could make out a small shack with a sign posted out front announcing that medical services were available. They hoisted Ethel’s stretcher out of the van and wheeled her in.

  The place was low, narrow, and practically bare—save for a few paper scraps scattered on the grimy floor. A lone lightbulb hung forlornly from the ceiling. They lifted Ethel onto a table. The taciturn cardiologist emerged, carrying what he said was a defibrillator. In an instant of sudden horror, Rohde realized that the device was, in reality, “a fake old radio set with tubes in it that lit up.”

  He looked at the contraption, baffled. Then he got mad. This quack had wasted precious time. Had he actually used this on patients in cardiac arrest? Was he even a real doctor? Rohde didn’t have time to contemplate the implications. “This will not do!” he said, as he continued to pump Ethel’s chest and as rivulets of sweat trickled down his face. John Grant was still giving his mother mouth-to-mouth. Her pupils were still responsive. They could still save her, but they had to move. They had to try someplace else. Ethel’s chances ebbed with every minute that passed. There must be a working defibrillator somewhere, anywhere. “Get us out of here!” Rohde yelled.

  They wheeled her back to the van.

  “Take me to the university hospital!” Rohde commanded. Sweat soaked his shirt. His muscles burned, but his hands never stopped moving. If they did, Ethel would die.

  After more interminable traffic, they pulled into the university medical school and stopped in front of the main door, but were told they had to try another entrance. They drove around the campus in the dark, looking frantically, slowing, speeding up, until finally they found the right building. They brought Ethel in and were directed to the emergency room. Rohde and John Grant had alternated pumping and breathing, and they were each still working feverishly. The second they stepped into the room, Rohde knew they would have to go elsewhere.

  “It was a filthy, blood-spattered, equipmentless hole in the wall,” he says.

  Exasperated, he pleaded with a nurse.

  “We’ve got to get a defibrillator!” Rohde told her. “There must be one in this hospital somewhere.”

  The nurse replied that there was one in the internal medicine ward upstairs. Again they were on the move, working on Ethel as they rolled her through the crowded corridor, praying that they would at last find a working defibrillator. They lifted the stretcher with her on it and carried it up a flight of stairs; all the while, Rohde kept pumping.

  They barged into the internal medicine ward and found a large room with about thirty beds, almost all of them occupied. As they lifted Ethel onto an empty bed, a terrified nurse jogged in, carrying a defibrillator. A bolt of optimism shot through Rohde. Finally, they had found it. Maybe they could still bring her back. But when he picked it up, one of its wires dangled uselessly, disconnected from the paddle, almost as if someone had committed a calculated act of sabotage. Their hope crumbled. Rohde could not believe it. He had spent most of his career in the developing world, working in extremely daunting, austere, pathetic conditions. He was used to improvising, even when there was not much to improvise with, but there were certain things you could just not do without. And when someone had a cardiac arrest, a defibrillator was one of them.

  Rohde knew that it was probably over, but he could see that Jim would not accept that. The head of UNICEF stood nearby, his face ashen, his eyes pleading. He kept saying, over and over, “Don’t give up, don’t give up … please, Jon, don’t give up.”

  Rohde looked at his boss. “There just isn’t a chance anymore, Jim,” he said.

  “Just keep trying,” Jim replied quickly. “Please don’t stop.”

  Rohde picked up the defibrillator. He could see that on both ends of the separated cord, a few loose threads of wire protruded. Pinching them between his fingers, he twisted the ends of the wire together until the cord was attached. He knew it probably wouldn’t work, but he was doing this as much for Jim now as he was for Ethel. He placed the pads on Ethel’s chest and gave her three jolts. The jury-rigged defibrillator worked, but barely. Ethel didn’t respond. She lay motionless on the bed.

  There was one other thing he could try. He asked for an intracardiac needle—the kind of long needle used to shoot adrenaline straight into the heart. They didn’t have one. They did have adrenaline, which they gave him along with another type of needle—a needle that didn’t look long enough to reach Ethel’s heart. Rohde used it anyway, raising it up and plunging it into her chest. It was the absolute last hope of saving her. It might work, a small voice inside him said, it could.

  It had been an hour and a half since Ethel’s cardiac arrest. Jon Rohde and John Grant were drained, debilitated, drenched, but they still kept trying to revive her. Finally, Rohde stopped. Ethel was gone.

  Today, Rohde is tortured by the most wrenching kind of second-guessing. He thinks they might have been able to save Ethel had they gone to the local army barracks and announced that the wife of an under secretary general of the United Nations was dying. The army would have had a defibrillator. “It never dawned on me that we could go to the army,” he says now. “If we had, things would have been different, because she was doing well for quite a while.”

  Had Ethel’s cardiac arrest occurred in New York or in another, richer country, there is a very good chance she would have made it. She died for the same reason millions of people in developing countries die: the tools or medicines or vaccines that could have saved them were simply not on hand. As Grant had himself pointed out hundreds of times, it was a deadly gap between what was needed and what was available. It is a cruel irony that a man who had strived to bring lifesaving interventions to the poorest corners of the world could do nothing to save his own wife from what was most likely a survivable cardiac arrest. Grant and Rohde had both visited many bleak rooms in overrun clinics, not unlike the room they stood in now. And there, on the margins of the most marginalized places, they had met dull-eyed boys and girls lying in old, ratty beds, quietly dying from things no one—especially children—should die of. They had met parents who had faced the ultimate grief of surviving their own children. And for millions of these ostensibly doomed families, these two men had set about building an immense levy against loss and suffering and death—a medical bulwark to hold back the silent carnage of measles and tuberculosis and diarrhea and malnutrition.

  None of this, of course, could help Ethel Grant.

  They didn’t stay in Agra that night. Instead, they wrapped up Ethel’s body in a sheet, put her in a UNICEF van—not the “ambulance” in which they had spent the last harrowing hour and a half—and a UNICEF staffer drove them to New Delhi. During the trip, Jim talked as he wiped away tears, recounting his life with Ethel, giving voice to all the moments that now played vividly in his mind. He may have told of how they met at a fraternity party at Berkeley. Their wedding in December 1943, weeks before he was shipped off to the war. How she journeyed to China after the war to join him. How she made famous waffle brunches on Sunday mornings for visiting dignitaries. How they raised their family all over the world—in India, Sri Lanka, Turkey, and Washington. As the darkest night he ever knew scrolled by his window, it was almost as though Jim were trying to keep a part of Ethel alive.

  When they arrived in New Delhi, they drove to the UNICEF office, where an official took Ethel’s body. Jim stayed at Jon Rohde’s house that night, and the next morning Ethel was cremated according to Hindu custom. Rohde held a reception at his house, which was flooded with diplomats and officials coming to pay their respects to Ethel—and not just because she was Jim Grant’s wife. Many of them had been to dinners she had hosted and some had been welcomed into the fold of the Grant family by its magnanimous maternal emissary. If Jim radiated extreme energy, she matched him in warmth. She had, no doubt, helped him win over many an ally.

  The following day, Jim
Grant flew back to New York, carrying his wife’s ashes in a small box. His executive assistant Mary Cahill and a few other UNICEF staff members met him at the airport. “Ethel is no more,” he said in a low voice. His eyes had dimmed, and his skin had turned a pale gray—he was not the Jim Grant they knew. But in one respect, he was unchangeable.

  Within a few days, he went back to work.

  Chapter 10

  THE ALIVE GIRL

  Big, sweet, and somehow knowing, her smile is bracketed by deep dimples. Her head is cocked slightly to one side and wrapped in a bright, colorful, poufy turban. Confident and unafraid and just the slightest bit playful, her expression radiates vivacity and possibility. Buttoned straps hang over her small shoulders. She seems to be wordlessly daring anyone whose gaze fixes on her to be as expectant and hopeful and cheerfully defiant as she is.

  Selamawit Gebreyes was four or five years old when a photographer took her picture, and she unexpectedly became the face of the child survival revolution. Her blithe, pixieish image would be featured on brochures, stamps, and big posters seen by millions of people around the world. She would help UNICEF raise untold sums of money.

  She was unaware of her fame at first. Indeed, people who saw her beaming face would not likely have imagined the arduous, austere struggle she faced every day. It was a typical existence for a family in a cramped, confining slum in Addis Ababa, Ethiopia. She lived with her mother, three brothers, and grandmother in a garage—a dilapidated, windowless, one-room extension from the back of a bigger house. They had no electricity or running water. There was no toilet. There were no beds or furniture. The walls of their home were crumbling, and the tin roof leaked. It was almost always dark inside the cramped, tiny room, even during the day.

  Selamawit’s mother supported them all by selling onions, peppers, and traditional Ethiopian injera flatbread in a nearby village market. Her father, a soldier in the Ethiopian army, had died before Selamawit had ever met him, according to an account of her life compiled by the UNICEF Ethiopia office.

  His absence was painful. The quiet, watchful little girl saw the fathers of other children in her neighborhood. She watched them giving their daughters and sons bread, sodas, and candy. She did not have these things. She did not have a father.

  The crying of young children all around was incessant. Many were sick with diarrhea and other illnesses. In urban neighborhoods like this throughout the developing world—where there was no trash collection, where sewage and garbage often mingled in the street or in tepid canals—deadly diseases raged. When small children died, Selamawit could hear their mothers wailing. She herself “felt an apprehension of death,” according to the UNICEF account.

  To make extra money, two of her brothers shined shoes after school and guarded parked cars to make sure no one stole them. One of the boys’ customers was a staff member from the British Save the Children organization. The woman and her male partner took a liking to one of the brothers, who would visit their apartment and do various errands for them. One Saturday, he stopped by for a teatime visit, bringing along his mother and little sister.

  Staying with the Save the Children staffer at the time was a professional photographer named Louise Gubb. She was working on a freelance basis for several UN agencies, including UNDP and UNICEF. When she met the Ethiopian family, Gubb was immediately struck by Selamawit. “Her face projected the innocence and joy of childhood,” Gubb recalls in an email. She asked the girl’s mother if it was okay to take her picture for UNICEF, and the mother said yes. They went out onto a balcony to snap the photo.

  Then, according to numerous UNICEF accounts and articles, Gubb asked Selamawit what she wanted to be when she grew up. The poised girl supposedly did not hesitate, replying in her native language, Amharic: “To be alive!”

  Gubb does not recall whether she actually asked the famous question; it is possible, she says, that someone at UNICEF came up with that line for marketing purposes. Either way, she says, the photo of the striking little girl spoke for itself. “She was so vibrant, so full of life and delight, despite the gnawing poverty in which she and her mother and siblings lived,” says Gubb, “that she encapsulated the essence of UNICEF’s message.”

  She sold the photo to UNICEF for thirty-five dollars. UNICEF officials immediately saw the fund-raising potential. Jim Grant had long been looking for a symbol for the child survival revolution—now he had one. A range of collateral was produced with Selamawit’s face and words. On the poster, the question “What do you want to be when you grow up?” floated over her image. Printed below in big capital letters was the reply: “ALIVE!”

  Selamawit did not know about any of this. The British Save the Children staffer gave her family money, and UNICEF provided clothing for her and her brothers. Despite these gestures, her hardships only grew worse.

  The family had lived for fourteen years in the dark little garage attached to the bigger house. The occupant of the bigger house was a Greek man, who had taken pity on the family and had allowed them to stay there. When he died in 1988, Selamawit and her family faced eviction.

  Around this time, a confluence of fortuitous events took place. UN photographer John Isaac, a gregarious Indian man who had earned a slew of prestigious awards for his arresting images, decided he would try to find out whatever happened to the UNICEF poster child. He went to Addis Ababa. On a Sunday in March 1988 he visited the family in their home. “She was in a little hut [and had] no money, nothing,” Isaac recalls.

  Even so, the grandmother performed the traditional Ethiopian coffee ceremony for Isaac, an elaborate affair for an honored guest that usually involves roasting coffee beans, pounding them with a mortar and pestle, and then brewing them. Isaac then learned that Selamawit’s leg had been badly injured in some sort of traffic accident (it’s not clear exactly what happened, but she may have been struck by a car while walking in the street). She was somehow able to get medical treatment and told Isaac that doctors, at first, feared they would have to amputate her leg. Fortunately, a woman doctor was able to save it. Ever since that day, Selamawit had decided she wanted to be something else when she grew up besides alive—she wanted to be a doctor.

  The family also told Isaac that Selamawit’s school fees had become too expensive, and that she might not be able to continue her studies. He gave them some of his own money. He even visited her teachers and told them the fees would be paid.

  When he returned to New York, Isaac went to see Jim Grant. “Jim would like me to tell him stories,” Isaac says now. He told him how UNICEF’s poster child was faring, about the terrible poverty that had ensnared her family. He showed Grant pictures he had taken of Selamawit.

  Isaac had decided to share this information with Grant specifically—because he knew Grant would take him seriously. Grant did.

  The UNICEF leader had also heard about Selamawit’s life from the photographer who had first taken her photograph, Louise Gubb. At some point, probably before Isaac came to see him, Gubb was in Grant’s office to take his picture. She had been recommended by her friend Maggie Black, the author and UNICEF historian. Noticing the “Alive!” poster hanging on Grant’s wall, she began to tell him Selamawit’s story. “In order to relax him for the photo shoot, I chatted about Selamawit and the background to that photograph,” she recalls. “He showed great interest.”

  Whether it was Isaac who spurred him, or Gubb—or both—Grant wanted to meet Selamawit. He wanted to see if he could help her. He would remark to several staff members that she had, after all, “done more for us than we could ever do for her.”

  During a trip to Ethiopia in May 1988 for an important summit, Grant asked UNICEF communications program officer Yohannes Tsadik to find Selamawit. Bring the girl and her mother to his room at the Hilton in Addis Ababa, he said, at the end of the day. Tsadik obliged.

  Selamawit was now around nine. It had been at least five years since that chance encounter when Gubb took her picture. She and her mother arrived at Grant’s hotel room
after eight p.m. He welcomed them inside, shaking Selamawit’s hand and then her mother’s. “How are you?” he said. They both stood, seemingly unsure of whether they should sit.

  “Please sit down,” Grant said, and the mother and daughter sat next to each other on a couch. Grant and Tsadik sat across from them in chairs. The mother was reserved and did not say much. Grant told Selamawit that he was going to order her some ice cream and then asked her mother if she wanted anything; she said she would like some mineral water. When room service arrived, Grant picked up the ice cream cone and handed it to Selamawit. She took it, her eyes wide. She had likely never tasted ice cream before. “She liked it,” recalls Tsadik. “She was so happy about it.”

  Grant told them he would consult with the UNICEF Ethiopia office and do what he could to help their family. His tone was friendly but cautious, recalls Tsadik, perhaps because he was unsure of exactly what he could promise.

  The shy girl was awed by Grant. Either on this occasion or a later one, Grant told Selamawit that she would grow up to become a “great lady” and be very successful. It was crucial, he added, that she stay in school.

  Though surely Grant did not intend this, she began to view him as a father figure, says Tsadik. “He treated her so nicely,” he says. “Such a big man, a well-known man, famous man, bringing himself down to the level of this little girl, buying her food, giving her money, buying her ice cream—so that’s how she considered him a father.”

  The meeting at the Hilton was a welcome bright spot for Grant, who was still recovering from the shock of Ethel’s death. Worse was her obtrusive absence—she might have been with him on a trip like this. She would have loved meeting Selamawit. He must have wondered what she would have thought of her.

  Once back in New York, Grant proposed something totally out of the bounds of normal practice: UNICEF would provide Selamawit’s family with long-term, regular cash assistance for school, food, and rent for a better house. The problem was that UNICEF did not sponsor individual children or families. The aid it provided was mostly channeled through governments, NGOs, and local organizations. But this, Grant insisted, was a special case.