by Paul Farmer
A lump lodged in my throat and I felt tears rush to my eyes. I took a quick breath and held it, hoping my eyes wouldn’t overflow. I didn’t want them to think something was wrong. They were enjoying themselves and so was I— three women sharing a manicure. But something was wrong. I thought about how different our lives were and wondered how many times a day I consume three or four times more than is really necessary. I’d never appreciated the value of a cotton ball before. My drawers were stuffed with them. I think I had as many bottles of vitamins and aspirin and Band-Aids in my cupboard as these nuns had in their whole facility. I took another deep breath and forced myself to apply the polish onto these beautiful young ladies’ nails.
“Bèi. Bèi. Mèsi,” they said when I finished. I smiled, but avoided eye contact, afraid I’d start crying. When I left the room I watched them over my shoulder, holding their hands up and admiring their new bright-red nails.
Beautiful Mother
On my next visit to Son Fils, I went into the intensive care room. I was nervous and kept reminding myself that I could handle sitting next to people who were about to die. After all, I’d knelt next to Rich in his final moments. I should be able to do this too.
The room was quiet. All I could hear was my sandals clicking on the cement floor. Most of the women were asleep, their bodies so thin that I could barely make them out under the sheets. I looked for medical equipment—ventilators, IVs, heart monitors—but didn’t see any. I decided to go to a bed on the far side of the room near a window.
As I sat down, a young woman opened her eyes to greet me. Her lids were heavy and they closed again quickly. I took her hand—skin and bones—and studied her stunning face. I wondered how old she was and what disease had brought her here. She looked like a model with her almond-shaped eyes and high cheekbones. Her eyes opened again. I held up massage cream, and she blinked yes. My hands shook as I gently massaged her hand and then her arm, afraid I might hurt her if I pressed too hard. When I got to her upper arm, I noticed it wasn’t any bigger than her wrist. I circled my hand around it, right near the armpit, to see if my thumb and index finger were able to touch. They did. Easily.
She motioned to her sternum, asking me to massage there, too. I hesitated, thinking that it seemed too intimate for strangers, but she reached out for my hand and pulled it toward her chest. As I moved her nightgown over to the side, I saw the familiar stretch marks of a mother. “Enfants?” I asked. “Oui,” she whispered. “Trois.” Three children. I wonder who’s taking care of them? How she must miss them. I wished I could remember more of my French so I could ask more questions. She asked if I had children. “Oui.Un.” She smiled and closed her eyes. I guessed she was thinking of her children, wondering what they were doing and how they were. I pressed gently on her sternum, afraid I’d break it, but she held her hand over mine, encouraging me to push harder. Then she let out one of those wrenching coughs. She had TB. The pressing on her sternum must have provided some relief. A few minutes later, she fell asleep.
Being with her reminded me of a day shortly after Rich died when a friend stopped by with a bottle of hand lotion. It had been a particularly difficult day emotionally and I didn’t feel like talking. She understood, put her arm around me, led me to a chair, and gently, in silence, massaged my hands. When she finished, she gave me a long hug and left. No words were needed. I never forgot her kindness and felt, in a small way, I was passing it on to this young woman.
The moans of another woman two beds down brought me back to present time. As I started to walk toward her, I passed a patient wrapped tightly in a sheet, like a mummy. I stopped and stared. I couldn’t see her face and didn’t detect any breathing. Had she died? My heart started to pound and a wave of heat went through my body. The already stifling temperature felt as if it went up 10 more degrees. The reality of impending death throughout the room suddenly hit me. I didn’t know what to do. I looked around to see if there were any nuns nearby, but I was alone.
Not sure where to go, I decided to keep walking to the bed of the moaning woman. I approached her slowly and timidly knelt down next to her. Would I know what to do if she reached out to me or if she pushed me away? I turned to look at the mother of three, and considered going back to her cot. It was easier to sit with someone silent and sleeping than to be next to someone so clearly in pain. I forced myself to stay put.
Back and forth the moaning woman rocked in the fetal position. Weren’t there any painkillers? She looked over at me, and I motioned to the lotion, but she shook her head no. I put my hand gently on her arm. I didn’t know what else to do. Tears dripped down her cheeks. Her eyes were bloodshot, revealing her physical agony and her despair. I tried to think of words in French that would convey how sorry I was that she was hurting, but I couldn’t remember any, so I sat there silently. Suddenly, she lifted her head, looked me in the eye, and spoke in English. “I have nothing,” she said, enun ciating every word. “No shoes… No dress… No money…” She lay back down on the pillow and stared at the ceiling. “I have big prob lems.” Her words startled me. I hadn’t expected English, and I didn’t know what to say. I just held her hand and waited for more. “I want to brush my—” she whispered as she pointed to her teeth and then her hair. I nodded. She started to say something else, but a coughing fit overtook her. Then she rolled over, exhausted, and closed her eyes.
I quickly left the room. As I stood on the balcony, my body shook with frustration and anger. Frustration because there was nothing I could do to help these women. Anger that this level of suffering existed—not only at Son Fils, but throughout Haiti. These women were dying young and alone—without their husbands or their children, without painkillers, IVs, doctors, or nurses. They couldn’t afford to go to a hospital, and even if they could, there was only one doctor for every 10,000 Haitians, a statistic I couldn’t get my mind around, it was so outrageous. In the U.S., the ratio is 1 to 350.
I leaned against the balcony railing, holding my head in my hands. Part of me wanted to run and get on the next plane. Another part of me couldn’t leave the women at Son Fils.
Searching for something positive, I told myself that at least they had a loving environment to die in. Or maybe they’d get better. What if a shipment of donated medicine arrived tomorrow and saved their lives? What if that mother with the beautiful eyes made a miraculous recovery and went home to her three children? What if the woman I was just with regained her strength so she could brush her teeth and hair? But that day, I couldn’t bring my heart to believe in possibilities.
Later, when we returned to the hotel, I was grateful to be separated from the rest of the city. I sat in a beach chair by the pool and stared at the palm trees waving overhead. I couldn’t motivate myself to write in my journal. Others in our group felt the same. We were all lost in our own thoughts—serious and silent.
Cité Soleil
Not far from the government buildings of downtown Port-au-Prince, near the sea, is a massive shantytown called Cité Soleil, built on a landfill that stretches as far as the eye can see. As many as 300,000 people live there. Bryan was involved in a community development project and had connections that made it possible for our group to visit. Our stay was only three hours, but that was long enough to witness the devastation. Before meeting at a community center to talk with residents, we walked fifteen minutes through the dense maze of shacks on our way to a tiny artisan shop. Our guides, residents of Cité Soleil, told us to stick close together and to stay in a single-file line. Poverty here is the worst it gets in Haiti and tensions ran high. It was not a safe place to be alone. One guide walked at the front of the line; the other stayed at the back.
From what I could see, most of the shelters were made of cardboard, tar paper, and pieces of tin or plastic, patched together to form tiny, one-room shacks. Some homes had cinder blocks for walls, but they looked like they’d crumble if you leaned on them. There weren’t many windows, so it was hard to see inside, but occasionally I caught a glimpse of a chai
r or a table or a pot. The floors were dirt, and a piece of ripped cloth often served as a door. No one seemed to have electricity, running water, or toilets. The smell of human waste was thick and nauseating.
Someone said that Mother Teresa called this 2.5-squaremile area “the poorest spot on earth.” I believed it. There were no sidewalks or even roads leading to the artisan shop. We followed a narrow path that ran between the houses, which were less than a foot apart from each other. I tried not to stare at the people we walked by, but it was hard not to. The scene was bleak beyond anything I’d ever imagined.
Later we were told that as many as a dozen people might live in one shack. At night, they had to rotate sleeping on the floor because there wasn’t space for everyone to lie down at once. During the rainy season, when the riverbed and the raw sewage ditches that run between the shacks overflow and the roofs leak, these homes flood, and the dirt floors turn into sewage-drenched mud.
We wove our way through the maze of shacks, passing frail mothers holding babies and young children playing in the dirt without toys. Some of the children had bloated bellies and a reddish tint to their hair—signs of malnutrition and starvation. My eyes met some of the residents and we exchanged nods and sometimes a “Bonjou.” Their voices were quiet and resigned, their eyes full of despair.
I was walking briskly along with the group, in a daze, when a naked 5-year-old girl with pigtails approached from the side and stopped in front of me. She was carrying a yellow plastic bowl of urine, and she needed to lean over the path I was on to pour it into the ditch that ran in front of her shack. She looked up at me with big brown eyes. I mouthed “Bonjou,” and she nodded, but didn’t smile. Carefully she poured the contents of her bowl. The urine splashed onto her bare feet and onto my sneakers. Then she turned and walked back a few feet, disappearing behind her cloth door.
I felt light-headed, queasy from the stench all around me, and I could hardly breathe. Scared, overwhelmed, and outraged by what I was seeing, I didn’t know what to do but keep walking. How could conditions like this be allowed to exist? If the world knew, surely it would do something!
I learned later that many of the residents in Cité Soleil were peasants. Unable to grow crops in the eroded countryside, they came to Port-au-Prince in search of work, food, and a better life for their children. But they were met with an even worse situation. I had no idea how they survived. The cramped spaces. The hunger. The filthy ditches. The flies. The disease. The heat. I couldn’t even begin to imagine what it would be like to give birth or raise children here.
Finally, we arrived at the art store, a one-room concrete-block structure without windows. I walked into the tiny space, and, once my eyes adjusted to the darkness, I was able to see paintings and woodcarvings on display. The artwork, all created by residents of Cité Soleil, was, to my surprise, colorful and bright, beautiful and full of life. Paintings of the countryside, the sea, palm trees, and exotic flowers leaned against the wall. Woodcarvings of women cradling children or carrying food in baskets on their heads were neatly placed side by side on a table. Metal cutouts of brightly painted fish and parrots were so vibrant they looked alive.
In the corner I spotted a small painting of a Haitian neighborhood. A husband dressed in striped pants and a blue shirt stood next to his wife, who wore a pretty blouse and skirt with a matching ribbon in her hair. They were outside their little white house. As I moved closer to the painting, I could see that the house had strong walls and a solid roof, windows, and a wood door. It was surrounded by beautiful flowers and a healthy tree. In the distance were other sturdy houses with small yards around them. Birds flew overhead and a mountain range was in the distance. Even the oppressiveness of Cité Soleil had not snuffed out this artist’s vision of hope.
I bought the painting and several other pieces, wanting to support the artists of Cité Soleil and their vision of beauty and life in the midst of overwhelming misery. I hoped the sale of the painting would help feed their children and make life a little more bearable—at least for a while. But I also felt uncomfortable reaching into my pocket for money—the American consumer, standing in the middle of the poorest spot on earth.
That night, I dreamed I was in a hospital, lying on a gurney. I pulled myself up onto my elbows and saw that my chest was cut open. I could see my heart—damaged, bleeding, and barely beating. I tried to scream to get the attention of the doctors, but no sound came out. No one heard me. No one saw me. I was forgotten in the corner. As I tried to sit up to grab the sleeve of a doctor who was walking by, hoping to get his attention to help me, I woke up. Images of the little girl with the yellow plastic bowl and the children on the street pleading “M’grangou” flooded my mind. I spent the rest of the night staring above my bed at the broken ceiling fan.
Holding Hands
Morning finally arrived. My head throbbed from lack of sleep, and my heart ached, reminding me of my dream. I con sidered spending the day in my hotel room, but when I thought of the mother of three lying on her cot near the window, I threw my sheet off, got up, and got in the van for the ride to Son Fils.
As I walked to the intensive care room, I tiptoed carefully around a group of women who were healthy enough to sit in the fresh air on the narrow balcony. The two friends I’d met a few days before were taking turns braiding each other’s hair. They nodded with recognition and proudly showed me their nails, still bright red and unchipped.
I went straight to the back of the room where the mother of three slept. With all the motionless bodies lying under white sheets, the room reminded me of a morgue. A volunteer offered me plastic gloves, but I shook my head, hating the idea of one more layer between my friend and me.
She looked frailer than before. Her eyelids lifted a fraction and then fell shut. I reached for her hand and slipped it in mine. Slowly her lips curled in a smile. I don’t know how long I sat next to her, watching the sheet rise and fall with each shallow breath she took. As the minutes passed, my breathing fell in sync with hers and everything quieted down. My mind became still. My body didn’t flinch. I felt no desire to move or talk. I felt calm and—was I happy? How could I be, with all the sickness and impending death around me and the memories of Cité Soleil still fresh in my mind? But I think I was. I felt filled up. It seemed impossible, but for that moment, I felt completely at peace. Time stopped and nothing mattered more than sitting on the cot holding her hand.
It must have been an hour later that a visit from a guest doctor brought me out of my stillness. He was gentle and kind, speaking quietly in Creole to each patient as he went from bed to bed with his stethoscope. I detected a Canadian accent as I overheard him give instructions in English to a nun, who was taking notes on a clipboard. I wondered what it must feel like to be a doctor with no medicine to give patients. The TB and HIV drugs that were needed to save these women were not on the shelf. I hoped painkillers had arrived overnight so he could prescribe something to make their days less miserable.
He lingered over a young woman who was lying in a cot near me. She looked about 18 years old and was frightened as he examined her. Rail thin, her body was barely noticeable under the sheet, except for a tiny bulge at her belly. I thought it might be a tumor. The doctor pulled a small device out of his bag and placed it on her stomach. A few seconds later, a sound filled the room. I’d recognize it anywhere. Thump-thump thump-thump thump-thump. He looked amazed. So was I. A baby!
Remembering the exhilaration of hearing Luke’s heart beat for the first time during one of my prenatal appointments, I wondered what was going through this mother’s mind. I didn’t know whether to smile or cry. Her baby’s heart sounded strong. But she was dying. The doctor’s face was full of concern as he whispered something to the nun and left the room. I turned back to my friend and squeezed her hand, hoping to return to that sense of peace I’d felt so strongly just a few minutes earlier.
But I couldn’t do it. My emotions swung from one extreme to another. Joy at the thought of a baby. Grief a
t the reality that the baby and mother would probably die. Hope that maybe the doctor could help. Despair at knowing he had no equipment or medicine to work with. My mind searched for ways I might help, but I was overwhelmed by the complexity of the problems. In a few days, I’d be leaving and would never see these women again. I was returning to my son and our comfortable life with cabinets filled with food and a doctor only a phone call away.
The mother of three must have felt the growing tension in my neck and shoulders as these thoughts filled my mind, because she opened her eyes and smiled at me. Her warm, loving expression seemed to be asking me to stop thinking and just hold her hand. I pushed all the other thoughts away and tried to settle back into the moment with her. Two mothers from completely different lives together on a cot, connected. I felt the muscles in my body relax again, including my heart. Love flowed between us. I could feel it and knew that I wasn’t just reaching out to her, offering my hand. She was also reaching out to me, offering hers.
Butterfly
Morning prayers at Son Fils began at 10:30. Those who were strong enough lifted themselves to a sitting position so they could see the two nuns standing near the doorway. A wooden cross and a picture of Mother Teresa hung on the wall behind them. Most of the women remained on their backs with rosaries wrapped around their wrists. I watched my friend to see if she would wake up, but she didn’t move.