“O O! Li mouri!!” one exclaimed, trying to catch her breath from laughing so hard. (“Oh-oh! It died!”)
“Li mouri?” another asked, laughing. (“Did it die?”)
“O wi, li mouri!” the first woman said emphatically. (“Oh yes, it died!”)
This made the other woman laugh even more. “O Ooooo! Li mouriiiiii!!”
They took turns explaining what happened. “We ran it over!” one said. “No,” another said, “it flew into the other car and died!” “No,” the third woman said, “it bounced off the truck and then we ran it over and that killed it.”
They argued playfully about it, their laughter punctuated by school-girlish squeals of “O O!” and “Li mouri!”
I felt slightly nauseated. I wasn’t sure if it was the thump I’d heard and felt as we ran over the poor bird or if I was just getting carsick from the vertiginous speed at which we’d just spun through the mountain roads and our start-and-stop weaving in and out of city traffic. I gritted my teeth and squeezed my eyes shut against the queasiness, hoping we’d be at the airport soon.
The ladies were still giggling away. It felt odd to keep hearing the phrase “It died!” accompanying such joyful laughter, not that I would have expected a somber period of mourning for a road kill.
I thought of how one of my American colleagues in Haiti described what happens when a patient dies in the hospital here, a sadly common occurrence due to how sick patients often are by the time they make it to the hospital and the limitations of locally available treatments when they finally do arrive.
“It’s always the same scene,” my colleague had said with jaded authority. “The patient is pronounced dead. The family wails dramatically in the courtyard for a few minutes. Then they compose themselves, come in, cover the body with a white sheet, take it outside, put it in the back of their car, and drive home to plan the funeral. It’s like they’re just used to death here because they see it so much.”
Used to death? It’s true that death occurs more commonly at all ages in Haiti compared to the US. Infants born in Haiti are eight times more likely to die than infants born in the US. Pregnant women in Haiti are twenty-five times more likely to die than pregnant women in the US. And the average life expectancy in Haiti is just sixty-four years—fourteen years less than on the same island across the border in the Dominican Republic and sixteen years less than in the US. But I thought it was insensitive and ignorant to imply that Haitians could get used to watching their loved ones die, their children and mothers and fathers and friends taken from them too soon.
My colleague’s comments reminded me of how after the 2010 earthquake killed hundreds of thousands and left more than a million homeless, nearly every article described the “resilience of the Haitian people.” A compliment at first glance, and one with some truth to it—Haitians and Haiti have survived countless disasters, both natural and unnatural. But as one journalist noted, “Sometimes compassion can be a form of contempt.” In a cynical piece on post-earthquake reporting entitled “How to Write About Haiti,” another journalist mocked the resilience trope as follows:
You are struck by the ‘resilience’ of the Haitian people. They will survive no matter how poor they are. They are stoic, they rarely complain, and so they are admirable. The best poor person is one who suffers quietly. A two-sentence quote about their misery fitting neatly into your story is all that’s needed.
How could we outsiders know what’s happening beneath the surface of so-called stoic, silent suffering in a culture that is not our own?
I wondered if my colleague would interpret the ladies’ laughter at the chicken’s death as symbolic of Haitians taking death more lightly since they are “used to” it. But there is always a risk of misinterpreting something that may have a completely different meaning—or perhaps no meaning at all—in another culture.
When we arrived at the airport, I thanked the driver and went around to the back of the van to get my luggage. One of the ladies sitting in the back opened the rear doors from the inside and slid my suitcase out to me. I thanked her and reached in to grab it. On the floor next to the suitcase were two large chickens tied together at the legs and wings. I couldn’t tell if they were dead or alive. Next to them was a large bucket of raw meat on ice.
The women saw me looking at the chickens and meat, and laughed. “Se pa pou w,” one teased. (“That’s not for you.”) They knew I was vegan, and they kindly made non-meat, non-dairy portions for me at each meal when I was working at HUM. They told me they were cooking for an event in Port-au-Prince later that day. I smiled, thanked them, and headed into the airport terminal.
* * *
After landing in Boston, I received this email from Nathalie:
Hi Aaron,
Our patient is in pain, we had to put more morphine in his treatment.
He is still conscious but sleeps more and more.
The family is putting on a lot of pressure. We are telling them that there is still hope . . . It’s hard for them though. But I know it takes time . . .
Nathalie
The fact that Francky was sleeping more and more suggested the pressure inside his skull was worsening, causing compression of the consciousness centers of his brain.
We were running out of time.
Anne and I wrote to the administrative contact at the hospital that had offered to help us with Francky’s case. We explained that the patient was getting worse and asked whether there was any progress on the possibility of free care. The reply:
I am not aware about free care. This can be discussed with my manager.
Clearly there had been a miscommunication. Why had we filled out all of that paperwork if not for a free-care request? The emails had seemed pretty clear from our perspective. There must have been some sort of misunderstanding.
Anne wrote back, asking how to contact the administrator’s manager.
The next morning, I awoke to find this email:
Hi Aaron,
I’m sorry I have very bad news.
Our patient Francky just died from respiratory failure.
He was really in pain so I guess it’s better for him . . .
Take care,
Nathalie
I was devastated. He was only eighteen. Eighteen! In so many other places in the world he’d have had surgery before it was too late. He’d have had the chance to become an adult. Instead, li mouri—he died. Like the chicken on the road to Port-au-Prince, Francky was in the wrong place at the wrong time. And so—“O O! Li mouri”—he died. He died what Paul Farmer, one of PIH’s founders and leaders, calls a “stupid death”—a tragically unnecessary death in a poor country from a condition that would have never been fatal in a rich country.
I was quick to blame the administrative delays for Francky’s stupid death. But Anne felt that was unfair. “We only had a month from the time you met him to his death,” she said, “and that is faster than any diagnosis-to-surgery time that I’ve ever had with these cases, other than post-earthquake. Even if they had accepted him right away, we would have needed a team to get a visa for him and make all the arrangements that you know took forever with Janel.”
Anne was right. It wasn’t “the system”—which it was my knee-jerk response to rage against—but “The System”: the lack of some type of global effort to address the inequities in access to medical care that cause treatable patients like Francky to die stupid deaths, and patients like Janel to wait so long for care that it could be too late to help them in any meaningful way.