Hard times come again no more

February 27, 2009

Dear Friends and Family,

Stephen Foster, often referred to as “the father of American music,” wrote the song Hard Times Come Again No More in the year 1854. The first verse is a plea to remember the suffering of others:

Let us pause in life's pleasures and count its many tears;
While we all sup sorrow with the poor;
There's a song that will linger forever in our ears;
Oh hard times come again no more.

Hard times have come again to the United States, and to the globe; times as difficult as any, we hear, since the great depression.  The financial crisis has not only brought hard times to many unaccustomed to hardship, but more poignantly, has deepened the daily struggles of the most vulnerable in the U.S. and abroad.  As we reflect on our own problems, it is critical to realize that most of us, affluent people in a rich land, do indeed have many pleasures. I write this appeal to briefly pause in those pleasures and to reflect on the many tears I see in my work.

Most of us who are receiving and reading this letter thankfully do not know the hardship of helplessly watching our children weep from hunger day and night or the hardship of running away from our home as floodwaters rise—forcing us to take refuge with our naked children, in a putrid shelter, for the next three weeks—or the hardship of watching our fourth child die of a treatable disease because we have never had enough money to pay the “modest” twenty-five cent fee for health services.  These struggles bring shame, rage, despondency, and sadly, cannot be fixed by a pill. We must find ways to feel and share these pains—what Foster called supping sorrow and what we call acting in solidarity with the poor.

In 2003, on one of the first trips I made to Haiti with my colleague, Dr. Louise Ivers, we encountered a six-year-old boy who was severely stunted from chronic malnutrition. He had the swollen legs and belly and peeling skin that are all hallmarks of acute deprivation of protein.  He and his mother had come from afar, renting a donkey to seek treatment for his fever.  In addition to malnutrition, he did, in fact, have malaria, which we duly treated when they arrived at the health center. But a few hours later the malaria had a firm grip on the child and he was in a coma. We pumped him full of quinine and sugar to treat the deadly cerebral malaria and sang Kreyol songs to him as we worked.  Miraculously, and to our joyful tears, he suddenly awoke.  The mother seemed as unmoved by his sudden recovery as she had been by the sight of her near dead child. We encouraged her to take her son in an ambulance to our hospital in Cange, where the child could receive a blood transfusion and the best medical care in Haiti. She was withdrawn. We were a bit surprised by her reluctance to bring the child to Cange.  Couldn’t she see?  We had saved his life! We cared about him. It was then that she began to cry softly, saying, “I have other children, they need food, there is no one to watch them, they expect me back.  He is better, yes, thank you. But what will we eat?” And she placed her hand briefly on her stomach and then turned her palm up toward the sky.  With sudden humility and embarrassment we—Louise and I—understood that we were wholly unequipped to really help this child or mother. It wasn’t just malaria, it was malnutrition; it wasn’t a lack of attachment to this child, it was the attachment to many more; it wasn’t a disease, it was misery, pervasive and full of compromises.  At that moment we felt that we could do nothing but to try to feel her pain, to sup sorrow with her.  And, I am afraid, the story does not have a happy ending. The child died at our hospital in Cange two days later from the hard times, from the cauldron of misery that he was born into.

In the face of such pain, I think to myself, what is it that we provided for that child?  Clearly, we save tens of thousands of lives each year. But what of the lives we lose? Is there a lesson in that little boy’s death?  I believe there is.  For me, it is that the struggle for human dignity is fought by remembering that though degrees of suffering are relative, the value of each and every human life is equal, incalculable, and absolute and that there is some absolute quotient of decency that all human beings deserve and cannot live without. Particularly at this time in history, it is important to remember that our own struggles look like luxuries in the eyes of those who live on the catastrophic margin of life.

It is in recounting the saddest stories that I am often asked, “Does what we do matter?”  I always say, resoundingly, “Yes.”  We won’t win every battle. We won’t save every child. But together we can be the standard bearers of human dignity by being present in humility and in solidarity with the world’s most vulnerable individuals, families, and communities. We must remind ourselves daily that the suffering of others is greater than our own and that the suffering PIH sees everyday can be measurably diminished by our generosity, good work, and our willingness to feel the pain of others, even if it unnerves and breaks us.  We become agents of change by ensuring access to food, medicines, school, jobs, housing—the basic needs of a life on earth for those who live without. And we do these things, even in the toughest economic times, as our bellies are full, our homes shelter us, and our other great comforts grant us a resiliency that the poor boy Louise and I cared for never knew in his short life. 

It is refreshing to pause and to imagine a world in which our worth as human beings is measured not by material wealth but by our commitment and attachments to the humanity of others.  It is my earnest hope that in pursuing our common goal of creating a preferential option for the poor, we are making this world a better place for all.
I ask you, in memory of those we have lost and in honor of those we have saved, to consider making a gift to Partners In Health during these hard times—every donation makes a difference.

In solidarity,

Joia Mukherjee, MD, MPH
Chief Medical Officer