But it wasn’t as though failure and death were all he could see from his perch. He could see the clusters of trees that marked the sites of Cange’s communal water fountains, connected to the sparkling clean underground river. He could see some of Père Lafontant’s communal latrines, which had all but eradicated typhoid in this village. He could see some of the hillside on which Zanmi Lasante had grown and picture the rest—the dormitory and church and the office of the public health project and a corner of the school, and behind the groves of trees he’d planted, the guesthouse, the artisans’ workshop, the substantial building that housed the Clinique Bon Sauveur, rebuilt with Tom White’s money. And looking back at the village itself, he saw a settlement no longer made of crude lean-tos. Cange had grown, from 107 to 178 households, and the hillside was dotted with little houses now.
Père Lafontant’s wife, Mamito, the matriarch of Zanmi Lasante, had supervised a home improvement project, distributing materials that Tom White had paid for and quietly arranging for the reconstruction of the worst of the dwellings. Most of the houses had only two rooms, and many still had dirt floors, but nearly all had roofs of tin, some painted, some rusty, some glinting in the bright sunlight. Six years since he’d first set foot in Cange, and it no longer looked like a miserable encampment of refugees but just a typical, extremely poor Haitian village.
Farmer received his Ph.D. and M.D. simultaneously in the spring of the following year, 1990. His thesis won a prize, and a university press accepted it for publication. Early on certain professors at the medical school—especially the eminent anthropologist Arthur Kleinman and the equally eminent child psychiatrist Leon Eisenberg—had taken a shine to Farmer and licensed his unorthodox habits of attendance. And, as the years went on, they and others would protect him from the enmities and rules of academia. Lives of service depend on lives of support. He’d gotten help from many people.
Farmer’s absences from Harvard hadn’t hurt his educational standing. For his graduate work in anthropology, Haiti had been a better site than Boston, obviously. And his grades in medical school were outstanding, in part because while studying his flash cards, he’d also worked for large portions of six years as a virtual doctor in Cange. By now, at the age of thirty-one, he’d dealt with more varieties of illness than most American physicians see in a lifetime. He’d also learned how to design and manage both a public health system and a clinic, built from scratch, in one of the most difficult places imaginable, among people whose governments had kept them illiterate, where on a good day concrete got transported by donkey. Not surprisingly, the Brigham and Women’s Hospital accepted him into its residency program. It was one of the world’s most prestigious, and flexible. A Brigham resident could get permission to pursue another interest. Farmer and Jim Kim, whom the Brigham also accepted, split a clinical residency. Farmer got formal permission, that is, to spend half his time at the Brigham and the other half in Cange.
It seemed possible that Haiti might have a real national election late in 1990. Clearly, though, it wouldn’t happen without a fight from the army and the Duvalierist elites and the paramilitaries who worked for them, usually at night. Returning to Cange from Harvard, driving north from Port-au-Prince to Cange, Farmer had to pass through five different military checkpoints. At each, soldiers routinely solicited bribes. Occasionally they confiscated medical equipment that he was bringing to the clinic. Not all the harassment was routine. Zanmi Lasante kept an office in Port-au-Prince. Several times in the months leading up to the election the phone would ring and a voice on the other end would ask for Farmer, then say, for instance, “You are going to be reunited with your granny’s bones.” He could hear loud clicks on the line when he picked up the phone. Farmer climbed up on the roof of the building, found the bugging device—a clunky-looking jury-rigged thing. Rather gleefully, he kicked it to pieces.
This was all slightly puzzling to him. He hadn’t played a visible role in politics. Perhaps he had come to the army’s attention because, whenever his patients got arrested, he would go to the jails and try to get them out. Soldiers at the barracks in Mirebalais had shoved him around during two of those attempts at what he called “prison extractions.” Or perhaps he cut a larger figure than he realized. It was possible, for instance, that the wrong people had spotted him in the company of Aristide.
In 1990 he saw a lot of the by then famous priest. One day when Farmer happened to be in the city, Aristide stopped by the Zanmi Lasante office, looking bedraggled, driving a white pickup truck with a load of flour for his orphanage in the back. The truck wouldn’t start, so he and Farmer loaded the flour into Zanmi Lasante’s van and took off. They hit a large puddle, the van stalled, and Farmer said, “I don’t think we’re going to make it.” Then he said to Aristide, “In the newspaper it says you’re going to be a candidate for president. I guess they don’t know you very well, because you would never run for president.”
Aristide said something noncommittal, and a week later declared his candidacy. For a while Farmer felt angry. “How could he participate in something as irremediably filthy as Haitian politics?” But then he thought, “What are the Haitian people saying about this? They’re demanding that he run.” In a journal Farmer kept during this time, he wrote, “Perhaps this is a singular chance to change Haiti.”
Soon he was rooting ardently for Aristide, like virtually everyone else in Cange, and like them listening almost constantly to the radio dispatches from the capital. He was in Port-au-Prince, along with Père Lafontant, on election day. Many foreign observers, including Jimmy Carter, certified the results—67 percent of the vote for Aristide, and only 33 percent for the twelve other candidates. In his journal, Farmer exulted. Haiti had not only the most popular elected head of state in the world but one who professed liberation theology and had promised to lift the country into “dignified poverty.” The new president had also promised, not very subtly, a change of fortunes for the Haitian elite. “The rocks in the water don’t know how the rocks in the sun feel,” said a Haitian proverb. In one of his speeches, Aristide had revised it, saying, “The rocks in the water are going to find out how the rocks in the sun feel.”
Farmer drove back to the central plateau the next day. Entering Cange, he spotted an elderly man climbing barefoot up an eroded hillside. Wincing, imagining the man’s feet being sliced on the shaley rock—“rocks with teeth,” as the local people said—he had a somber thought. “I wondered fleetingly what even a government of saints and scholars could do in the face of such odds,” he wrote shortly afterward in his journal. But exultation returned. To Farmer, Aristide wasn’t the real victor. It was, he thought, the Haitian peasantry, people like his friends and patients in Cange, who had really won the election. They’d braved intimidation, even massacres, to make it happen and to vote. It seemed as if, at last, after centuries of misery, of slavery and subsequent misrule and foreign interference, the people of Haiti had claimed their country. Nothing, he would later say, had ever moved him so deeply.
He had many reasons to feel hopeful when he went to Boston to put in his time at the Brigham in the summer of 1991. Rumors of coups abounded. One real attempt was aborted. But the new government had assumed power. When he drove to the airport now, he didn’t have to stop at army checkpoints and roadblocks. They were gone from National Highway 3. What seemed like a revitalized Haitian Ministry of Health had begun collaborating with Zanmi Lasante on AIDS-prevention work in the central plateau. And at long last it seemed that a real hospital might be built in Cange. Indeed, most of the money had been raised.
On the twenty-ninth of September 1991—a date he wasn’t apt to forget—Farmer got Jim Kim to cover for him at the Brigham and set out on a short trip back to Haiti, for a meeting about the new hospital. These days a lot of Boston’s cabdrivers, as well as its janitors, were Haitian. The cabbie who picked him up at the Brigham happened to be both Haitian and an acquaintance. As he drove Farmer toward Logan Airport, he said, over his shoulder, “Dr. Polo, there?
??s trouble down there.”
“No way,” Farmer thought. “This government has the most massive popular support of any in the world.” He said to the cabbie, “Don’t worry. I’ll be in Haiti tonight.”
His route was a well-worn path. When he landed in Miami, he went to the usual gate for Port-au-Prince. But the sign above the check-in desk read, CANCELED.
“Whatever for?” Farmer asked the woman at the counter.
“I have no idea,” she said.
He checked into a motel near the airport and tuned the TV to CNN, which was just then broadcasting the news that the Haitian army had deposed Aristide. Farmer sat up all night watching, stupefied.
He waited around for flights to resume, then got word that he couldn’t take one anyway. The new authorities, the junta, had put his name on a list of personae non gratae. So he returned to Boston. Day after day for two months, he called the Lafontants in Haiti, asking, “Can I come back yet?” Finally, in early 1992, he was told he could. Père Lafontant had bribed a Haitian army colonel to expunge Farmer’s name from the list.
When he got off the plane in Port-au-Prince, he was drenched in sweat. He thought, “My pheromones are announcing fear.” But he made it through immigration without incident and drove straight to Cange, through the many reconstituted military checkpoints. Two days later he was working in his office at the clinic, beginning to feel calmer, when a former TB patient of his, a young peasant woman with a baby, came in speaking frantically. The local authorities had beaten her husband. He was dying, she wailed. Haitians were always dramatic, though. Imagining a few broken bones, Farmer packed his doctor’s bag and went off with her. They hiked across the dam to a hut on the other side of the reservoir.
To protect the victim’s family, Farmer would give his patient’s husband the pseudonym Chouchou Louis. Later, he’d learn some of the background to the story. While riding in a passenger truck through the central plateau, Chouchou had made a disparaging remark about the state of the road. Inside the truck there was a soldier out of uniform. He overheard Chouchou’s pwen, his pointed comment, and interpreted it correctly as anti-junta, pro-Aristide. At the next checkpoint, in the town of Domond, soldiers and members of a civilian group called attachés hauled Chouchou out of the truck, took him inside the headquarters building, and beat him. Afterward they let him go. But his name went automatically onto a blacklist kept by the local branch of the state’s security apparatus. Chouchou lay low for a while, but when he tried to sneak back home, the local section chief and an attaché were waiting for him. They had finished their business, and Chouchou was lying on the dirt floor of his hut when Farmer arrived.
He did all he could with the equipment he had in his bag, but even the Brigham’s emergency room would probably have failed. Afterward, Farmer recorded the wounds:
On January 26, Chouchou, a handsome man in his mid-twenties, was scarcely recognizable. His face, and especially his left temple, was misshapen, swollen, and lacerated; his right temple was also scarred, although this was clearly an older wound. Chouchou’s mouth was a coagulated pool of dark blood; he coughed up more than a liter of blood in his agonal moments. Lower down, his neck was peculiarly swollen, his throat collared in bruises, the traces of a gun butt. His chest and sides were badly bruised, and he had several fractured ribs. His genitals had been mutilated.
The accounting continued:
That was his front side; presumably, the brunt of the beatings came from behind. Chouchou’s back and thighs were striped with deep lash marks. His buttocks were hideously macerated, his skin flayed down to the exposed gluteal muscles. Many of these stigmata appeared to be infected.
The people who did this probably weren’t far away. Farmer didn’t dare go back by the same route, on foot over the dam. He borrowed a canoe, a hollowed-out mango tree, from a local fisherman, and he paddled it back across the lake.
Farmer had to get the story out. He contacted Amnesty International, which added Chouchou’s name to a growing list of victims of the junta, and he wrote a piece called “A Death in Haiti,” which The Boston Globe agreed to publish under someone else’s name.
To classmates, later to his students, Farmer’s medical memory seemed encyclopedic and daunting, but it was not inexplicable. “I date everything to patients,” he told me once. Patients, it seemed, formed not just a calendar of past events but a large mnemonic structure, in which individual faces and small quirks—he’d remember, for instance, that a certain patient had a particular kind of stuffed animal in his hospital room—were like an index to the symptoms, the pathophysiology, the remedies for thousands of ailments. The problem of course was that he remembered some patients all too well. In later years he didn’t like to talk about Chouchou. He told me, “I take active precautions not to think about him.” By then he’d already described the case in print several times. To me, he simply said, “He died in the dirt.”
CHAPTER 12
Ophelia visited Cange during the time of the junta, in the early 1990s. She slept in the main dormitory over the communal kitchen. One morning when she came down to breakfast, Paul said, rather casually, that someone had stood outside his window last night, striking matches.
She’d often felt nervous in Haiti in the turbulent years after Duvalier was thrown out. This was worse. When they ran into soldiers at checkpoints and roadblocks, Paul wasn’t even civil to them. He would not take down the iron sculpture that hung in his small room off the clinic, the Aristide symbol of the kòk kalite, the fighting “quality” cock. He would leave his books about Che Guevara and Castro and the like unhidden. She thought, “It would be dreadful if they came and searched the place.” She lay in bed at night, listening to the dogs barking and the roosters crowing and the drums beating in the hills. One evening she awakened as headlights swept through the louvered windows of her room. The next morning people said that soldiers had been poking around Zanmi Lasante in the night. She thought, “The plateau central is the home of the resistance, and there’s no way to get out of here, except that road, and everyone knows that this place is full of Aristide supporters.” She asked the woman in charge of the kitchen—she was known as Iron Pants, a generic Haitian nickname for a tough woman—“What if they came in to massacre us?”
Iron Pants said, “We’ll defend this place with our lives.”
Ophelia thought, “With what? Our pots and pans and Culligan watercooler?”
Paul continued to make the edgy transit between Cange and Boston. Indeed, he made it edgier. He asked Tom White to give him ten thousand dollars in cash, which he planned to smuggle into Haiti and turn over to the underground, pacifist resistance. In the car, driving back with the money from Tom’s house on Cape Cod, Jim Kim said to Paul, “You’re no use to anyone as a martyr.” He tried to soften his tone. “If you get yourself killed, Pel, I’m going to kill you.”
Paul’s face turned bright red. “What the fuck do you want me to do!”
Paul had yelled at him before, but Jim had never heard him scream. Paul smuggled the money into Haiti.
Safely back in Boston, Ophelia fretted about him in Cange. He was so angry he might do anything, she thought. What if a soldier came into Zanmi Lasante and tried to arrest one of his patients? “Oh, God.”
He seemed to be growing more and more reckless. He invited some nuns from the Catholic group Pax Christi to Haiti, hoping they’d help advertise the junta’s depredations. Twice at roadblocks, soldiers searched both him and the nuns. One time the soldiers ordered him to get out of the jeep and say, “Long live the Haitian army.”
“I’m not going to say that.”
“You better say that.” They lifted their weapons.
“Okay,” he said sweetly.
In Cange, he slept in his clothes, with his shoes on. His room was adjacent to a piece of thickly planted ground, reforested by him. He imagined what he’d do if the soldiers and attachés arrived—jump out the window and hide among the vines and trees from the beams of their flashlights. This was
morally acceptable, he thought. “Because they’ll be coming for me.”
Then one day a lone soldier started to enter Zanmi Lasante carrying a gun. Farmer came out to the courtyard. As always, a crowd waited there. “You can’t bring a gun in here,” Farmer said to the soldier.
“Who the fuck are you to tell me what I can do?”
“I’m the person who’s going to take care of you when you get sick,” Farmer answered. He was feeling mildly amused, until from the crowd behind him he heard a voice say, “Ket”—in rough translation, “Oh, shit.” It had the sound of someone anticipating disaster. Farmer thought, “Oh, God, I misjudged the situation.” The crowd suddenly seemed like a liability. The soldier couldn’t back down in front of them without losing face. But his answer to the soldier was probably the right one, and probably contained the main reason that he wasn’t banished or worse during those years. In fact, he was the best doctor in the central plateau, and Zanmi Lasante was the only place where anyone, including soldiers and their families, could get good medical treatment. The soldier growled some menacing words, then left. Farmer’s Haitian friends and colleagues scolded him. After that he curtailed his travel. Shots had been fired at Zanmi Lasante’s office in Port-au-Prince, and Père Lafontant had decided to close it. Farmer stayed out of the city except when catching planes back to Boston.