Le Cout de Sa Vie

(The Cost of His Life)

by Joel Hanson

 

Roughly 8,000 Nigerian Naira not only buys a roundtrip ticket between Lagos and Cotonou on ABC Transport but unsolicited sermons, too. “Our journey is in the hands of God!” a zealous minister shouts into his microphone. Like most Biblical sermons, the preacher has very little to say but endless ways of saying it.

The passengers, however, don’t seem to mind this call and response approach—even if it delays our journey to Benin by another 30 minutes. “Tell your neighbour, ‘You can relax, the Lord is in control.’ “ They respond with cries of “Yes” and “Amen!” as if God will descend from heaven and enter the bus if they shout loudly enough.

I have other thoughts on my mind, mainly a message I’d like to share with my fellow passengers. You threw off the shackles of the colonizer who claimed to bring a religion of love while forcing your people into slave ships. His religion was wielded against you as an instrument of social control. Why not eliminate it from your lives as well, particularly when there’s far more to be learned from the subtler forms of good and evil which surround you every day?

The purpose of my journey between Nigeria and Benin is not to sermonize against the self-evident evils of European colonization, but to meet my dear friend, Spero, in Cotonou. He was once a student in my Intermediate 4 class at the American Language Center in Casablanca. When the class ended, Spero asked me to tutor him before we discovered a mutual interest in contributing—and thereby validating—the regions of our personalities undervalued in our respective cultures. He is now a physician and medical administrator for a large district about 40 kilometers away from Cotonou. We haven’t seen each other in five years.

On the morning after our joyful reunion, Spero introduces me to his colleagues while giving me a tour of the entire medical facility. Before we walk into his air-conditioned office, he directs my attention to two soldiers in green uniforms.

“They’re my bodyguards,” he remarks as though men with guns are a doctor’s most common accessory.

Before I have the chance to ask him why the men are necessary, we’re inside the building and Spero’s inundated with the business of the day. There are questions to answer, patients to see, and forms to fill out and sign, but eventually I receive an indirect answer to my question.

 Spero attends to his last three visitors in the early afternoon: a father, his brother, and his son. The father sits down next to me, shakes my hand, and does most of the talking. His brother sits on a chair to the left of Spero. His son stands between them and remains taciturn throughout the meeting. I can’t follow the conversation, so I wait until the men leave, the father departing with a slow deferential bow, before asking Spero for an explanation.

The day before, while his father was away, the boy fought with his neighbour in a dispute over a goat. Eventually, he became so enraged that he grabbed a machete and cut his opponent in half with one mighty stroke. Unqualified to judge the mental condition of the accused, the police chief of the Kpomasse district ordered Spero’s armed bodyguards to escort him to the hospital so he could receive the opinion of a medical professional.

The family pinned its hopes on convincing—or bribing—Spero to write a medical certificate stating the boy was clinically insane at the time of the murder and therefore not responsible for his actions.

The boy remained silent for most of the conversation and Spero could distinguish immediately that he was not deranged. Much to the family’s dismay, no amount of money—the initial bribe was 200,000 CFA (about $500)—was going to persuade Spero to change his opinion.

My first question: “Couldn’t they try to get the certificate from another doctor?”

“I don’t think it’s possible,” Spero responds, although he admits that he can’t be entirely sure, “because the crime occurred in his district and he’s the only doctor in the area authorized to issue a certificate of this kind.

Sure enough, the father calls Spero about 15 minutes later and increases the bribe to 400,000 CFA. “I won’t do it for any amount of money,” Spero assures me, “but I bet the offer will be 1,000,000 CFA by tonight.” My mouth opens in surprise and Spero laughs. “This kind of thing happens all the time around here.”

Now I know why the bodyguards are necessary. Spero has been threatened in the past by individuals—or families like this one—that can’t accept the finality of the answer “no.”

We spend the remainder of the afternoon visiting two, half-finished outpatient clinics in the bush. Spero must check on their progress and report to the Minister of Health. Getting there is the most arduous part of the job. The reddish dirt paths, carved with ruts and rivulets from torrential rains, are at times virtually impassable.

Tall plants grow in the middle of the road. This is the wet season after all and automobiles are rare in these parts. Our driver skilfully guides the vehicle over the exposed rock and around the craters, but my conversation with Spero is frequently interrupted by spine-crunching jolts.

On the way to the first clinic, we make an unscheduled stop in a village where three men are building a latrine. I watch one man pouring cement into four large square molds while Spero converses with the others. We stay long enough to look at the large rectangular hole they’ve made in the red earth and to ask a few questions. “It’ll be finished in three months,” Spero informs me as we drive away, “but they’ll never use it.”

“Why is that?” I ask. He pauses with an audible sigh. “Because it’s very difficult to change old habits.” Illness in this part of the country, Spero reminds me, is caused not by infection but by spells and curses cast by one’s neighbors. Thus, when a person becomes ill, the family typically spends its money on the services of a local doctor who’ll concoct some herbal mixture to reverse the curse. They only resort to modern methods when they’re bankrupt and have no other choice. “By then,” Spero laments, they’re usually on the brink of death and there’s very little I can do for them.”

We eat lunch beneath the shade of some palm trees by a massive lake called Les Alizées du Lac. The sound of waves washing up on shore is peaceful and it’s mesmerizing to observe the silhouettes of men propelling their long wooden boats with long wooden staffs. But I feel a sense of guilt eating a mildly expensive lunch by the shore while destitute fisherman cast their nets into the shallow water less than 50 meters away.

Two boys notice me reading a book and swim up to the shore to beg for money. I have 15,000 CFA in my pocket in two large notes. But even if I had smaller bills, giving the money to them presents an obvious problem: the boys are naked and laying in water. Where exactly would they put it?

The depth and importance of our conversation over lunch has the effect of making the idyllic setting disappear. Spero’s ready to make sweeping changes in his life. He wants to leave the medical profession to become a teacher even though he’s the only doctor in a district of 80,000 people. Benin itself has just a few hundred qualified physicians to serve a country of 7 million people. He wants more time to travel, more time to pursue other interests, like his writing. He’s also weary of the inexorable cycle of suffering and death he witnesses on a daily basis.

Spero will get his first opportunity to try his new profession in about two weeks when he takes a short vacation from his current job in order to teach a biology class at a local university.

The man is talented in many subject areas—physics, biology, and French among them. He’s benevolent, passionate, articulate, and skilled in the fine art of improvisation. That’s what makes doctors excel in jobs with limited resources. It’s also the foundational clay that enables teacher trainers to shape people like Spero into effective instructors. What he lacks is extensive teaching experience and a network of supportive friends. And I tell Spero that these absences work in tandem to contribute to his fear of the unknown.

On a whim, Spero decides to stop at Ouidah Hospital. Patients from local clinics with life-threatening situations are sent here for further treatment. Those that can’t be treated here are transferred to Cotonou. Spero offers to show me the morgue—the man who was severed at the waist by his neighbor’s machete is still interred here, but I politely decline. That simple choice as well as the decision to visit the pediatric wing may be ultimately responsible for saving a life.

The first person I notice in the pediatric building is a young woman pacing up and down the corridor, clutching her malnourished five-year-old son—her first and only child—in her arms. The child’s face is gray, his face impassive. Spero gently opens one of the boy’s half-closed lids with the tip of his index finger and we watch with horror as his eyes roll into the back of his head. The final face of death, I decide, is not terror, but indifference. This boy’s glassy eyes are proof that if he hasn’t already left us, then his departure is imminent.

That child has malaria,” Spero informs me. And he’ll probably die within the hour.” He’s tearing up as he reveals the diagnosis, but I can hear a trace of lethargy in his voice. And it frightens me to discover that the repetitive act of watching children die has hardened a portion of Spero’s compassionate nature.

“Isn’t there anything that can be done for him?” I ask. “Not really,” Spero answers. “A blood transfusion, perhaps, but there’s no available blood in the entire hospital and the mother can’t afford to pay for it.”

Spero pauses to shake the hand of an emaciated woman with AIDS who thanks him for the simple act of befriending her, of treating her humanely after she’d been ostracized by her friends. Spero and I continue down the hallway and all he can tell me about is the futility he feels when he’s done all he can for a patient and ultimately realizes how small his contribution has been.

Immediately, we return to the subject of the boy’s fate. “How much does a blood transfusion cost?”

“At least 10,000 CFA (about $20) for the first treatment. Do you have any money?”

I reach into the pocket of my shorts and pull out a 10,000 CFA bill and put it into Spero’s hand. “Here’s 10,000…” and Spero jogs down the halfway to inform the boy’s mother. I follow. 

We hear shrieks of pain coming from the room where the boy is being treated. Spero motions me into the room and I reluctantly acquiesce. The child is now lying on his back, stomach slightly bloated from malnutrition, waiting to die. The cries, however, are coming from another boy next to him who could be his brother. Two female doctors are holding him down while another tries to clear the phlegm from his throat so he can breathe. The boy struggles for air, his body contorting with the effort. He’s trying to fight off the nurses, but his agonizing screams are strangled by the mucus in his nose and throat.

Another nurse is talking to Spero about the logistics of the other boy’s blood transfusion. Spero calls another hospital for a blood donation and requests an ambulance. I leave the room, tormented by frustration and a formless rage. All I can think about as I stand in the hallway is the futility of human life, the maddening inequality that persists in the world, and human beings’ unflappable indifference to preventable suffering and death.

The US donates hundreds of million dollars to an African malaria fund but clearly it’s not enough. Another sportscaster for ESPN started a program called Nothing But Nets that accepts private donations in order to provide mosquito netting to West African countries. So why are so many people dying of a treatable illness? Is it a question of inadequate funding and a lack of resources, or are the money and supplies simply siphoned off by corrupt government officials? I suspect that it’s a combination of the two.

Every year, tens of thousands of people die from malaria in Africa. These statistics always depressed me but, until now, they’d remained little more than numbers on paper and therefore intangible. Seeing this boy’s suffering face, though, has made the crisis indelibly real for the first time.  

I return to the building to ask Spero for an update. He’s found blood at a nearby hospital and called an ambulance, but it’ll take 30 minutes to arrive.

“Can’t we just put him in our truck and take him over there ourselves?”

“No, because it would take too long to find the appropriate people and sign the forms to release him. And we’d be legally liable if he died on the way.”  

“Well, has anyone checked his blood type?” I continue.

“Not yet,” Spero answers.

“One of us must have the same blood type and then he could get the transfusion from one of us.”

Spero follows my logic but he can tell that I haven’t yet become habituated to the limitations imposed by the medical bureaucracy. “They don’t do direct transfusions without testing the blood for HIV first and the hospital doesn’t have the equipment to do the transfusion.”

“But can’t they waive those rules if the boy’s going to die anyway?”

Spero shakes his head and I notice other people slowly exiting the pediatric building behind him. “Spero, before we leave, I want to see the boy one more time. What’s going on?”

“The boy just died,” Spero answers.

“Which one?” The boy with the tube down his throat or the boy who’s dying of malaria?

“They’re both dying of malaria but the boy who was screaming. As soon as he died, the mother started crying and they ordered everyone out of the room.”

I begin to ponder the prosaic sequence of events that brought us here. If Spero hadn’t suddenly decided to visit the main hospital in Ouidah, we never would have discovered there were two children dying of malaria.

If we had visited the morgue as planned, that child we’re trying to save would surely have died. And if I hadn’t had the money to give to Spero, the boy’s death would have haunted me for the rest of my life.

Later, I asked Spero what happened when he gave the money to the mother.

“She cried,” he answered. “She thought we were messengers from God.”

If that were true, I silently ponder, then who did the mother of the dead child think we were? Shouldn’t we have been allowed to save both children? Or the innumerable multitudes who die from malaria—and malnutrition—every day?

Why would an omniscient god allow innocent children to suffer? It’s a timeless philosophical dilemma dogmatic believers have difficulty answering: either God is incapable of intervening in human life or he simply doesn’t want to. Presuming that God exists, it’s easier to accept the idea that he’s not all-powerful than to believe he’s cruel or that deaths like this one are due more to mismanaged political systems than from a dearth of supplies.

An hour later, before driving the final 15 kilometers to Spero’s village, the driver stops for gasoline. Spero gives him a 10,000 CFA coupon (he receives from the government) to half-fill the tank of his pickup truck. As he signs the receipt, my mind is still on the boy on his way to the hospital and I remark: “C’est le cout de son vie,” and Spero turns to me and nods. “Oui.”

We’ve been in the house for less than 20 minutes when Spero receives another call. A close friend of his named Elizabeth has just died, even though he saw her just the day before. C’est pas vrai,” he tells me absently. “She was happy to see me and we made plans to get together next month.” “So it couldn’t have been a suicide,” I remark.

He calls her husband for more details but none are forthcoming. We also rule out a heart attack but can’t help wondering if she was killed in an accident—or murdered. I don’t know what else to say. Words are incapable of mollifying Spero’s pain and I’ve silently decided that now is a time for listening to whatever he wants to say. I put my hand on his shoulder and offer him a beer.

Then, when he’s recovered from the shock, I share a story about my cousin who died in a snowmobile accident back in 1997. I tell Spero how I declined the opportunity to see him one last time in the morgue, how I didn’t want the image of his corpse to usurp my memories of him in life nor did I want to know about the minute details of his painful drowning.

But I can’t imagine what Spero’s feeling right now. Knowing a friend has died but not knowing how she died makes it easier to deny the finality of what just happened. Elizabeth’s husband promised to call in the morning but, as of now, Spero knows nothing more about her mysterious death.

At breakfast the next day, Spero reports that the boy in question is still alive at nearby Comé Hospital but remains in critical condition. Nevertheless; I can’t help wondering if we’ve really helped him by prolonging his life. Our unexpected intervention may save his life in the short-term, but it can’t change the fact that his mother still lacks the money and resources to ensure his long-term health. And it can’t spiritually compensate for the loss of the boy next to him—or for the thousands of other children who die from the same disease each year.

Most deaths are outside the realm of our control, but every now and then we do have the means to directly impact the lives of those around us. And we have to do more to prevent senseless deaths from treatable illnesses, even if getting to the source of the problem requires solutions that are exponentially more complicated.

For example, should we first deal with the social conditions that encourage parents to produce large families which contribute to unemployment and increased competition for limited resources? Instead, perhaps our efforts should be focused on battling the corruption of the local government which lacks the organization to adequately distribute donated supplies. Or maybe we should fight to change the political priorities of governments like the US that value military spending far more than humanitarian aid.

Nevertheless, I’m reluctant to return to the hospital in Ouidah. I fear that there’ll be another child dying of malaria in the pediatric wing and I won’t be able to do anything about it. In the meantime, I wonder if the 400,000 CFA bribe Spero was offered yesterday is still on the table. I can see at least one advantage to accepting it. Of course, the act will exonerate a guilty man, but just imagine how many children it could save. 

Joel Hanson is a former Seattle resident who in recent years has been teaching English language in a variety of countries.