Saturday, August 27, 2011

"I Would Like to Give You a Chicken or a Pig"

"A sad-faced young man takes his seat beside Farmer and stares down at his own feet, shod in ragged running shoes, splitting at the heels. His name is Ti Ofa. He has AIDS.... from his long experience Farmer knows the virus is about to begin its endgame with Ti Ofa, its overwhelming stage. Ti Ofa says, 'I feel ashamed.'

'Anybody can catch this. I told you that already,' Farmer says. He opens a drawer in his desk and takes out a large plastic bottle. It contains indinavir, one of the new protease inhibitors used for treating AIDS.

No one else, not at this time, is treating impoverished Haitians with the new antiretroviral drugs. Indeed, almost no one in any poor country is treating people who have the disease. Even some of Farmer's friends in the Haitian medical establishment have told him he's crazy to take on AIDS this way in Cange, and certainly many experts in international health would agree. Leaving aside all other objections, the new AIDS drugs could cost Zanmi Lasante (the Haitian sister organization of "Partners in Health") about five thousand dollars a year per patient. Nonetheless, Farmer had started some patients on triple therapy.... He and his colleagues back in Massachusetts are working on grant proposals to obtain a larger, more reliable supply. They'll find the money he's told me.

He holds up the precious bottle for Ti Ofa to see. He shakes it, and the pills rattle around inside. He tells Ti Ofa that he'll start treating him with this drug and two others now. They won't eradicate HIV from his body, Farmer explains, but they will take away the symptoms, and, if he's lucky, let him live for many years as if he'd never caught the virus. He only has to promise that he'll never miss a dose.

Ti Ofa says he won't, but he's still looking at his shoes. Farmer leans closer to him. 'I don't want you to be discouraged.'

Ti Ofa looks up. 'Just talking to you makes me feel better. Now I know I'll sleep tonight.' He wants to talk, and I suppose he knows he's welcome to do so. 'My situation is so bad. I keep hurting my head because I live in such a crowded house. We only have one bed, and I let my children sleep on it, so I have to sleep under the bed, and I forget, and I hit my head when I sit up. I don't forget what you did for me, Doktè Paul. When I was sick and no one would touch me, you used to sit on my bed with your hand on my head. They had to tie up the dogs in the village, you walked around so late to see sick people.' Ti Ofa declares, 'I would like to give you a chicken or a pig.'

Ordinarily Farmer's skin is pale, with a suggestion of freckles underneath. Now it reddens instantly, from the base of his neck to his forehead. 'You've already given me a lot. Stop it!'

Ti Ofa smiles. 'I'm going to sleep well tonight.'

'Okay, neg pa'- 'my man'- says Farmer."

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