Mohammed* is 35 years old. He looks like he is 70. Well, until he smiles, that is. Then everything changes. He has some malignancy growing in his liver that is destroying it and his entire body. It is causing his muscles to waste away; nearly every bone in his arms and legs is visible. His feet are hardened from walking to our clinic, sometimes daily, when the abdominal pain is too much or the swelling becomes unbearable. In his condition, he should not be able to walk. But he has to. There is no choice. The flesh that hangs from his face lights up—wrinkle pleating upon wrinkle— and packs itself backwards into his gaunt cheekbones when Anam walks into the room. She hands him a green coconut. Abdul Hamid brings him juice, Rache and Chris bring sweet crackers. All smiles. For two weeks we’ve brought in needles for injections of antibiotics and pain medication, and also a long cannula to insert and drain the pernicious fluid that accumulates in his belly. From Mohammed, when I do this, I get frowns and glares—I see a young man who is dying. But when the needles come out and the fluid is drained, he also smiles at me. He rests for a bit, then he takes his walking stick and carries himself home, barefoot, exhausted.
Mohammed is on palliative care now: there is nothing more we can do besides keeping him comfortable. This would be true in the U.S. too, but still, it smacks of shame. Mohammed has come from a country where he has likely not received medical care for most of his life. He crossed the river between Myanmar and Bangladesh in the middle of the night, fleeing a backdrop of burning villages and gunfire, rape, incomprehensible violations of human dignity, and profound fear. He carried with him all that he had, including his cancer. And yet he has survived. He has survived the indignities forced upon him because he is Muslim, because his skin is darker than most Burmese citizens, because he, as Rohingya, has been declared “stateless” by a government and military regime desperately trying to maintain power.
You’ve likely seen Mohammed’s face if you’ve paid any attention to the news. His face is that of the thousands of faces burdened by suffering and fear. But you’ve likely not seen his smile. The media follows the suffering, a one-sided story of sorrow. Mohammed’s smile, though is subversive. It is a parry against the genocide—denied by Nobel Laureate and current State Counsellor of Myanmar Aung San Suu Kyi—that lays waste the Rohingya. Mohammed’s smile is a bold resistance against a cruel state. His smile resonates like the words of Holocaust survivor and philosopher, Viktor Frankl, “In some ways suffering ceases to be suffering at the moment it finds a meaning.”
For those of us treating him, we catch a sense of that meaning – incomprehensible but real and present every time he smiles. It is a wordless, revolutionary act.
It is this revolution of resilience that brings light to Hakimpara Refugee Camp in the southern region of Bangladesh, home to 1.2 million people—mostly Rohingya, but also Christian and Hindu minorities who have also fled Myanmar. Here, it is mostly peaceful. Here, communities support one another with the little that they have. I worry deeply, however, about what the future will bring. Stateless in Myanmar and stateless in Bangladesh, the citizens of this camp have very few rights. They are not allowed to own a cell phone. They are not allowed to work. They are not allowed to travel outside the military checkpoints. There are, of course, exceptions. With countless phone calls and letters, we can sometimes move a sick patient across the boundary so that they can receive essential medical treatment in Cox’s Bazar. The movement of these patients, as exceptions go, is unpredictable. Far more people get turned away at the checkpoints than those who are able to cross, even if their lives depend on it.
History throws opaque shadows. We can look closely at what happens when people are stripped of their rights while living in a place surrounded by others with so much more. As we move into 2018, the word radicalization is heard frequently. Governments continue to turn a blind eye to the acute suffering of millions. People with nothing also have nothing left to lose. People with no granted rights may make a stand in order to achieve group actualization. They may do so with force. We see it time and time again.
Here, today in the Rohingya camps, there are endless opportunities to treat the sick and feed the hungry, while supporting the educational, creative, religious and community needs of millions. Here, in this place, there is a peaceful, but poor setting that is primed for success. The opportunity for optimism remains strong. And even as the rainy season threatens the infrastructure of the camps, there is much good work being done. World Bank President, Jim Kim says, “Optimism is a moral choice. Pessimism in the face of extreme poverty can be a self-fulfilling prophesy that is deadly for the poor.” Optimism is the only option here, but it must be shrewd and calculated. It must be planned, well-coordinated and ethically sound. There is no other choice.
Each day on our way into camp, we pass busy markets full of tom-toms NGO vans, buses overcrowded with Bangladeshi citizens and lorries stacked with bamboo to make shelters for the camp’s newest arrivals. In the markets, we see fresh fruit and meat: legs of cows and lambs hanging from roofs; men who stand around paan vendors to buy beetle-nut and leaf-wrapped treats; piles of daikon radishes; clothing; and other food staples. And there are coconuts, tasty green coconuts, full of isotonic fluid. Delicious and nutritious. We stop in one of these markets before we cross the military checkpoint. On the other side, there are markets (and they seem to expand each day). The goods sold there, though, are older and less fresh. There is a limited selection. There are no coconuts.
The last time I saw Mohammed and we drained fluid from his abdomen, it had gone from clear to cloudy, which suggests infection. When the draining was almost complete, the yellow tinged peritoneal fluid changed to a rich, burgundy-red. Blood in the peritoneal cavity indicates a sinister progression of his disease. He thanked us when he walked out of our clinic that day and smiled his radiant smile. He asked us to find another green coconut for when he would return.
We know that we may never see him again.
* The patient’s name has been changed in this text to honor his privacy.