Here in Niger, greetings are very important. You exchange bonjours, and then you are asked “ça va” (how are you). But it doesn’t stop there. Actually the “ça va” is just the warning shot, a shot across the bow, the opening salvo of a fusillade of inquiries which are about to be launched your way, rapid-fire:
“How is your family?”
“How is the house?”
“How is work?”
“How are the children?”
“How is the heat/cold?” (this one varies according to season)
You ask them, they ask you and then you are free to carry on with the rest of your day. Of course, the rest of your day usually involves running through this same list of greetings with many other people. On a typical day, you will go through this exchange about 85 million times. So, although I have not been here very long, I feel as though I have already collected sufficient data and picked up on some observable patterns. I don’t think I can start drawing any conclusions yet, but I can at least start asking some questions.
I have noticed that often, when you ask “ça va?” people will answer by saying “ça va un peut,” which basically means “it is going ok.” This is markedly different from the standard “ça va bien,” or even the somewhat more bland (not to mention repetitive) but still perfectly acceptable “ça va.” I began to wonder if people in Niger are just not as happy as elsewhere. Are they pessimistic people? Do they temper their optimism with caution? Or maybe they are just more honest? But then I noticed something else. Whenever I ask a patient how they are doing, and if they are doing better, they usually answer “ca va un peut mieux” (I am doing a little bit better). This seems to be the answer of choice if they are doing a bit better, but they say the same thing even when they are obviously doing a lot better.
The other day at lunch, I brought up this phenomenon, and asked if anyone could explain it to me. “Why is everyone just ok? And why are they only a bit better?”
I was told by a Hausa that in the Hausa language, to say that someone is healed is another way of saying that they died. So you can never say “I am totally healed” or that someone who is sick is “better.” It would be misunderstood. I don’t know if there is a connection there, but it seems possible. I found this really interesting, and also kind of funny. It means that in Hausa you can have a conversation that goes like this:
“How is your grandmother? I heard she is not doing well.”
“She is totally healed.”
“Oh, I’m so sorry. When did it happen?”
The question of whether it is our language that influences our perception of reality, or vice versa is still up for debate (in my opinion), and it is an interesting one. But either way, this view of healing and health speaks volumes about the culture that produced it. According to this worldview, we will never be totally healed in this life; we will never be totally whole. Full health can only come when the question of health is no longer relevant. Perfection can only come through death.
This is my kind of lunch-time conversation. I find that metaphysics helps digestion. Sometimes.
As I was mulling over these thoughts, someone else spoke up. They said that in Tamashek, the language spoken by the Tuareg people, they have a different way of saying that someone has died. When someone dies they say that the person has “gone home.” This started another discussion, and a number of different theories on the origins of this expression were proposed. The most interesting one for me was also the most convincing. Since the Tuareg people are traditionally nomadic, they think of “home” differently than others. Their concept of home is more fluid; it is not rooted in a specific geographic location since they can (and frequently do) pick up their tents and move somewhere else. From this perspective, it makes sense that they would view death and the afterlife as home, as a final and eternal resting place, in contrast to their temporary terrestrial wanderings.
By this time lunch was over. I went back to my office, but I kept thinking about these two different perspectives on death, and what they have to say about the cultures they come from. The way we think about death, and what we say about it tells a lot about us, because death is an important part of life, and something that everyone in every culture around the world has to deal with eventually.
Hospitals are wonderful places, they are houses of healing, growth and even rebirth. I think this is true of hospitals in general, but it is especially true of our hospital here in Niger. It is a beautiful, cheerful place. But if you are at any hospital long enough you will also encounter pain, difficulty, grief and loss. It is unavoidable. Everyone loves to see the healing and bring good news to the patients, but sometimes we have to help patients and their families cope with loss and this is much more difficult.
Often, I feel totally unprepared. Like when there is a 14 year old girl with a tumor on her foot that is so big and painful, she is actually happy to have it amputated. What do you say in that situation?
Recently Dr. Roak gave me a few books on grief, grieving and how to comfort those who are dealing with loss. So I started looking through them, and one of them in particular, The Art of Condolence, I found very interesting. It shows that one of the best things you can do is to simply be there for those who are grieving (if they want you there that is). We feel like we need to say the right thing, or do something to make the pain go away. But often there is nothing to say, and nothing we can do. We just have to be.
Also, everyone has their own time frame for grieving, and goes through their own process, and the process is different in each culture. For some it might help to think that their loved one has finally been healed. For others, that they have finally gone home. In any case, one truth seems to apply across the board, and this is something that I have found in my own life as well: “The risk of love is loss, and the price of loss is grief.” Similarly, you cannot lose if you do not love, but if you do not love, you have already lost.
 Leonard M. Zunin and Hilary Stanton Zunin, The Art of Condolence, What to Write, What to Say, What to do at a Time of Loss, (Harper Perennial, New York : 1991) pg. 11.