(...)The lack of ward staff (about one tenth of what would be required in Europe) is so severe that there are procedures that I tacitly decided never to do. No feeding though a tube, no prevention of venous stasis, no appropriate quarantine, no sterilisation of dishes, and so on.

We have limitations.No, no-one would have refused to allow Western volunteers access to the wards. Volunteers who try to think they can be useful to the destitute. So they come, from everywhere, particularly from Europe, and particularly in the pleasant season (the one in which they sweat less). Some come to solve their own problems, of narcissism, or of religion. Some come out of curiosity or to add a line to the curriculum vitae. Here 'humanitarian tourism' rages. It has become a trend for us, a need, much as sex tourism was a few years earlier.Perhaps it is not we who are disrupted, it is our society.

The non governmental organisations, the professional 'humanitarians' are less naive. "The management of money and distribution of power is not clear enough" they might say, as if to apologise for not helping those who are already dying.Most of the volunteers don't speak Thai. Could they learn on the job ? It appears difficult, and people who have stayed working on the ward for two months tend to leave with only about ten Thai words and even these they pronounce incorrectly. Most of us overestimate our strength or potential utility. Most underestimate the difficulty of the work. Some, though fewer, underestimate the repulsive nature of the work (the foul odours, the feeling of powerless in the face of pain, the hideous look of the skin diseases, the physical risks, the enormous symbolic power of impact of death…)So, many of us don't stay long, they make their excuses and leave taking their snap-shots with them. Others stay on, but then refuse to do the hard work (to be blunt, dealing with vomit and shit), or put in an appearance for just a couple of hours each day.The ward is organised regardless of the presence of volunteers.

Death continues regardless of mood or volunteers' whims. The slaves trudge on even if the volunteers don't.But, occasionally there are volunteers who stay longer and make themselves precious. Generally they arrive alone, and are not fully conventional (damaged, homosexual, artistic, very rich, debauched, wasted...) To settle in such a place without salary one must be a little if not totally mad !

Actually, these volunteers often have a heightened sense of autonomy. This hospice, contrary to that of Mother Teresa's in Calcutta is not Christian and is not known by the Western Christian network (and its inexhaustible supply of volunteers). Those who remain here do not come for God or to create an impression in their parishes, and are more prepared to act with total gratuity and without any thanks.

On the whole the work is the same as that of Mother Theresa's. I have worked in both places. Volunteers help the workers wash bodies, massage, comfort, feed... Some, clean away the excrement, mop away the vomit, changethe beds, clean the urinals and so on.(...)


(...)One day, curious, I asked the nurse what she thought of the western volunteers. After brief consideration she answered that she would like it if there were more of them.

- Why?, I asked her, We don't even speak Thai!

- Because you are not scared! she answered.

Suddenly I realised something important: Westerners, who fear so many things, don't actually fear contracting HIV. They treat the patients with the proximity for which they hunger so. Each week hundreds of Thai visitors come. They may give money, fruit, a kind word, but, they are terrified to approach the patients, and it is obvious.The whole nation is in a state of terror, this is the result of poor HIV prevention tactics. Those same people who come to the hospice to make donations are the same people who would discard their HIV positive relative the moment he started to have visible symptoms.

Thus, the volunteers provide something that is irreplaceable: human contact. I decided to act upon the nurse's teaching, by practising that which makes me useful: touching the patients. Touching them as often as possible, without wearing gloves.

- You dared to touch me, you, you dared to touch me… Oh… Doctor… One patient said, she began to cry.

And others have reacted in the same way. In need of touch.There was another fearsome patient, covered in wounds, with bones exposed in three areas of his body. He waited for me, and then said :

- Permit me doctor… permit me to touch…

And he stroked my forearm, with his right palm. His eyes were moist, his throat tight.The Thai workers, immersed here for years, don't dare to do what we, the 'farangs', dare to do from the first day. Touch.I know that psoriasis and eczema are not contagious, that scabies isn't very dangerous, that herpes will never manifest itself as much more than a cold sore on my body. I know that I need not be afraid of Karposi's sarcoma, of the spectacular ugly generalised allergies on the skin (Steven Johnson's Syndrome, Lyell's...) of other alarming necroses. I know that usually there is little to fear in simply touching a patient.

My only fear was tuberculosis. I avoided, as much as possible, to work without a mask. Then, I finally removed the mask, for the same reason I removed the gloves. And then, I caught tuberculosis of course. However, we can cure everything except HIV. And HIV ? We accept the risk, but know the risk is small.(...)


(...) A western volunteer asked me to take an interest in a depressive patient who had been crying. When I went to speak to him, he cried again, for what appeared to be valid reasons. Being the 'hard man' that I have become I quickly got bored and left him under the pretext of having to attend to an urgent case. A third westerner came to take over, and again he cried.

Eventually a worker who had been watching at a distance came over to his bed and instead tried to make him laugh. She had succeeded within a few seconds. It is possible her approach was too light-hearted, but the westerners on the other hand are mad. Our immaturity gives us pleasure. It gives an odour of unconscious or badly assumed sadomasochism. We go to the hospice as we would go to see a weepy movie, on the quest for strong sensations.

- Don't extort my death. They should suffer a lot, in order to offer me the pretext for beautiful miracles! In their suffering I become great! I am so beautiful when I bathe in their tears. Look at me! Look at us! At the tears transfigured by my compassion!!

I watch a new volunteer working. I look at myself. The mirror of myself! The me before I became 'ice'. Me too, I let my soul simmer in this soup of tears, tragic confidences and miracles flowing from my hands.Me too I don't shine in the sciences, nor art, or in business, or by producing a splendid offspring… but I thought I had found the means here to like myself and to justify my existence. I too was on a quest for an artificial holiness which exhausted me… Yes, I too fell into this obsequious sentimentalism that degrades the patient rather than empowers him, and it ridicules us until we learn how to see it.

I moaned to a close friend that, since I became a 'strong man', I am no longer able to offer true compassion to a suffering patient.The friend asked me who I took myself for. He added that, probably, these suffering patients made fun of my sentiments.

- They want your medicines, not sentiment! Expertise and efficiency, not tears! Sweetness, if you can. A lot of sweetness. But, a mechanical, impersonal sweetness, like the curve of a cello or the texture of old leather. To play the mother unduly has been the cause of too many fucked-up people in the world. One shouldn't go about making babies of everyone who suffers, as well as those who are under fourteen or sixteen years old!

I was shocked by the pertinence of this subject. I was particularly astonished about sweetness, of which I am an impenitent fan; suddenly I was released from this loving molasses in which I believed it was bound. I realised at last, that my most beautiful experiences of sweetness were anonymous and without inference to the future. Some experts at sweetness, who might have seemed as cold as marble, imbue it with such power that one reverberates from it for years, without really knowing its identity. This intense sweetness has, in sexual terms, allowed me to be fearless of the 'other', to abandon my self to the subtlest pleasures. Apparently sentiment also allows these experiences, and I believe it, but it makes us as vulnerable as prey, and consumes us.

An icy Dutchman arrived. He didn't speak much. He watched the ward for a few days; the fed up workers who cherish their dogs when the patients are thirsty, the westerners who try to play the miracle game with or without success.Then he put on a pair of gloves, and a mask to protect himself from tuberculosis, and without a word of reproach to anyone, without sentiment, without even knowing a name, he started to clean the pee, excrement, and vomit of a patient. Without a word he passed on to the next one. Then the next, and the next.If he had good reason to believe I had overlooked it, he would tell me, briefly, of a patient's pain. He wouldn't add any superfluous comment, repeat it if I forgot to attend to it, or bother me if the pain was stronger than my medication.

At the start, seeing this zealous cleaner, the patients would call him for every pee, excrement and vomit. They were stupefied by his efficiency. Alone he achieved the equivalent of five workers. The slaves were moved by such an impressive volunteer. They mentioned him to me because he is so discrete they think I might not have noticed his work. They wanted me to express their admiration to him, an admiration which he had no interest in knowing about.Then, the patients talked about the Dutchman between themselves. They respected him so much that they hardly dared call him. They would simply wait for him to do his rounds. They don't want to cry on his shoulder; in fact they would rather consider him than themselves.Then the Dutchman returned home. The survivors, the names of which he still didn't know, were confused by his absence. Then, we missed his sweetness.

That is probably holiness.(...)

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