Disease-stricken Bodies and Land: Care Ethics in Khaled Hosseini’s And the Mountains Echoed
Dr. Suja Mathew
The term health humanities refers to the transdisciplinary engagement of medical sciences with arts and humanities that focusses on an interdisciplinary approach to explore and investigate the deep impact of illness on patients as well as their caretakers by applying humanistic perspectives to healthcare. As human wellbeing means a holistic and comprehensive state, it is a humane healthcare that is needed, where impairment, suffering and illness should be considered as human experiences, rather than a bio-medical reductionism of patients. Arts can assist healthcare professionals in reflecting upon the condition of human beings, apart from the scientific and medical analysis of the illness. Also literature that deals with any kind of illness, psychological or physical, plays a decisive role in shaping the public perceptions regarding those diseases. The present paper tries to explore how care practice and care ethics can be a healing force in our society, which is torn apart by several calamities and wars. It analyses the healthcare approach and care ethics as portrayed in the novel And the Mountains Echoed by Khaled Hosseini, an Afghan born US based writer, famous for his portrayal of Afghan culture and history.
Keywords: Medical humanities, Health humanities, health care, care ethics, caregivers
The transaction and negotiation between two fields as diverse as medicine and humanities come under the purview of the interdisciplinary approach of medical humanities. It helps in enabling the medical personnel to appreciate and understand the context of the disease and its treatment. A medical situation is approached from the perspective of a human experience. A recent offshoot of medical humanities, health humanities refers to the transdisciplinary engagement of medical sciences with arts and humanities. It “embraces interdisciplinarity and engages with the contributions of those marginalised from the medical humanities – for example, allied health professionals, nurses, patients and carers” (Crawford et al 4). It focusses on an interdisciplinary approach to explore and investigate the deep impact of illness on patients as well as their caretakers by applying humanistic perspectives to healthcare. Human values and human dignity should be indispensable factors in medical field. Human wellbeing means a holistic and comprehensive state encompassing emotional, physical, mental, social and spiritual aspects of human life. It is a humane healthcare that is needed, where impairment, suffering and illness should be considered as human experiences, rather than a bio-medical reductionism of patients. In the opinion of Peta Bowden, “caring expresses ethically significant ways in which we matter to each other, transforming interpersonal relatedness into something beyond ontological necessity or brute survival” (1). Arts can assist healthcare professionals in reflecting upon the condition of human beings, apart from the scientific and medical analysis of the illness. Also literature that deals with any kind of illness, psychological or physical, plays a decisive role in shaping the public perceptions regarding those diseases.
The present paper tries to explore how care practice and care ethics can be a healing force in our society, which is torn apart by several calamities and wars. It analyses the healthcare approach and care ethics as portrayed in the novel And the Mountains Echoed by Khaled Hosseini, an Afghan born US based writer, famous for his portrayal of Afghan culture and history. And the Mountains Echoed is his third novel, written after the critical and commercial acceptance of the first two, The Kite Runner and A Thousand Splendid Suns. The novel, episodic in nature, portrays the story of a brother and sister, separated in their childhood. Viewed from the perspective of health humanities, it will be interesting to analyse how the disease-stricken lives of many characters and the war-stricken condition of the country need a proper healing. Beneath the explicit themes of love and relationships, lies the deeper and consistent narrative of health, illness and care. The paper focusses on how Hosseini, himself being a doctor, portrays many of the characters practising their own care ethics by being caregivers. It analyses how a care-based humanity becomes helpful in alleviating the sufferings of the people.
The interweaving of health and illness in life features in the novel in every episode, though the plot unravels through the memories of different characters in different temporal and spatial zones. Along with memory and history, sickness becomes one of the main narratives in the novel. The sick and the people who take care of them feature in the memories of every character; there is a patient –caregiver pair in almost all narratives, be it that of Parwana, Nabi, Markos, Idris, Pari the senior and Pari the junior. The ethico-political complexities of health, illness and wellbeing are encapsulated in the work by Hosseini through the portrayal of the caregivers and their approach to the sick. A person with the right virtues or dispositions need not be a caring one; caregiving demands the ability to engage in the practice of care, which cannot be expected from everybody. The interpersonal processes involved in the provision of healthcare comes under the purview of health humanities, as they throw light upon the humane aspect of the medical condition. Exploring into the nuances of a patient’s reflections and beliefs proves to be fruitful in providing the apt care to the person, which will fast forward the healing process.
There are different levels of healthcare portrayed in the novel, ranging from the professional medical care provided by Markos, Idris and Amra Ademovic, to the home care provided by Parwana, Nabi, Pari and so on. All these characters practice their own care ethics by being caregivers. Hosseini does not try to create any general statement that all the people are ready to offer care to the needy. Some may be skilful in it, whereas others may find themselves inadequate to do so. He is not judgmental regarding that.
Going deep into the intricacies of the characters’ minds, one can identify a guilty conscience within many of those who offer selfless care. They do it as a sort of penitence for their earlier negligence towards their loved ones who were in need of their care. Nabi and Markos are remorseful of not providing care to their close ones in moments of distress. Nabi escapes from the village to work in Kabul because he does not want to spend his days looking after his bedridden, paralysed sister Masooma. He admits that he “felt stifled by the life [he] had in the village with [his] sisters, one of whom was an invalid” (85). He leaves the village for Kabul as he felt that his prospects are being truncated because of his invalid sister. Markos is always ashamed of his initial behaviour to Thalia, his mother’s friend’s daughter, who was disfigured in the face as a dog had eaten half of her face. Parwana behaves nicely to her paralysed sister Masooma and does the cleaning process every morning without grumbling because she knows very well that it was of her doing that the accident had occurred to Masooma. She takes it upon herself just because “this is her own handiwork, this mess. Nothing that has befallen her is unjust or undue. This is what she deserves” (57). Hence she suppresses her howling into a weak smile and cleans the soiled linens.
Hosseini undermines one’s typical notions regarding gender and care. Usually, one connects women with care, whether it is in family or outside. But Hosseini portrays Nila who does not do the caring that the society normally expects from her as a wife. When Mr. Wahdati suffers from a stroke, it is Nabi, their chauffer cum cook who takes care of him. Nila retreats to her room with her daughter Pari, much to the chagrin of her mother-in-law, who expects her to be at the bedside of her husband. Nila leaves Afghanistan taking her adopted daughter Pari with her, as she finds herself not able to manage the situation. Being bold and outspoken, she does not want to maintain appearances before anybody, be it the mother-in-law, the servants or the society in general. Another character who overthrows the typical sacrificing image attached to women is Madeline, Thalia’s mother, who very conveniently leaves her daughter with her friend Odie and her son Markos, in search of a new life of pleasures. Parwana, though nursing Massoma all the time, does not fit into the selfless, angelic image that patriarchy often thrusts upon women. At the same time, there is Pari, Abdullah’s daughter who gives up her dreams of attending the art school to look after her mother who was a cancer patient and later, her father who suffers from Alzheimer’s disease. There is Amra Ademovic, the nurse who considers Roshi, the girl attacked by her own uncle, as her own daughter and fights with everybody to get her surgery done so as to make a normal life possible for her. Thus, Hosseini undermines the gender stereotypes regarding health care. There are men as well as women who are caregivers and vice versa.
The emotional turbulence that doctors pass through is also portrayed in the novel through the characters Markos and Idris, both of them doctors. Idris suffers the most because he is working under a rigid hierarchical system, whereas Markos, working with an NGO, experiences relatively less tension from the system. The system that taxes the doctors with its formalities is evident in Idris’s case. Though he had serious concern regarding Roshi and had shown true care for her while in Afghanistan, after coming back to the US to his hospital duties, he slowly forgets her.
The mental state of the patients who are reduced to mere bodies without any agency to do anything gets reflected in Massoma and Mr Wahdati. “Massoma starts to weep without a sound, without even a shift in her expression. Only tears, welling, trickling down” (57). Mr Wahdati makes clear with his functional left hand that he does not want the presence of the sympathetic visitors in his room, as “he had no use for their pity, their woebegone looks, all forlorn headshaking at the wretched spectacle he had become” (122-23). The novel shows the reader how losing one’s health changes the disposition of the person completely. Mr Wahdati, one of the most stoic men Nabi has ever seen, becomes very emotional: “Since the stroke the most trivial things made him agitated, anxious and tearful” (127). Mercy killing or euthanesia is also depicted in the novel as the extreme form of care by the novelist. Nabi, who, through his patient care, had retrieved Mr Wahdati from the verge of death many times, performs that final act for him at the end, as he had given his word regarding that. Also, Parwana abandons Masooma in the desert to her death, obliging her request to do so and walks to a new life with Saboor.
Hosseini portrays how illness brings chaos into a household, with the swarming in of visitors with all kinds of opinions and instructions on how to look after the patient, and also how the family members have to spend more time in receiving these visitors than nursing the patient. Nabi says: “Most of them I had rarely seen at the house, and I understood that they were clocking in an appearance more to pay respect to Mr Wahdati’s matronly mother than to see the reclusive sick man with whom they had but a tenuous connection” (122). The societal expectations regarding sickness is fulfilled by the disinterested visitors who are there just to please the mother, whereas the patient detests their presence. Mr Wahdati’s mother also acts accordingly, to satisfy the society with her wearing black to exhibit her grief “as though her son were already dead” (122). Thus, the bystanders and the visitors alike become performers who play their roles expected of them by the society.
The bond that develops between a patient and caregiver is emphasised by Hosseini in the portrayal of Nabi and Mr Wahdati. As Nabi is always with Mr Wahdati, he could “unlock the enigma of his speech” more than his mother could (126). The unintelligible groans and mumbles to others are easily deciphered by Nabi as request for water, bedpan or an appeal to be turned over. Thus Nabi becomes his “de facto interpreter” (126). Hosseini depicts how patient caring and nursing become helpful in bettering the condition of the patient rather than mere administration of medicines. Through his patient care, Nabi is able to work wonders with Mr Wahdati, whose condition improves dramatically. Nabi takes him for walks in the wheelchair. There are many more instances of sickness being the main narrative along with memory and history in the novel, as in the case of Odie, Pari the senior, and Nila who suffers from alcoholic addiction and a suicidal tendency, to which she succumbs at last. The arrival of the medical team with Dr Markos Varvaris and Amra Ademovic among them takes the readers to the repercussions of the incessant wars fought on the soil of Afghanistan.
Certain characters like Nabi and Pari the junior develop a care ethics of their own in the novel. Nabi, remorseful of his earlier negligence towards his sister, decides never to desert the needy around him: “I had run once before from someone who needed me, and the remorse I still feel I will take with me to the grave” (137). Even the house that Mr Wahdati leaves to Nabi is utilised to lodge the medical group that came to Kabul to operate on children who had suffered injuries to their face. Similarly, Pari, Abdullah’s daughter, decides to take care of him at the house itself as long as possible, even though it was possible for her to leave him into institutional care. One gets a detailed description of Alzheimer’s disease in Abdullah’s episode, with the deep darkness of forgetfulness, patient’s occasional fleeting bubbles of normalcy and so on. Though people praise her for her sacrifices, Pari considers her as more humanly than saintly, with all kinds of emotions. Thus, Hosseini portrays all caregivers as having human elemnts.
In short, the main plot of the novel is the estrangement of two siblings in their childhood, along with the history of the country traced through the narrative of various characters. But what evolves in between these episodic narratives is Hosseini’s portrayal of a land torn apart by incessant wars and people affected by diverse physical and mental illnesses. The novel explores the ways in which different people respond to illness and situations which demand care from them; some showing a spirit of self-sacrifice and developing a true bond with the patient, some realising themselves ill-fitted to do the service; some of them being empathetic, responsible and emotional, and some others not. Thus, the novel presents so many instances of illness being a major concern in the lives of people, being decisive in their behaviours and lives. Caring for each other and providing proper care to the sick bring about changes in many of their lives. In a country devastated by continuous wars, the lives of the people can be made better only by resorting to a care-based humanity. The solution lies in the humanistic approach to each other. Joan Tronto notes that care ethics of a moral ideal is “the highest social goal” (175). Individual’s willingness matters in care, as it cannot forcibly be provided. Hence caregivers become instrumental in the creation of an ideal and happy society without exploitation or domination. There can be found a parallel between the country torn by back to back wars and attacks, and the people suffering from different illnesses that make their lives terrible. The remedy to both lies in showing care and concern for each other.
Crawford, Paul et al. “Health Humanities: The Future of Medical Humanities?” Mental Health Review Journal, vol. 15, no.3, Sep 2010, pp. 4-10.
Hosseini, Khaled. And the Mountains Echoed. Bloomsbury, 2014.
Tronto, Joan. Moral boundaries: A Political Argument for an Ethic of Care. Routledge, 1993.