This Is a Soul: The Mission of Rick Hodes

Chapter 1

This is a Soul

HE WAS THE MOST BEAUTIFUL CHILD I had ever seen—and certainly the dirtiest. I came upon him in the middle of a crowded sidewalk, crouched in front of the Florida Pastry, a small bakery on Arat Kilo, one of the main avenues of Addis Ababa. Hundreds of pedestrians, from his vantage point probably a forest of legs and sandaled feet, were gliding by in that distinctive and elegant walk typical of Ethiopians. A row of shoeshine boys waited for customers; a few peddlers hawked toothbrushes and shoes and jeans and shirts.

The small boy looked to me to be about four years old, his tiny right hand cupped skyward to catch the occasional coin that came his way, his eyes staring up at me through impossibly long and dusty eyelashes. His arms were no bigger around than a garden hose, and his filthy green T-shirt outlined a back that was humped out in a perfect pyramid. I’d been in the Ethiopian capital of Addis Ababa for just a few days, but I had already learned that this was a sure sign of tuberculosis of the spine.

I happened to be walking on this particular day instead of taking my customary $1.50 taxi ride, enjoying a moment to relax because I’d completed all my reporting and was satisfied I’d gotten the story I came for. I was returning to my hotel from the clinic where Rick Hodes, an American doctor, treats impoverished children who have any number of diseases, the worst being TB of the spine, scoliosis, heart disease, and cancer. He takes on the most intractable cases, particularly when there is a chance of a cure. I had come here to write about Dr. Hodes, not only because he has devoted his life to ministering to some of the poorest people on the planet, curing what he can, ameliorating what he cannot. That is rare enough for this product of America’s suburbs. What had particularly grasped my imagination was the way he lives in this impoverished country. He has taken some twenty poor and sick children into his own house and officially adopted five of them. He cares for them, feeds them, and sends every one of them to private school.

When I started to reach for some money to put into the outstretched hand of the small boy in the street, I remembered that I’d been told it’s wrong to give money to beggars, that the right thing to do is to support organizations that help them.

There are hundreds, even thousands of children begging in the streets of Addis, or so I thought. I was wrong by a long shot. UNICEF reported in 2007 that there are five million orphans in Ethiopia, one of the largest populations of orphans in the world, and the number has been steadily increasing as more and more children are orphaned by AIDS. With no other means of support, these children end up looking for handouts on the street.

Still, of all the beggars in Addis, I was haunted by the one little fellow with the deformed back. I kept replaying in my mind the way he looked directly at me with his gorgeous pleading eyes, and I couldn’t wait to tell Rick about the boy who had the precise disease that he could cure.

An hour later, I was in Rick’s clinic, which sits outside the chapel of the Mother Teresa home for the destitute in Addis, where the Missionaries of Charity carry on the work of their renowned founder. The sisters, all identically dressed in their blue-trimmed white linen saris, cheerfully minister to some six hundred sick and dying men, women, and children. They oversee an enclave of neat dormitories nestled behind a blue metal gate guarded by a genial but firm man who has to have the fortitude to turn away even more of the sick and dying. As desperate as the condition of the people inside the gate may be, those clustered outside are the street people with no shelter or care at all.

A neat border garden greets those who make it inside, and off to the left is the chapel and a small room set aside for Rick’s clinic, furnished only by a table and a few chairs and totally devoid of any medical equipment. Patients hoping to see him line up outside where they can sit on a low stone wall. Kids from the mission hang around on the days Rick is there, some hoping to be invited out for a glass of juice when he takes a break.

About a dozen years ago, Rick started volunteering at the mission in what he liked to call his free time. But that soon became virtually a full-time job, and now he is supported in his work there by the American Jewish Joint Distribution Committee (JDC), which was founded in 1914 as a relief agency to help Jews in trouble all over the world but from its inception rendered help to those in need regardless of religious affiliation.

Rick was still at Mother Teresa’s when I found him that day, seeing patients and doing his daily walk-through, his way of appearing in each dormitory in case somebody wants to bring a problem to his attention. When I told him about the little boy I’d found and described his deformed back, Rick hesitated for no more than a nanosecond before he said, Let’s go find him—as if he didn’t already have enough work to do with the hundreds who wait in line to see him. He takes on new cases with gusto, so much so that even on the odd Sunday when he’s out hiking and sees a fellow with a bad back, he actually stops the man and tells him to come to the clinic.

His patients—some are among those living at Mother Teresa’s; others make their way from the barren countryside or the dusty villages that make up Addis Ababa—wait and wait for hours on end, without complaint, for a chance to have a consultation with the doctor, which in some cases will save their lives, in others, relieve them from constant pain. Some of the sickest kids who are housed at the mission roll themselves around in wheelchairs, while others stand about hoping for nothing more than a high five from the doctor. One teenager in a wheelchair crochets and sells colorful caps and carries an x-ray that he keeps showing to Rick, hoping for a new—and more favorable—diagnosis for the ailment that is crippling him.

As soon as Rick finished with his last patient, he and I and Berhanu, Rick’s Ethiopian man Friday, who is himself something of a miracle worker, piled into Rick’s beat-up Suzuki and drove to the place, in front of Florida Pastry, where I had seen the boy. It was a beautiful day, and the air in the eight-thousand-foot altitude of the city was sparklingly clear. Hundreds of pedestrians were still making their way down the street (the Ethiopians describe this as going by leg), but when we got to Arat Kilo, the boy was gone.

We asked some of the shoeshine boys nearby if they knew where we could find the child. They directed us to his neighborhood around the corner, but there was no sign of him there either. While my heart sank, Berhanu found a young man named Yeshetilla—which means the great protector—whose brother had been treated by Rick. Berhanu asked him to call if he saw the boy. We didn’t have to explain whom we were talking about—everyone in the neighborhood seemed to know him.

We drove back to the clinic down broad avenues divided by medians full of sturdy weeds and passed flocks of goats being herded to the slaughter and donkeys with their burden of fresh-cut firewood. Addis is a fascinating city, but I was now too edgy to focus on the scenery; I was worried that we’d lost my boy—for that’s how I’d started to think of him. As we were pulling up to the clinic, Berhanu’s cell phone rang.

That’s him, I said, practically jumping up and down like an excited kid.

As Berhanu listened to the caller, a gentle smile spread across his face.

How did you know? he said.

Rick steered the Suzuki back to the appointed spot, and there he was, standing on a side street with Yeshetilla, ready to squeeze into the car. The boy did not hesitate for a moment, almost eager to set off with a bunch of strangers, and not just strangers, white foreigners. He was still wearing the same dirty green T-shirt, and now I noticed that the worn soles of his sneakers were flapping loosely from the tops. He struggled mightily to keep the dark jeans he wore from falling down.

He said his name was Danny—as with most Ethiopians, last names don’t matter—and that he lived on the street. Yeshetilla told us—only somewhat correctly—that each night Danny paid the equivalent of ten cents for a place on the floor of a video store—nothing more than a flophouse—with about twenty older vagrants who smoked and chewed khat and where lice and fleas and rats feasted on all of them. He also said that Danny was about seven, maybe even eight, but not four. So the first diagnosis was easy: in addition to the hump on his back, he was suffering from malnutrition.

Danny, photographed by Rick, on the day he was found on the streets of Addis Ababa.

We returned to the clinic once again, where the first thing Rick did was to ask Danny to stand in front of a bare white wall so he could take his photograph, just as he does with all of his patients. In addition to a profile of his back—which was even more severely deformed than I realized when it was covered by his shirt—Rick wanted a picture of his face. He told the boy he had to smile.

Doctors always ask why I send photos, why I don’t just send the x-rays and blood studies, Rick said. I want them to know this is a human being, he explained. This isn’t just a back. This is a soul.

Those photos are sent along with the lab work to Rick’s contacts around the world; some will offer to perform surgery, some will confirm his diagnoses and provide advice on proper levels of medication. Others will send money.

Once Rick finished taking the pictures, he reached for his stethoscope, the only piece of medical equipment he has (if you don’t count the Toyota key he uses to roll back eyelids and check for trachoma), and listened to Danny’s lungs. He then tells the boy he’s been having chest pains and puts the stethoscope in Danny’s ears. Would the boy please check his heart?

You’re the doctor; I’ll be the patient, Rick told him.

This got a big smile. It works every time.

Then, holding Danny by the shoulder with his free hand, Rick placed the stethoscope at various places on the boy’s lungs, listened intently, and then looked up at me over his glasses.

Marilyn, Rick said gently, you’ve just saved a life.

If I was smitten before, now I was in love.

Had Danny gone untreated, which was practically guaranteed if he stayed on the street, his condition would have become critical. What he was suffering from, tuberculosis of the spine, would have caused him to become even more misshapen and crippled, like many of Rick’s patients, and he would have been in ever-increasing pain. Within two years, Rick said, Danny’s spine would collapse, damaging the spinal cord and causing paralysis. Lung function would slowly decrease and an excruciating death would follow.

Rick noticed that the boy was breathing very rapidly. It’s really important that we take care of him, he said. If you’re paralyzed in Ethiopia, and you can’t move, you can’t beg, and if you can’t beg, you can’t eat.

Rick got a kick out of my correct walk-by diagnosis of Danny’s problem, which I was able to do from having observed him in the clinic. Here one week and you’ve become a specialist in a disease few doctors in America have ever seen!

This kind of tuberculosis—spinal spondylitis—is virtually unknown in the United States, and doctors who come to Ethiopia are at a loss to diagnose it.

DANNY IS ONE OF THE THOUSANDS in Ethiopia who suffer from diseases such as spinal TB or severe scoliosis. Some conditions are caused by birth defects; others, from severe malnutrition, infection, and lack of medical care. It is not rare to see these people on the street, their backs seriously distorted, some of them so crippled they can barely walk.

Ethiopia, once known as Abyssinia, is one of the world’s oldest countries and a cradle of the human race, containing humanity’s most ancient traces. It is rich in history and has more UNESCO world heritage sites than any other country. But in everything else, it is the poorest country in Africa but one, subject to periodic drought with all sorts of distribution problems. Medical care was hardly a priority under the famed Haile Selassie—certainly not for ordinary people—and it did not become a priority under the successive Communist government or the one after that.

Today the country has fewer than three physicians for every forty-five thousand inhabitants, but most of them are not in the public health service. Just one of many discouraging medical statistics illustrates how serious the doctor shortage is: 119 out of 1,000 babies die before they are five years old. Rick says there are more Ethiopian doctors in the Washington, D.C., area than in their entire homeland. That is why the diseases Rick sees have reached almost untreatable levels by the time patients get to him.

UPON COMPLETING DANNY’S PHYSICAL EXAM, Rick asked Yeshetilla, who was an old hand at navigating the medical system after caring for his brother, to take Danny for x-rays and blood tests the following day. Rick gave Yeshetilla money to buy dinner for the two of them and sent Danny back to the neighborhood where we found him. I was surprised that Rick didn’t arrange for Danny to stay in a safe place right away, but he explained, I don’t feel it’s right to grab a kid off the street precipitously, just like that.

The tests confirmed everything Rick had suspected. The x-ray—which Rick read by holding it up to the sunlight—showed tuberculosis of the lung and the spine, and the blood tests revealed malnutrition (this seven-year-old weighed no more than thirty pounds), iron deficiency anemia, and worms, which are very common. They are so common, in fact, that when Ethiopians are sick, they say my worms are not eating. They think worms are a normal part of the anatomy that transform food and drink into waste and may become angry if the person doesn’t eat properly.

Once Rick had the test results, he put out a call for Danny to come back to the clinic, but the message came back that Danny was too busy. He was watching a video, and it was not convenient for him to come. Among other things, Rick wanted to give Danny some hard-boiled eggs, and he’d put a few in his pocket that morning. Twenty minutes later he ran into an old friend who gave him an enthusiastic Ethiopian hug—a tight shoulder-to-shoulder three-kiss embrace. So much for the eggs. At least they were cooked.

Within days, Danny turned up, and Rick started him on the medicines he needed. He found a place for him to stay in a dormitory at Mother Teresa’s, where the beds abut each other side to side and end to end with just enough space between them for the kids to sidle through. This bed, one of hundreds of cots neatly made up with matching flowered quilts, was the first real one Danny ever had. Now he was safe and sheltered from the elements and surrounded by other boys, some orphans, others with the usual array of problems from heart disease to cancer.

But Danny was not a happy boy. He told us that the next day was Timket, the holiday that commemorates the baptism of Jesus, and like many Ethiopian holidays, a day particularly profitable for beggars. Yet here he was, stuck inside, missing out on a big payday.

I talked to him at length, Rick said, about how I want him to have a bright future and to help him go to good schools. He was a bit okay with that, but still bummed to be away from his street-boy friends. The people in his village are delighted that he’s off the street and has more of a future.

It didn’t take long for the little boy to adjust to the good life. Danny, did you have a shower? Rick asked him a few days later. Yes, with warm water, Danny replied, his eyes wide with amazement at this new luxury. He also found out what it is to wear clean clothes and shoes that are not falling apart, to eat three meals a day, and to have the companionship of the other boys.

In the days ahead, he especially seemed to thrive on his daily outings with Rick, who became as taken with him as I was. They’d walk hand in hand to the juice store down the block, where Rick drank his usual—a rainbow parfait of avocado, banana, guava, and papaya layered with a dash of grenadine, his entire lunch. It was on these outings that Danny discovered the pleasure of warm milk and cake at the adjacent Italian coffee bar, one of the many reminders of the brief Italian attempt to colonize Ethiopia. The Italians didn’t last long—only five years—but they left a tasty legacy of macchiato, pizza, and spaghetti. And the word ciao has been incorporated into the Ethiopian language.

One day as Rick and Danny were making their way down the street, the boy stopped for a moment and looked up at Rick. Let’s hop, he suggested. So there they were, Rick, in his striped button-down shirt and khakis and baseball cap and Danny in his mission-issued (clean) hand-me-downs, hopping along on the rubble of stones that passes for a sidewalk, holding hands and laughing their way to the kiosk. It was just about the first kid thing the boy had ever done.

Earlier that week, Rick had said to no one in particular, I’ve got half a mattress free. This meant that there was a small bit of unused space at the house he shares with the horde of children who have become his family. Some of these kids are patients who have already undergone surgery, like Dejene and Zewdie, whose crippled backs were repaired, and Mohammed, who lost a leg to cancer and now wants to become a cancer researcher. Others, like Tesfaye and Zemenewerk, are still awaiting their operations. Some made their way alone from the countryside and had the good luck to find Rick; others were abandoned by their families and left on the streets of Addis to fend for themselves until Rick found them. Recently, some girls were added to the mix when Rick took in two spinal patients and then Zewdie’s sister, Balemlai (whose name means on top of the world), because she was eager for an education, and then another when he literally bumped into Zemenewerk, a tiny twelve-year-old who was walking along the street in Gondar with her uncle, both of them in tears because the hospital had turned her away as a hopeless case.

These improbable encounters have led Rick to fill his conversations with references to God and miracles. He’s convinced that some mysterious power keeps putting people in his way who need help.

If you are not religious, he said recently, you ascribe it to coincidence; if you are a believer, you attribute it to God.

Rick, who was born Jewish but of the three-day-a-year variety, became a modern Orthodox Jew when he was thirty-seven years old. Now he is completely convinced that God makes everything happen. Even my decision to walk that day instead of taking a taxi went into his miracle category because that’s how I found Danny.

Rick is an enigma, although here the word seriously understates the