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MOLYAN, Bulgaria — The man in the coffee shop held out a shaking, tightly clenched hand. Did I have any money, he mumbled softly in Bulgarian. “Nyama!” (I don’t), I replied instinctively. Looking surprised, he made his way to a table of middle-aged women. Each one pulled out a few coins and placed them in his hand. He left slowly, dragging his limp right leg behind him.

His unremarkable passage through the coffee shop opened my eyes to the many sick and disabled people I see every day in this small, smoke-stained town nestled in the folds of the Rhodope Mountains. On the bus, I stand next to those with eyes clouded by cataracts or backs twisted by untreated scoliosis. At the market, I shop beside elders lost in dementia, their hands gripped tightly by grandchildren. Here in Smolyan, disabilities and illnesses are often left untouched by the medical establishment and chronic illness is woven into the fabric of everyday life. I know this must be the case in every country without good medical care, but it was the first time I had seen it up close.

When I first arrived in Bulgaria to teach English, I was shocked at how plainly illness was present and how little help seemed to come from doctors, hospitals, and other health care entities. As the poorest country in the European Union, the Bulgarian health care system ranks dead last in public funding. Bulgarians die more than five years earlier than their British or Greek counterparts. Given the lack of governmental support, most of the medical assistance comes from family members or neighbors.

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A geography teacher at the school in which I was working told me that her 30-year-old son was unable to bathe or dress himself without help. Each day after teaching about the Alps or the path of the Danube, she returned home to feed and care for her son. That is very difficult, I offered uncertainly. “No,” she said in English, “it is malko trudno (a little hard) but it is not so bad — he is at home.”

What does it mean to have sickness so blatantly unhidden, so accepted as a natural and expected part of life? After the initial shock, I realized that there is something both powerful and comforting about illness and disability being part of everyday life rather than hidden away, as it so often is in the United States.

When my landlady’s father-in-law grew sick, he was cared for in the house he had built and where his children and grandchildren lived. Sophia, my landlady, and her husband, Slavi, spent countless hours administering the difficult daily care that many Americans relegate to hospice workers. His granddaughter, Alexandra, did her homework next to his sickbed. When Grandpa Dino died, the grief was public. Sophia and Slavi pasted his obituary on our door, a Bulgarian custom. The day after his death, Dino’s black coffin was sitting in the back of Slavi’s truck, parked in front of the house. The neighbors packed the building, bringing cheesy banitsa pastries and singing traditional Rhodopean songs.

In Atul Gawande’s best-selling book, “Being Mortal,” he argues that in American society “the terror of sickness and old age is not merely the terror of the losses one is forced to endure but also the terror of isolation.” In Bulgaria, sickness and death aren’t isolated. Instead, they are woven into daily life.

I’m torn by this. I know that access to better care could alleviate some of the illness and disability I see. Yet I also take comfort in the inclusion of these people in society. Perhaps the challenge is how to combine the American drive to relentlessly treat illness and lengthen life with the Bulgarian acceptance of illness and death.

In the meantime, I’ll follow the Bulgarian tradition of celebrating life and death with a glass of throat-burning rakia and a shout of “nazdrave” — to health!

Sophia Padelford is a recent graduate of Amherst College and a current Fulbright English Teaching Assistant in Smolyan, Bulgaria.

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