On Tuesday, September 21th, it seemed that the only thing on anyone’s mind in the entire country of Mali was the cinquantenaire. Mali was celebrating the 50th anniversary of its independence from French colonial rule the next day, September 22, 2010. The event was not only notable for its historic significance, there was something in it for everyone: free concerts, at least five patterns of cinquantenaire fabric to buy and have sewn into ever fancier modeles, two huge parades, visiting dignitaires (Gadaffi!) and, most importantly, rumors that not just the 22nd but the 22nd, the 23rd and the 24th were all work holidays. Even though official holidays from work only affect the formal sector of salaried employees—that is to say a tiny fraction of the population—all this and more equaled enormous cause for celebration.
As a visitor, I was happy to watch everyone preparing to showcase their national spirit, and even more interested to listen to the undertones of political debate (especially since no one seems to ever talk about politics here in Sikoro) over the grandiose spending in honor of the event. “They are building an island in the middle of the river to build a great statue on. Why do we need to spend all that money on a statue when a single tomato costs 100 CFA (20 cents)? And don’t they realize that the Niger is the lifeblood of our nation? How can they risk impeding its flow, and cut off the water that nourishes the rest of the country?” “Anyway, its all financed by the Chinese.” “It’s the Libyans, Gaddafi is paying for the whole cinquantenaire.” “The Prince Agha Khan bought the national park, and now they made it beautiful for the prince but Malians can’t go inside.”
Different versions of the same questions have been burbling below the surface all over West Africa as country after country hit the 50 year mark. Nigeria baked the largest cake in the world and suffered a homegrown terrorist attack. Mali installed a fake waterfall on a lovers lane full of quaint lampposts, and outlined large thoroughfares with flashing, red, yellow and green lights; I imagine they look like Christmas light twinkling snakes of Malian flags if seen from above. From car level, they look like a seizure waiting to happen. They are solar powered, and so will theoretically last forever.
The cinquantenaire phenomenon captured the national, continental, perhaps even global consciousness. But in the Ballo-Sanogo household here in Sourakabougou, what most interested everyone, even more than all the rumors and excitement over the party that was to come, was that Tanti was in labor!
For me, Tanti’s pregnancy had been a bit shorter than the standard 9 month period. Given that she went into labor on the eve of the cinquantenaire, she had to have been pregnant when I moved into the house in late January. As time passed and the situation should have become obvious, I just figured that maybe she’d always been a bit plump, it seemed certain that she’d always been irritable, and she always told me that she never liked to have her picture taken. For everyone else, I suppose the fact was so obvious that they never bothered to tell me. That is, until one day in June, Mama and I were walking to the market, and she told me that when Tanti went into labor, I’d be the one to go with her to the clinic. Sure that I must have heard wrong, I asked, “When Tanti does what?” And there it was, the Toubabou knows nothing. I asked if it was a secret, she said, “That’s something that you can’t hide, can you? How could it be secret?” I asked if we would have the baptism party at our house, she said “Isn’t it for the propreitaire of the child to do that?” And so, in June, I was launched clueless into the murky waters of Malian pre-marital pregnancy, a situation not at all uncommon here in Sikoro, but a total unknown to me.
- The only picture Tanti let me take of her during her pregnancy
As soon as I had been told what was going on, I kept trying to see how I could have missed the signs which were so obvious. Certainly the normal silhouette for women’s clothing here is better equipped than the American one to hide a bump, but now that I knew, it seemed impossible that I could have missed it. Mama would watch me watching Tanti and would laugh and laugh that I was afraid of Tanti’s belly. Tanti would yell at me in rapid-fire Bambara, until, sick of being caught in the act, I tried to distance myself a bit. I wanted to avoid being the bossy white girl, making pronouncements on Tanti’s health when the collective number of births to women living in our courtyard alone must be between 15 or 20. I was aware that she seemed to be going to the clinic for prenatal visits, and that her boyfriend, Sinaly, was paying to fill the prescriptions she was given. I gave Mama an extra mosquito net to be sure that Tanti was protected from malaria. Then once I brought home a lot of eggs so that she would get some protein. She professed not to like eggs at all, Mama claimed that pregnant women cannot eat eggs, and I gave up on meddling entirely.
So on that Tuesday when Mama told me Tanti was having pains, and that they were going to go to the CSCOM that evening to see if this was the real deal, I was somewhat surprised. Given my obliviousness to her condition, I certainly hadn’t felt capable of judging what stage she was at in her pregnancy. When I found out what was going on, Mama was already saying that she was due next month, which I found hard to believe. She had also once mentioned that August 15th had been Tanti’s due date, but when a full month passed and Tanti was still doing laundry and climbing up and down the rocks in the courtyard, I figured I must have completely misunderstand. And since Fanta (Papa’s mom, from back at Pig Corner) claimed to be due in October but already looked about twice as pregnant as Tanti did, I was expecting Tanti to be pregnant for a while longer.
But there she was pacing the courtyard in obvious pain, and I asked if we shouldn’t take her to the CSCOM that morning, as opposed to waiting till nightfall. “No, explained Mama, “If we go in the day people will see, and they shouldn’t know she is going to the clinic until we are sure that it is really the moment.” Despite the fact that this made no sense to me, they obviously knew best, and they waited. They went that night while I wasn’t home, and the people at the clinic evidently told them that it wasn’t time. On the morning of the 22nd, while the whole family gathered around the TV to try to catch a glimpse of Mama’s oldest son Lamine marching in uniform as a newly minted soldier in the military parade, Tanti paced up and down the opposite side of the yard. No one paid too much attention, we were all too engrossed in president Amadou Toumani Touré’s (ATT’s) wardrobe choices (austere black outfit, neither Western suit nor Malian boubou, with very un-head-of-state baseball cap), his amazing ability to hold a salute for the entire length of the parade, and the magnificently terrifying figure that Gaddafi cut in his swirls of white and purple bazin. While I was in the city that day and that night to celebrate the occasion and the day off , I kept calling neighbors with phones to find out if Tanti had given birth yet. They all told me no, not yet.
That night she slept at the clinic, and Mama explained to me that it wasn’t the Sikoro Community Health Center, it was a different, private clinic down the street. The public clinic was too full. Thursday, I came back early, expecting to meet my newest Malian brother or sister. But Mama was back at the house, explaining that Tanti had been evacuated to the health reference center. Sinaly’s sisters were going to spend the night with her there so Mama could get some rest. I was immediately alarmed, but she told me there was nothing wrong, the people were just worried that Tanti hadn’t given birth yet so they had sent her there. When I came back from showering, Mama told me that Tanti had given birth to a baby boy! She was okay, the baby was okay, the sisters were with her, and we would go see her in the morning.
Mama and I chatted while we watched the civilian parade on a TV. Held at the stadium, it was more of a ballet than a parade, with hundreds of Malians moving together to act out the history of Mali. The soldiers were still featured prominently, and my friend Bai came running in to tell us that he had just seen Lamine. Sad to have missed it, we watched more closely, and I noticed that there were people holding up colored squares of paper on one side of the bleachers. They were creating giant mosaics of important Malian historical figures and their quotes. ATT’s outfit was designed to make up for the disappointment of the day before. A full Malian boubou, it was made of the shiniest white bazin, with a small Cinquantenaire logo on the left breastpocket. But it was when he turned around and raised his arms to wave at the crowd and you saw the giant red-green-yellow cinquantenaire logo on his back that the full ensemble combined to create the effect of Malian superman.
As we talked with Bai about the parade and about how tired Tanti must be after all that labor, Adama came over. As one of only two courtyard residents with a functional phone, he is the official communicator between the house and the outside world on most evenings after 9PM when he arrives home from the artisanal market. He told Mama that she had to go to the health reference center right away. The baby hadn’t cried, he was being evacuated immediately to the Pediatric Ward of the city hospital, the sisters were going with him, and Mama had to go stay with Tanti so she wouldn’t be alone. The Pediatric Ward is the place of last resort here, we were all frightened. What was wrong with the baby? Nothing, he was just so tired that he hadn’t cried, so they wanted to get him checked out. Bai drove Mama to the reference center on her moto, leaving the rest of us waiting and wondering.
As I lay in bed reading, trying to fall asleep, I heard knocking at my door. A small child I didn’t know was telling me something about Ma, Mama’s 11 year old daughter, who appeared to be sitting right across the courtyard. Finally I understood, she was afraid to go to bed because Mama and Tanti were gone, and her older brothers were all still out chatting and drinking tea with their friends. She didn’t want to be alone in the room, so she was falling asleep on the ground outside. I told her to come sleep in my room, but she refused. I told her I’d go into her room with her, and prove that there was no one there. She refused. Bai came home so I asked how Tanti was. “Foyi-t’ala” (she has nothing, meaning, nothing is wrong). Ma perks up from her sleepiness and her fear, and like the true little sister she is, with extreme interest asks “A be kashi la?” (Is she crying?) She looked relieved but maybe also a tad disappointed when Bai told her that no, she wasn’t crying she was just tired.
Mama came home early the next morning, and we called Sinaly to get news about the baby. “Est-ce que ale man kashi folo?” (Hasn’t he cried yet?) “Ale kashira” (He cried) “A nyogoyara?” (He’s healed?) “Ayi, a segenna kojugu” (No, he’s so tired). And that was all we knew.
Makoroba (Adama’s mother, known as The Old Woman named Ma), went to fetch Tanti at the health reference center. She was weak and in a lot of pain, but everyone told me that there was nothing wrong with her. I was shocked to see her back so soon, not more than 12 hours after such a difficult birth, but I knew that that is normal here. Women aren’t welcomed into the clinic until a labor is well advanced, the woman is expected to do that first part on her own. And after it is over, you get to spend the night or just a few hours, and then you need to go back home. It’s a question of space, and a question of the unpleasantness of hospitalization here. Your family has to constantly shuttle back and forth with food and clean clothes, it is hot and stuffy and full of sick people, and doctors are constantly giving you new prescriptions that cost money to fill. No one wants to stay any longer than is absolutely necessary, but it still pained me to see her walking around when it seemed to cause her so much pain. I told her to lie down and I would bring my fan so she could nap comfortably. She said no, they would leave right away to go to the hospital so she could breastfeed the baby. “Maimouna,” she said looking at me, with less force and self assurance than I’d ever seen her speak, “den mankene kojugu.” (Maimouna, the baby is really sick.)
They left, and we waited for them to come back that night. They didn’t, and no one had any news. I bemoaned the fact that Mama did not own a telephone. On TV, the cinquantenaire events continued with the parade of the private sector, which seemed like a bit much as a category. Though these boubous were shinier and more ornate, if such a thing were possible, it seemed to me everyone looked a bit bored by that point.
In the morning, I kept asking the kids if there was any news, and there still wasn’t. I listened to the members of the family and the friends on the block have the same conversation over and over again “What is wrong with the baby?” “Oh well, he is just so tired. You know, she was in labor for three days, such a long time. Of course he’s tired.” Finally Abdoulaye, the only other member of the household with a phone, told me he’d been at the hospital yesterday. “What is going on, what is wrong with the baby, is he doing better, when can he come home?” I asked, bombarding him with questions. “Well, the baby is really tired.” I was growing more and more frustrated with the diagnosis of “tired”, especially coming from Abdoulaye, a practicing nurse. Tired doesn’t require that you spend two full days in the ICU of the pediatric ward. Tired doesn’t explain why the labor was so long, why the birth was so difficult and so painful, or whether or not the baby and Tanti will be okay.
Finally Mama came home. Again I posed the same string of questions, and she told me that “Foyi ta den la, a segenna droon” (There’s nothing wrong with him, he’s just tired). ‘Had she talked to the doctors?’ ‘No they don’t tell her anything.’ ‘Had Sinaly talked to the doctors?’ ‘No, they don’t tell him anything.’ ‘Was he at the hospital now?’ ‘No he had been there before, but now his brother’s wife was staying with Tanti. He has already spent 150000 CFA ($300) on the delivery and hospitalization costs. That’s a lot of money.’
Mama had come home to cook food and fetch clean clothes. We agreed to go back together tomorrow. I was determined to quiz the doctors, to find out what was actually wrong with the baby, somehow ascertain if the treatment was really effective, and make sure Tanti was okay.
Gabriel Toure Hospital is not what you think of when you imagine the horrors of overcrowded, undersupplied, crumbling African hospitals. The place is clean and white, with tile floors and seemingly sufficient space. Though it is disconcerting from the Western context to see scores of people, mostly women, lying on the hospital floor on brightly colored plastic mats, I quickly realized that this was not evidence of the conditions of hospitalization for the patients, but instead for the accompagnateurs, in this case the parents. We found Tanti in the corner. “Eh, Maimouna nana!” (Oh wow, Maimouna came!) she said smiling. We chatted together, and it seemed that there was no news about the baby. The only thing that had happened was that the doctors had given another very expensive prescription, and Sinaly had had to go all the way to the other side of the river to find the medicine.
As soon as the doctor came over to talk to them, I was going to use my toubab status to find out what was going on. Except the doctor never came over. There was no interaction between the medical staff and Mama, Tanti, or Sinaly’s sister, except to discuss a medication that had gone missing overnight but was then eventually found. No status updates. No diagnosis. No prognosis. No one allowed to go back and see the baby except Mama, Tanti and Sinaly’s sister. Finally I just followed Sinaly’s sister back into the ward, hoping no one would notice and stop me. I made it in, and was confronted with a room full of gleaming incubators on my left, and a room full of tiny, baby sized ICU beds on the other. There was Sinaly’s sister, so she must be near the baby. All the babies looked tiny, but these babies weren’t in incubators, so he must not be premature. “Look,” she told me, laughing a little, “he’s the one with the huge head, just like Sinaly.
Staring at this baby, I had no idea if his head was big or small, if he was too pale or okay, if he was tiny or normal sized. I never have had anything much to do with three day old babies before. All I could see was how fast his breathing was, and how his face was obscured by a teeny, baby sized oxygen tube in his nose. I tried to remember anything I knew about babies and neonatal care and the only relevant observation I could ascertain was that he did not, unlike his baby neighbors, have a central line feeding tube. Maybe that was a good sign, that he could eat? But they weren’t letting Tanti breastfeed. And how could he possibly sustain such fast breathing? I tried to figure out who to question, but the nearest (very professional very efficient looking) nurse descended at that moment to kick me out of the ward. “She has to go,” she told Sinaly’s sister in Bamabara, “she can’t be in here you know.” Not wanting to anger anyone, I left, figuring I’d come back in to try to ask questions later.
But Mama wouldn’t let me. She said that if I went in, the hospital staff would think that the family was putting on airs, having a toubab pry into their business. When I left, she said, they would insult the family and provide inferior treatment. Sinaly would ask the doctor what was going on tomorrow morning. Since only the interns were around right now over the weekend, they didn’t have any information to give anyway. After my third attempt to convince her to let me talk to them failed, I gave up and left, saying I would come back tomorrow to talk to the doctor.
As I sat in the new office later that night watching a movie on my computer with another volunteer, Mama stuck her head in the compound door. “We’re back,” she said. Excited, I ran out to great her. “Yes, the child is dead. So we came home,” she said matter-of-factly. “The child is dead? When did he die?” “Just now. Tanti is already at the house.”
We left the movie paused as I told Alex what had happened. And then I sat there unable to believe it. Of course, I had known that the evacuation to the hospital meant the baby had slim chances for survival. I had been surprised he had survived the first night, and the second, and the third. But that very survival had encouraged me. And having seen him just a few hours before, and being told over and over again that he was only tired had reassured me. Perhaps, I had convinced myself, he was really and truly just fatigued, and they were keeping him for observation. Now, instead, he was dead and I still knew nothing about why. No illness, just one baby so tired he wound up dead. Hundreds of dollars spent on his care, people bustling in spotless scrubs with gleaming tools working to save his life, and yet, he’s dead and Tanti and Mama are back home.
When I think about child mortality in Mali, I think about children dying in villages, far from medical personnel. I think of children dying in Sikoro because they arrive at the clinic too late for doctors and nurses to be of help. I think of children dying of the diseases we treat in our program: malaria, malnutrition, respiratory infections and diarrheal diseases. I never thought of this particular way.
I didn’t know quite what to expect as I followed Mama back home a few minutes later. Sobbing? Normalcy? The family was sitting silently outside the door of their room. Bai was over, and was quietly offering blessings. People began to mutter softly about how the pediatric ward is bad, how they just take your money and don’t do anything. Murmurs about tiredness, three days of labor, etc. I heard someone enter the courtyard, and turned around see a soldier loom out of the darkness. It was Lamine, he’d taken 24 hour leave. He didn’t say anything, or sit down, or even really look at Tanti. But his presence made me feel a little better, I don’t know about anyone else. We all continued to sit, and after showering and changing into civilian clothes, Lamine joined us as well.
Mama began telling us that we should go to bed, but we lingered. Finally everyone admitted to feeling tired, Ma was already falling asleep on the ground. Everyone started to shift and move towards bed. Except Tanti. “Ne te’n da,” she said (I will not go to bed). “Moona?” (Why) I asked? “Sunogo te’n a” (I’m not sleepy), she said. “Y man segen folo?” (Aren’t you tired?) “N te se ka sunogola, ne te se” (I can’t sleep, I can’t). “Moona?” (why again?) At this point Mama butted in. “She can’t sleep,” she said, “because she was crying. I told her that she shouldn’t cry over a baby, that that isn’t something to cry over, but she didn’t listen to me, she cried anyway. Is that a good idea?” I attempted to counter with a feeble, “Sometimes, its important to cry.” She did not seem convinced.
I hated this culture that shuns showing emotion, I hated Mama’s jovial tone and above all I hated my inability to speak fluently. My language-induced-muteness was all the more frustrating, not just because it meant that I had no genuine words of comfort for Tanti, but also because it had gotten in the way of us forming a real relationship, one which would have positioned me to be a support in this moment. I hated not understanding how others, and therefore I, were reacting and dealing with this event. I hated most of all not understanding what had happened to the baby. What happened to Tanti, why was the birth so difficult, why was the baby so tired? It felt somehow as if, if I just knew that there had been something actually wrong with him, that something beyond negligence, incompetence, lack of resources had killed him, I would feel better.
It was tempting to turn the situation into a narrative that involved me. Perhaps, if I had only gone to hospital the first day to offer to pay, they would have bought the medicines faster and the baby would have been okay. If I had only gone with her to the CSCOM during the labor, maybe I would have understood what was happening and would have been able to help at whatever moment things went wrong. Maybe I should have gone with her on her prenatal visits? But I knew that this wasn’t about that. Sinaly was committed to taking care of her and their baby. He had the resources and the willingness to do so. This wasn’t my story. I just happened to be here to witness it.
A week past. Sinaly came to visit almost every night. Hoardes of female friends and family members came to pass each day in the compound. They all brought their babies and I couldn’t stand to watch Tanti watching them breastfeed. They all would have come if the baby had lived. Thursday came and went, without the festivities of the baptism. No one killed the goat, no one cooked beans and zame, the multitudes of women didn’t descend in the evening with their loads of gifts.
This story is about that absence. It is also a story that can flail endlessly searching for blame. I can criticize everyone involved: myself, the doctors, the family, the hospital, the country for celebrating fifty years of independence when a baby can still die this way. It seems to me though, this desire to know where to pin the blame is coming from that same American cultural need to understand what happened to the baby. As if that could make it better, somehow. Underneath, this story isn’t about any of that. This is a story about a country setting forth into the unknown of its 51st year, unsteady and unsure of exactly what that ought to mean. More importantly, this story is about a baby who isn’t here.
Tanti has opened up to me more now that my Bambara is better and now that I (and my fellow MHOP volunteer Devon) supposedly saved her life by whisking her away to the hospital the day she fell ill due to complications caused by the delivery. That is another story; she is healed now, and back to her loud and assertive self. We sat on a mat in the office compound in the early evening, a couple of weeks after all of this had ended, and I tried to ask if Sinaly wanted more children. My Bambara failed, so I asked something more along the lines of, “Does he want the baby?” She told me that Sinaly goes to visit the baby in the cemetery every day. “Every day,” she said, “he goes to see him. Is that normal Maimouna?” I said it seemed normal to me, if that was what he wanted to do. “Do you go too?” I asked. “No,” she said, “I won’t ever go. That place is scary.” She paused. I ventured to ask, “Does he want to have other children?” “No,” she gestured forcefully. “And you?” “No, none, never.” “Never? Sometime you will have a new baby!” “No, I never want to do that again.” “But don’t you want a child?” “I’m not having another one. I’m going to buy my babies instead,” she paused, “in the market!” she yelled triumphantly, and we laughed.