Winner of the 2004 Prize for Creative Non-Fiction
BY Munju Ravindra
Photography by Munju Ravindra
Boxes tumble down from the upper shelves—mebendazole, chloramphenicol, aureomycin…. Which one, which one? Clumsy with fear, panic and a five-mile mad cycle from the health clinic, I scramble through the pile. Surely someone else could be doing this—someone with a better understanding of this strange Latin. But they sent me because I bitched. Because I insisted we try. Because I was just a clueless volunteer in Africa, brave with ignorance, and I refused to believe that fate was in God’s hands—and out of ours.
The tiny room is stacked high with boxes, all shapes and sizes—homogenous in shades of white, with orange or blue writing on the side promising relief. The drug names always written without capitals as if intended to make the contents seem like candy, innocuous. Teetering precariously on the top shelf are carton upon carton of Prudence condoms, the boxes stuffed so full the contents spill out, making a squeaky carpet on the floor.
Sweat trickles along the bridge of my nose into my eye—stinging and salty. Christ, it’s hot in this country. I feel queasy. How will I ever find the right box in time?
Thank God for Pierre—calmly sorting through the boxes scattered on the floor, classifying them: antibiotic, anti-inflammatory, anti-dehydrant. Always “anti,” never “pro.”
“Why aren’t these medications kept over at the health clinic?” I ask, only half innocently. I’ve been in Mali just six weeks, but I can already sense friction between the clinic workers and the director of the nearby Catholic aid organization that supplies it. One of the nurses has nicknamed Pierre the drug dealer.
“These people! Vraiment! They would use it all up,” comes Pierre’s haughty reply. “We make certain they always have what they need.”
Oh. Right. I guess that would explain why I’m over here looking for antibiotics, why we have no anaesthetic of any sort at the clinic, and why I spend my evenings wandering around preaching abstinence as the best way to avoid HIV.
“D’you notice these dates? This stuff’s expired.”
“Oui. It is all expired. What are the companies to do with it? Throw it out?”
Well, no. I guess not. Why not just offload it on some third world health clinic where no one will know the difference? Shit.
I’m not sure what I think of Pierre. He’d been in the colonial army, and his wife had sold handcrafted African fabrics in France, where she’d made a tidy profit. They fell in love with Mali, and moved back here to “help.” His superior tone makes my skin crawl. But he has found what I need.
“How many are there?”
“Çinq. This one’s not on your list, but it is strong. It will do.”
I carefully stow the vials in my hip pouch for the bumpy return ride. “Thanks.”
Time check, a quick squint at the sun—barring flat tires, wipeouts and other mishaps, I should be back at the clinic before her temperature starts to rise again. Poor kid. She came in a couple of days ago, babbling and semi-conscious with a fiercely infected uterus. She’d given birth to a stillborn two weeks earlier, and her family hadn’t bothered (or didn’t have the money) to get her antibiotic prescription filled. If they’d only come into the clinic, we’d have given them the pills for free—if we’d had them. And now we’re frolicking in God’s domain, trying to catch the infection before it goes septic.
At the clinic, I watch as Oumar mixes the antibiotic. “Where’s her husband?”
“Unmarried.” Flick. “Unwanted pregnancy.” Flick, flick—his finger taps against the syringe, a routine he’s repeated thousands of times before. “Stop thinking about this, Ami,” he says, using the Malian name I’d been given on my first day here. “Getting her the antibiotic is all you can do. She and Allah must do the rest.”
“Is it enough? The antibiotic I mean?”
“Ah. I don’t know. We’ll find out tomorrow, in sh’Allah.”
If God wills it. Yeah. What’s keeping Him anyway? As far as I can see, this clinic could use a good dose of God.
This whole country could. Like much of Africa in the early ’90s, Mali lurches from drought to the precipice of famine. And there’s little money for imports since the dictator was ousted last year, cleaning out state coffers as he fled. But there are worse things than famine and poverty, Oumar tells me one evening, translating shortwave radio reports of the fighting in Sierra Leone and in Togo, where members of one ethnic group parade around grotesquely, carrying the heads of another on sticks.
“Could it happen here?” I ask him.
“In Mali? Non. Le Mali c’est different.”
Here, even in this dry, desperate landscape, we are in an oasis of lush coexistence.
Back at the family compound at the end of the day, I go through the ritual series of greetings with my host mother, affectionately known to everyone in the village as “Ma.”
“I ka kene wa?”
“I am well. How are your children?”
“A kadi. How are your friends at the clinic?”
“They send their greetings. How’s the cat?”
Somehow that announcement seems a touch too perfunctory for the passing of my pet. But the line between life and death is blurry to the point of irrelevance here. All goes according to “God’s will.”
Wood smoke clouds another dawn, if you could call it dawn. “Dusk” and “dawn” have so much meaning at home—where they actually describe a time of day. Here, the dusk brushes past you like a mosquito on a mission. The nights slam shut. And dawn is a bright light switched on.
I find Oumar in the clinic courtyard, spooning up the last of his millet porridge. His face is unusually grey and his long eyelashes are glued together above his perennially sad eyes. I know some people whose eyes always twinkle, even when they’re in pain or despair, but though I have seen Oumar smile, even laugh; I have never seen a sparkle in his eyes.
“How’s the girl?” I ask.
“Stable. We moved her into a bed in the maternity ward.”
It is just a room with two beds and a solar powered light bulb for night deliveries.
The girl is asleep; the clinic’s sole IV attached to her arm, dripping the last of the donated antibiotic. I look at her smooth, fever-stressed face—she can’t be more than 16. A much older woman sleeps on the cement floor next to the bed. Her headscarf has fallen off, revealing the short grey fuzz of her hair, a worried halo framing her face. She must be the girl’s mother.
“Eh Allah! Eh Allah!” the woman’s cries jolt me out of my late-afternoon stupor.
“What’s going on?”
“The girl with the infection—her temperature has been going up and down all afternoon.” There’s the slightest flicker of fear in Oumar’s voice.
“What’s the chanting about?”
“Her mother thinks she is going to die.”
“Ah,” he shrugs. “If her temperature goes up again, it is likely.”
“What can we do?”
“Can we give her more antibiotics?”
“We used them all. In any case, her mother has started the mourning.”
But, she’s not dead yet, I think. “I’ll go get some more medicine somewhere.”
Ever calm, Oumar replies, “no doubt the infection has spread—we would need something very, very strong to work now.”
Septicemia. Blood poisoning. This was what we had feared. If only we’d had the right antibiotics on hand. If only her family had brought her in earlier. If only they’d bought the damn medications in the first place. If only. No time for this kind of thinking.
“What if it hasn’t spread? Could we remove the infection somehow?”
“That would mean surgery.”
“Yeah—could we operate and take out her uterus?” My limited medical knowledge gives me the confidence to ask anything. When you don’t know anything, there is no point in fear.
“Ah. We do not have the equipment.”
“Are you saying it might work?”
“Ami, we do not have the equipment.” He sounds final. “We do not know how to do it. And her mother has already decided that she will die and has started the mourning ritual.”
“Is there even the slightest chance that a hysterectomy might work?” I cannot let go of this. I am horrified that we might not try everything we could do to save her.
“There is a very slight chance.”
“Well, then let’s take her to the hospital in the city.”
“We do not have a vehicle.”
“So?” I can feel my exasperation building like a blister. “We’ll borrow one. We’ll steal one! For God’s sake—we can’t just give up!”
“I do not know how to drive.”
It takes every ounce of self-control I have not to throttle this man—my boss, my teacher, my friend. “Oumar. I will go find a car. You get the girl on a stretcher and ready to go.”
“What about the mother? She wants her to die quietly.”
“Tell her mother that we are going to drive them back to their village.” I can hardly believe myself. I sound like such a Western know-it-all, defying tradition, denying this girl the right to die peacefully at home. And lying to an old woman from a rural village, who has never even seen a hospital, who has no concept of surgery, who believes that we will take her daughter home to die.
No one is awake to see us leave the clinic—lucky, really, or the village women would make a circus of my driving ability. They regard my various talents with suspicion and are at once pleased and deeply disturbed that I know how to climb trees, read books and drive cars.
I drive the dark riverbed to the city with my heart in my mouth—navigating between holes and around rocks. I am sure that each bump will be the girl’s last. The old woman asks twice about the circuitous route we are taking to her village, then stops—she must guess that we have other plans.
The truck is an old Peugeot with a mystifying gearshift—just one long rod that is pushed in or pulled out to change gears, like the selector arm on the bowling alley cigarette dispensers of my childhood. As I shift gears, I am suddenly 13, in blue jeans, Cougar boots and feathered hair, checking the cigarette machine for forgotten quarters to play another round of Ms. Pac-Man. Even then I was dreaming of Africa, but who would have thought that, eight years later, I’d be here?
Our route is lit in headlight flashes as the truck dips up and down. I know it well, but at bicycle speed, and by daylight. Driving it at night adds an eerie dimension, the villages we pass look deserted—everyone asleep, and no electricity to leave a friendly light on. My rubber flip-flops keep catching on the clutch and brake pedals when I shift gears. I finally kick them off and drive barefoot. As we leave the riverbed and pick up speed, we roll up the windows to keep out the dust. It sticks to my damp face and tongue—like licking sandpaper.
Entering the city is entering another world. Bare bulbs dangle from the roadside huts. Tired men and colourful women sell fried plantain, yogurt, and plates of rice and beans. I am famished, but we will have to eat later. Music blares from loudspeakers along the road. Young men are dressed in their fancy strolling shirts, with lurid designs and long buttoned sleeves. There is traffic. There is a hospital.
The hospital smells of food. Tin pots and enameled bowls are stacked in the corridors outside doorways next to jumbled piles of sleeping children and women. For a place filled with people, it is deathly quiet.
“We cannot operate.”
The words of the chief surgeon slice through the silence. Why did I force this situation? Why hadn’t I just given up, like Oumar? Like the girl’s mother?
“She is too sick. Her body is too weak. It cannot take any more stress,” the surgeon is saying. Disbelief must be written all over my face. I am well beyond logical explanation. He tries again, “je suis desolé, madame. She would die if we cut her.”
“There must be something you can do.” I can hear the pleading tone in my voice. I am exhausted. Why do I have to beg for a hospital to save someone’s life?
Oumar’s soft voice cuts in, self-effacing. “We tried our best, sir, but it is only a rural en brousse clinic and we have very little equipment. Surely here in this big hospital you have something more … modern?”
“Well.” The surgeon seems to be sizing us up. Quite a pair we make, Oumar and I—both jagged from a long day of battling God and each other. My frustration painted all over my face and posture, my fists clenched for a fight; Oumar’s frustration buried deep inside, as if he is storing it for a purpose I don’t understand. Perhaps his anger will fuel yet another day of compassion.
The surgeon continues, “we could shoot her full of antibiotics, and wait for her fever to break.” I feel as if we’ve been here before. “If she survives until morning, we’ll operate on her then.”
“If she survives until morning.” The words settle around my heart like ice. The morning is so far away.
I feel Oumar touch my hand. “An ga ta.”
“Maybe I should stay here with her?”
“‘If’ is better than ‘no,’ Ami. You have done enough. It will have to do. In sh’Allah.” He continues, “let’s go. It’s late, and tomorrow is Saturday.”
I love Saturdays at the clinic. We run a vaccination program and the grounds are always overrun with women and children, some walking for as long as five hours to come here. The crying and laughing and sheer madness of human life make me feel as if I’ve found home.
“I sent her family a bag of oranges on your behalf,” Oumar announces one evening, a few days later, as we slouch back in our plastic chairs in the clinic courtyard, staring at the stars.
“The girl with the fever. A kid came from the city today on a bicycle with the message. She is OK.”
She had survived the night. The surgeons had operated. She lived. I study the eternity of stars above me. Perhaps her baby is up there somewhere, but the girl has been given another chance. I don’t even know her name.
“She will never be able to have children, though,” Oumar continues.
“But she’s alive, Oumar. She almost died. She’s alive.”
“Ah,” he shrugs one shoulder, “that’s true. But her father will ask, ‘What good is she now?’”