Erdman - Nine hills to Nambonkaha: two years in an African town

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Contents

FOR

MY PARENTS

AND FOR

BILLY DIDIEGO

radiant, good, and gold around the edges

The world will freely offer itself to you to be unmasked, it has no choice, it will roll in ecstasy at your feet.

KAFKA

I

A MEMORY

A single lantern filled the room with flickering light, throwing Fantas shadow toward the door. The glow bronzed her tight cheekbone, her deflated breast, her moving stomach. There was not a cushion in sight, not a sheet, not a bar of soap, not a bucket of water. There was just the hard mud floor to support this woman struggling through labor. I could only think of the blinding fluorescence of the American delivery ward: the blankets, pink or blue, the menu of painkillers, doctors in white coats, white gloves, the hard white hospital light. How much different it was here in the hushed, dark tension of the hut.

From the start of my two years as a health worker in rural Cte dIvoire, Id known that trust would be vital to my work. But that meant a certain degree of assimilation, which is not always easyespecially for an educated Western woman living in a tiny, traditional, West African village on the cusp of change.

The early days were rife with small talk and polite misunderstandings. I wanted so much to get past it all, to connect on a deeper level with the people I was supposed to be helping. The waiting was hard. But that night, about two months after I arrived in the village of Nambonkaha, it became apparent that the villagers were just as eager to bring me into the fold.

I was tinkering with dusty cans of food, trying to summon the creativity to make dinner, when a breathless man appeared at the screen door.

Come! he said, his eyes wild. My wifes stomach hurts.

Whats wrong? Is she throwing up?

No! he cried. A baby is coming out!

I knew nothing about childbirth. Why have you come for me? I asked, steadying the rising panic in my voice. Id been dispelling myths of my medical expertise ever since Id arrived. He answered, in his tattered French, My wifeshe said to find you. Suddenly my ignorance just seemed an excuse: the fear on his face persuaded me. I strapped on my headlamp, grabbed my Birthing for Midwives manual, and followed him into the night.

The man led me to a courtyard not far from my own, then pointed to a dimly lit doorway. Pei ba, he told me in Niarafolo, the local language. Theyre there. And then he was swallowed into the shadows. Low voices came from inside the hutcreaking, scratchy onesand my pulse slowed as I listened. Tonight this birth would not depend on me. The elders were there. For centuries, the village has relied on its grandmothers, its vieilles, to deliver its babies. One of the old women, a friend who sold salt at the village market, beckoned me from the doorway. Come look, she said.

My neighbor Fanta sat naked on the dirt floor. She seemed so calm despite all the women pacing around her. The salt seller stood straight, arms akimbo, a presence far greater than her four and a half feet warranted. Her jaw rotated in slow circles around a cheekful of snuff. I could tell right away she knew I had not seen this before. The other old women scrambled to find me a stool, urged me to sit. I couldnt yet speak Niarafolo well enough to say much. I had learned many phrases, but none applied to childbirth. We communicated with hands and eyebrows.

Crouched on the stool, I opened my book to find the right page, but there were hundreds of pages about childbirth, and Fantas labor wouldnt slow for me to catch up. Pain crumpled her face in waves. I had only known Fanta as a pregnant woman, but that night, as the baby shifted downward, her scrawniness was suddenly apparent. A shoulder jutted out grotesquely above her hip and I realized I could trace the babys progress through her thin flesh. I riffled through the pages of my trusty manual, but instead of answers, I found a whole catalog of causes for panic. The salt seller rasped orders to the others, chomping vigorously on her tobacco, shaking her head.

One woman grabbed Fantas belly from behind and rocked it vigorously, as if she could shake out the baby. Suddenly there was blood pooling on the floor. So much blood! Fantas teeth flashed in a grimace, and then she clamped her lips together. She seemed so strong, but I was scaredthis might be the end of Fanta, and I, the ostensibly trained one, was a helpless spectator. My teeth carved up the inside of my lip; I watched anxiously, feeling useless. The bloody prelude gave way to a pale patch of skull, visible just under the bright pink scar where Fanta had been circumcised.

The swollen head emerged slowly, and then the necknoosed with a blue umbilical cord. I turned back to my book, trying frantically to find this particular complication. After the tense and sluggish delivery of the head, the rest of the baby slid right out, flopping against a cloth on the ground. I was used to scenes of babies smacked and screaming seconds out of the womb. This one lay still, translucent and whiter than me. The hut filled with our breathing. The salt seller poured water on his chest in a thin stream to check his reflexes. Nothing. Fanta lay on her back, staring at the ceiling.

Without speaking, the women simultaneously picked up the rusted tin basins theyd been sitting on and started hammering them with spoons and fists. The metallic din smashed our dark silence; it suffocated the room with noise. The sound was violent, unbearableit seemed to explode in my head. But the women banged on, louder and louder, as if the worlds noisiness were reason enough for the baby to stay.

The childs chest barely moved. I flipped through the manual, squinting against the clatter, embarrassed not to have found any answers.

And then, amid all the ruckus, the tiny thing gurgled and flickered a hand. Thats all it took. The old womens voices returned, their faces crinkled into smiles.

I had just watched a miracle, but the others didnt seem to notice. Fanta didnt look flushed with excitement, didnt reach out her hands to hold him first. The atmosphere turned curiously businesslike. The vieilles cut the cord with a razor blade, sprinkled some dust on it to stanch the bleeding, and stuck him in a basin of dark red bark water. Fanta crouched over, the placenta slipped out, and she slid it directly into a clay pot. According to tradition, she alone must bury it in a secret place outside the courtyard. She would also be expected to laugh and sing as she buried it, or the child would be sickly. If a sorcerer got hold of the placenta, he or she would have complete power over the babys mortality.

An old woman scooped the tiny boy out of the water and tossed him in the air three times, muttering prayers as he fell back into her hands. Then the child was wrapped up and passed straight to me for inspection. I tried to hand him to Fanta to start nursing, but all the women shook their heads. Yirma wo ba. She doesnt have milk, only water, they said sadly, as if she were defective. Strange that they regarded this normal delay in milk production as the result of something Fantas body had done wrong. How could I explain the virtues of colostrum in Niarafolo? I said, The water is good! They cocked their heads, smiling quizzically, and kept passing the baby.