Taking it Personally

It had already been a memorable day when we rolled into the health center that evening.  Memorable in both a bad and good way.  Our car had broken down about halfway into our voyage into the deep bush to conduct malaria testing sweeps of five villages that are serving as comparison sites for our active early diagnosis and treatment project.  The project had reached its midpoint, and we needed to see whether the proportion of the population with symptomatic malaria was any different at that point than in the project villages. 

After some hot and frustrating spent time waiting on the road, we finagled some creative hitch hiking and successfully made it to four of the five villages.  In the village where I went, the health worker treated 26 people for simple malaria.  The meds are very effective and given for free by the government, and I love accompanying health care workers as they sweep the village looking for anyone with symptoms, administering rapid diagnostic tests, and treating positive cases on the spot.

The car still wouldn’t start when we made it back to the breakdown site that evening, and the hospital had to send an ambulance to pick us up.  On the ride home, my exhaustion started manifesting itself in random giggles, and I announced I had the tired jollies.  But as we rolled into the health center, I was concerned by what I saw. Two of my neighbors were standing next to the night guard. Siriman, the patriarch of the family we refer to as our second host family, had had a stroke several years ago and rarely leaves home at night—he wasn’t there just to hang out with the guard.

I jumped out of the car and went over to them. “Bebe is sick,” Moussa told me, his face somber, a contrast with the sly grin he usually exhibits. I had last seen Koumba, the four year old girl they referred to as Bebe, a few days before at a neighborhood gathering to prepare a big meal for our soccer team as they got ready to face their cross-town rivals.  She had been lethargic and wouldn’t even smile at me, a rarity. I had told her mom Oumou to take her to the health center—this time of year, any time a kid isn’t acting normal, it’s safe to assume they have malaria.

I started to head to the other side of the health center where the hospitalized patients were, but Moussa grabbed my arm and pointed me in a different direction. The motorcycle storage shed had been converted to an overflow area with two beds. I saw her lying in one, flanked by her father, and her namesake, grandmother Koumba. As I approached, I could hear her labored breathing before I even saw her up close, hooked up to an IV, her small body heaving with each breath. “Thank God they finally brought her in,” I thought.     

“Dobotala?” I managed to squeak.  This is the standard thing to ask any Malinke who is sick or injured. It literally means, “Did some come out of it?” the it referring to the sickness. The standard answer is to say that yes, some came out of it, no matter whether you are actually feeling better or not. But this time, the elder Koumba just said, “We are here.”

I sat with them for a bit longer on a dusty bench before getting up to take care of some things from the day’s outing, assuring them I’d be right back. They were stupid things like paying for the gas and driver for the ambulance that had picked us up. Nothing that couldn’t wait. I was so naïve. Even after having seen two small bodies carried out of that place that week, I didn’t know.

I came back ten minutes later, having gotten distracted telling stories of another day full of adventure in the bush to the nurse from that area, who loved hearing about us getting wildly lost and caught in a rainstorm. Pat’s posture and red eyes gave it away before anything else.

“Did she die?” I asked. As I heard my own voice, I was incredulous at how flat it sounded. This was just not any child, but someone dear to us, someone we had thought of when we chose presents to bring back from the US, someone who was a presence in our daily lives. But that’s shock, I guess. This was the day I had been terrified of for my entire service.

Pat’s eyes flooded.  He had taken my place on the bench, watched her father Omar tell her “dondin, dondin” as she continued to struggle to breathe. Little by little. Then her breath stopped and her eyes rolled back. Omar had sighed with relief; he thought she had finally relaxed. Pat had to tell him that his little girl had died.

I couldn’t do anything but repeat, “I just can’t believe it.” In English, in a whisper, as my own tears started to fall. We had spent the day getting meds to people in villages that are nearly impossible to get to, and now this had happened to a family who lives a five minute walk away from the health center.

“Stop crying, you two,” Siriman admonished in our direction. To Pat, he added, “Ibrahima, there are women present.” We couldn’t stop. “It is God who gives life, and God who takes it away. What can you do?”

I have heard the wail several times before, the signal of death echoed by women across the town. But I have never heard the original wail, the first sound of a mother’s grief. I couldn’t see Oumou as she howled, but the sounds of grief were distinct enough to create a mental picture that will continue to haunt me. The sound simultaneously evoked several emotions. Guilt. How could I have possibly walked away in her last moments? Deep sorrow. There can be nothing worse than losing a child. Raw rage. Why the hell did they wait so long? Indignation. How can we live in a world where the 50 cent cost of a consultation can be too big of a barrier to access  care?

I’ve watched so many kids get malaria over the past two rainy seasons. I have yelled at my host family for delaying in taking kids to the health center. But the kids I know have always been fine in the end, to the point where I had started to wonder whether I had been overreacting. 660,000 children die from malaria every year, approximately one every minute. That minute it was in Saraya, and Bebe turned a horrifying statistic into a horrifying personal reality.

 Much of my Peace Corps service has been dedicated to fighting malaria, particularly in getting early treatment to those who contract the disease, despite the arsenal of prevention efforts. Back in August, the director of Peace Corps Senegal came to visit us in Saraya and accompanied me supervising an active sweep of a village. He talked about how important the project is, how it can serve as a model in preventing child deaths across the continent, showing that it’s possible to play offense instead of defense. When he talked about the project’s importance, I was gladdened to realize that there was nothing I would change about the way we were implementing the project or the work I was putting into it.  I had been giving it my all to this fight against malaria, without knowing who was watching.

But the fight became personal that night. I am taking malaria personally, and the gloves are off. I am channeling my sorrow and rage into this work. Because, Siriman, that is what I can do.

Bebe, second from right, with a present brought to her by my friend Kara on her visit last November.