A Morning of Weighing Babies
- Africa, Mali
Excerpt from Monique and the Mango Rains: Two Years With a Midwife in Mali by Kris Holloway.
Monique opened her tin trunk and took out the scale, a round disk like a clock face, marked off in kilograms, with a steel ring to hang it from. The scale reminded me of something from a corner grocery store in my childhood, only this one had a sling rather than a tray dangling from it. I took it from her and stood on a chair to suspend it from a hook near the doorframe. I attached the newly washed cloth harness (a frightened babe had wet it last week) as Monique got out a packet of blank charts for new arrivals. A chart recorded a child's progress—or decline—in the first years of life. Mothers were gathering outside. It was time to begin weighing babies.
The first woman came up and gave us her child's chart, retrieving it out of a deep fold in her pagne as if by sleight of hand. The clinic did not have a filing cabinet, so it was the mother's responsibility to keep the chart. I took the thin little girl and put her in the sling.
"Seven and one-half kilograms": Less than 17 pounds.
"And she is over one year old," Monique said as she unfolded the green, tattered paper and recorded the weight on the graph according to the child's age.
The graph was divided into colored zones: green meant fine, yellow beware, and red severely malnourished. The color coding was intended to make the chart easy to interpret for people who were not literate, which meant everyone in town except Monique and a handful of men. I had quickly noticed a trend. Most of the really young babies were healthy, but after they turned a year old or so, many dipped into the yellow and red zones.
"She is in the yellow," Monique said to the mother in Bambara as I got the child out of the sling. "She has lost weight. Has she been sick?"
"Yes," the woman answered, and they began a dialogue in Minianka. Monique raised her voice a little as other women gathered in the doorway to listen in and learn, some coming inside to sit on the floor of the clinic and others standing just outside. Monique used her arms and hands when speaking, clearly but gently pushing her words toward her audience. She looked around and made eye contact with everyone. The mothers clicked their tongues against the back of their throats in understanding. When the impromptu lesson ended, another mother approached with her baby, and the rest of the group dispersed onto the porch, picking up their conversations where they'd left off.
"That woman is pregnant again, her ninth child," Monique explained to me in French as I weighed the next infant. "She stopped nursing her child when she realized she was pregnant."
"Why?" I took the squalling infant out of the sling and handed him back to his mother. "This one weighs eight kilos."
"Ten months old. Still in the green, but barely." Monique carefully marked the chart before answering my question. "It is believed that the milk becomes bad for the nursing baby when a new one is growing inside. So she weaned the child right away and put her on adult food. The girl has had diarrhea ever since. I told her and the other mothers about the importance of not weaning abruptly, and about the importance of putting more time between their pregnancies. These are very, very common problems here."
She reached behind her, where Basil nestled in his sling on her back, and patted his bottom and protruding pudgy leg.
"He is almost four months old, three years younger than his sister Geneviève. And I will wait again to have my next baby. I don't care what le gars says," she added, lowering her voice.
Did François want another baby already? If so, how would Monique prevent it? I did not get a chance to ask.
"I ni sogoma," came a sluggish voice. Monique's sister-in-law Elise appeared in the doorway. She had cut to the front of the line and now approached Monique. She walked so pigeon-toed that her big toes almost touched. Her hand was wrapped in a strip of pagne. Strapped to Elise's back was her son Karamogo, his emaciated face and thin hair edged in dirt.
Elise had cut her finger this morning with a knife. After Monique cleaned the wound and wrapped it in a sterile bandage, she motioned for Elise to put Karamogo in the sling to be weighed. Elise shook her head no. Monique spoke to her in Minianka for some time, but I could tell from Elise's tone that she was adamant. Finally she mumbled a thanks and left. The next mother approached and handed me her little girl. I put the baby in the sling and watched the needle jiggle and settle.
"Elise is lazy," Monique said. "And stubborn. I even have a chart for him, which I keep here, so she doesn't have to remember it. Did you know that 'Karamogo' means 'teacher'? She believes the name alone will give him a long life. Part of her knows Karamogo is sick, but she doesn't want to be told there is anything wrong with her son. And as you see, when she came here she did not even know it was the morning to weigh babies."
I took the girl out of the sling and handed her back to her mother. Monique recorded her weight on the chart. Green. Fine. Vaccinations up to date, too. Monique spoke with the mother for a while. I was still thinking about Karamogo.
"What can we do about Elise?" I asked, when Monique was finished. She sighed.
"I asked her to please come next week. I'll remind her and we'll see if she does."
Another mother came forward, bearing her infant.
The Death of Old Woman Kelema
The airy hollow sound of balafons and earthy beat of drums had started at 4 a.m. Monique explained that Nampossela's oldest woman, one of the Kelema clan, had died in the night. The Kelemas, at least the men, were blacksmiths, and the blacksmiths had strong and ancient ties to the féticheurs, perhaps due to their work with fire and the forging of iron for tools and weapons. In the villages, the blacksmiths were the poorest of the poor, but what these families lacked in financial power they made up for in sacred connections to the supernatural world. It just so happened that the Kelemas were an enterprising lot. They invested in a blacksmith shop complete with welding torches and a generator that operated their tools. Gone were the hand bellows and crude hammers. They had done so well they owned several mopeds. In short, they had the magic and the money.
Old Woman Kelema timed her death well. If she had died during the planting or harvesting season, or even last month during Ramadan, the village would have postponed the major celebration. They all wanted to party together. Her status, and timely demise, ensured a spontaneous, full day of festivities: une fête of music, dancing, and feasting.
Monique and I closed the clinic early; there were no patients, since everyone was at the funeral. We walked past the fête in the village center on the way to Old Woman Kelema's home, located in the oldest section of the village, close to the stream and surrounded by enormous néré and baobab trees.
"We must give our sàya fòli—death greetings—to her family, the benedictions one gives when someone has died." Monique said as we walked. "I'll tell you some common ones: Allah ka hiné a la—May God have pity on the deceased." "Allah ka ye fisaya ma —May God put him in paradise." " Allah ka dayoro sumaya—May God cool his resting place..."
"Wait, stop. Let me memorize these before we arrive, so I at least have something to offer." The same blessings were used no matter what religion the person practiced. I stopped walking and repeated them to myself as Monique waited, chuckling at my earnestness.
The compound was as packed as Koutiala on market day. Men sat in clusters drinking dòlo, and kids ran about in packs. Younger women were cooking large cauldrons of rice and sauce. There was talking and laughing, but no crying. A lone white sheep, soon to be killed and eaten, was tethered to a stake near the entrance.
Under a large straw hangar, an open-air structure with a thatched roof, old women were gathered, ancient women in fact. A couple were fat and substantial, but most were frail, the sagging skin almost sloughing off to the ground. I could place the faces of about half. Many of those over 70 or 80 stuck close to their compounds. Unless they came out for a special occasion, like today's, I did not see them. They sat in a rough circle while girls tended to them, bringing tea, kola nuts, dòlo, and bowls of food.
I was so besieged with greetings that it took me a couple of seconds to notice Old Woman Kelema. She was lying in the center of the circle on a mat, wrapped in pagnes, except for her hands and feet. A large woman held her left hand as she talked to the corpse.
A girl came up with a chair and a wooden stool. Monique took the stool, and as soon as we were seated we were offered dòlo and food. I declined. I could not imagine eating, or drinking, and found my eyes going back to the dead limbs. Monique accepted rice and meat, swinging Basil off her back to feed him small, pre-chewed bits.
I had attended my first funeral just months before going into the Peace Corps. My maternal grandmother had been my favorite relative, despite her intense dislike and fears of my impending work in Africa . She was the first dead person I had ever seen. I remembered standing in front of the casket during viewing hours, wanting to make some special gesture of parting, but I couldn't lay a hand on Granny. I could look at death, in a sky blue dress, but could not touch it.
The wrapped parcel that had been Old Woman Kelema seemed so small, hardly capable of holding the remains of a life. The same large woman continued her monologue, holding the one limp hand. I couldn't make sense of the Minianka but thought I could get the gist: Where we have been, where we are, and where we are going. Where you have gone. We will follow.
Monique nudged me after eating, signaling that she was done and we could begin our death greetings. Monique gave hers and then spent a couple of minutes "introducing" me (everyone knew me, it was a formality) before I gave the one greeting I had memorized, the one that spoke to me most on this hot, dry day: "May God cool her resting place." The old women who could hear me responded with "Aminas" and nodded.
"Monique, am I expected to hold the old woman's hand?"
"No. Why, do you have something you need to tell her?"
She had a slight smile.
"No, I was just wondering...."
"You said your benediction. To the living. That is enough. Soon it will be time to take her to the four quarters of the village. More people will say goodbye before they run—I mean they truly run as they carry her above their heads—to the cemetery. There she will be buried, and her last serving of tǒ will be placed on the ground beside her."
Later, after dinner, Monique and I followed the sound of the balafons back to the Kelema quarter. Old Woman Kelema, wrapped in an old straw mat, one arm still exposed and dangling, was held high in the air above the heads of four men. Some people approached, reached up, and swung her hand to the music. Her body dipped and swayed in ways it had not in years, I was sure. Women put their hands to their mouths and yipped and hollered.
People began to dance, and as they did the strangeness began to fade. I had never lived so close to death. Death here was not quarantined, something that took place only in slaughterhouses and hospitals, that only occasionally escaped in the form of car accidents. It was in every home, all the time. And for a person to have lived this long, in a place where life is frequently cut short, it was truly something to celebrate.
"Monique, let's dance with everyone."
"Oh, no, Fatumata, you go. Your Monique can't dance."
"What? You can't dance? I don't believe it," I said, grabbing her hand.
"My feet don't move like that," she said. "Even as a child, I could not dance."
"Come on," I pleaded. "It's never too late to learn how to dance."
She bent over, allowing me to pull her arm, but her feet remained planted.
I looked at her and saw what amazingly looked like shyness.
"You go, Fatumata," Monique said.
I looked at the stamping and swirling feet, dropped her hand, and entered the dusty fray. I loved dancing—the faster, the better. I had trouble keeping up with the intricate rhythms, but I was quick. My feet pounded like the hooves of panicked beasts. I spun and spun, the crowd pushed back as my arms swung and my derriere pulsed. The crowd went crazy. They created a circle around me, pointing and cheering. One woman came forward, grabbed my hand and raised it high in the air. She let out a shrill cry, and others joined in. Children laughed at me, and men and women smiled and shook their heads. Panting, I rejoined Monique.
"Pati, Fatumata, you have given them a sight they will not soon forget."
"Next time, you're coming with me," I responded.
Feeding the Chief's Twins
"Maintenant—Now—Mawa," Monique said, holding a flattened metal spoon in one hand and a plastic bag of black-eyed peas in the other, "listen closely and I will show you how to make baby food."
She sat next to a small fire with a bulbous pot of boiling water balanced on three large rocks. Mawa sat on a mat beside her with the twins, as well as three other children. She sat close enough to the pot to watch, but kept a respectable distance. Small children had a horrible habit of stumbling into open fires.
Fousseni and Lassine, at almost a year old now, could barely sit up. Their eyes were half-lidded and crusty, and they leaned their wasted little bodies, bare except for protective amulets on their waists, into Mawa. They may have been a miracle, but now they were dying. I saw it in their lethargy, pale complexions, and lackluster attempts at eating food. Their weights had slowly and steadily dropped for several months, taking a sharp turn downward in the last few weeks. It had happened so fast.
I couldn't help but contrast them to Basil, who at a year and a half was storming about and had just cornered a chick. He was chunky and feisty. I was astonished that Monique could still lug his ample girth, but many women here carried their kids even at 20 kilos, over 40 pounds. I had carried Basil on my back only once, from the clinic to my house amid Monique's howling laughter, a distance long enough to make my back ache from the weight and my breasts sting from the pressure of the tied cloth. Since Basil had learned to walk, though, he preferred spending more time on his own feet, overturning bowls and keeping livestock on the move.
The chick's kin were distraught. Its mother clucked and pattered to and fro, followed by her other offspring, all fluster and peeps. The hen issued some quick instructions; the trapped chick feigned left, skittered to the right and past Basil. The chicken clan made for the courtyard entrance and the relative safety of the village paths. Basil fell back on his wide, naked bottom and hollered his disappointment. Monique ignored him. He got back up and, wailing all the way, ran into her lap. She put aside her spoon for a moment to position him at her breast.
"First, take these beans, Mawa, and grind them into a powder," Monique said. "This makes them easier to swallow, since Fousseni and Lassine do not yet have all their teeth."
Mawa got up, put one of the twins on her back, laid the other on the ground, and walked over to a large flat rock in the middle of the compound. She began to grind the beans expertly, as I had seen Monique do so many times with peanuts and karite nuts. Soon she had a pile of coarse bean flour.
We had done this same demonstration just a couple of weeks back for a large group of mothers. Mawa hadn't been there, but Elise had. We had yet to see Elise institute anything she may have learned. Karamogo remained the poster child for childhood sickness. I hoped with Mawa and the twins it would be different.
Sickness could come in an instant. Death was skulking behind every calabash of dirty water, untreated burn, or mosquito bite. This was true for anyone, but with their young immune systems, the children, after being weaned from protective breast milk, were especially vulnerable. Lack of the right foods during and after weaning was most important. Typically, a child's diet abruptly changed with the advent of a younger sibling. While the newborn got the bosom, the older child went straight from breast milk, with sips of water. The toddler's digestive system had little time to adjust, and tǒ with sauce did not have the concentration of vitamins and protein he or she needed. Even in lean times, I had learned, the men ate first, meaning they skimmed the meat and vegetables before the remnants were passed on. Infectious diseases, mostly caused by dirty water, took lives as well. The making of baby food, a new concept to the village women, tackled both these problems. It was high-protein food cooked in clean water.
"The dùgùtigi has five children with Mawa and three children with his other wife," Monique said, watching the twin on the ground by Mawa. "And he is looking to take yet another wife. If he wants all these children, he must feed them. If we succeed in bringing the pill to the village, he might let his wives use it as well."
"Mawa must make the baby food for a week or two, until she can see her babies are healthier. She must make it every day. Every day. This will be difficult, as I do not have the time to come here and do it."
Monique's schedule kept getting busier. We hadn't had a night in Koutiala with Pascal for weeks. Henri was a help, but he could not yet run the clinic on his own.
"I'll work with Mawa," I said.
My mind wandered. John was in the capital, awaiting word on the funding of our maternity ward project. I was worried about him, as the political situation in Bamako had worsened. Unlicensed vendors (forced by General Traoré to close down their shops) and students had demonstrated in Bamako by throwing rocks, looting stores, and burning automobiles. General Traoré had cracked down with an iron fist of teargas and mass arrests. Thousands had then taken to the streets to demand the dictator's resignation. I hoped John would return safely, and with good news about the funding.
I looked around the compound, with its scattering of pots, stones, mortars, and sigilans (small seats). The firewood, a jumble of twirling branches and asymmetric logs, was piled in a far corner. Mawa and her older daughters walked several kilometers into the bush to gather it. Draped over the pile was clean, wet laundry. The drying cloths were drawn taut between the branches and looked like outstretched bat wings.
One of the little girls who had been sitting by the fire got up and walked toward the woodpile. She squeezed in by the wall, squatted and strained and, after a minute, got up and walked away. Flies wasted no time settling onto the small mound left behind, the same flies that would soon gather on the bean powder, on the rim of the cooking pot, and on the tiny hands and faces of the twins. Normally, Mawa or an older daughter would sprinkle dirt on the pile, slide it onto a piece of cardboard and deposit it outside the compound door, or use a small cup, as Monique did for Basil, but this time, no one seemed to notice.
Mawa finished crushing the beans into a coarse powder, no lumps or shells to be found. She lifted the pagne, folded it to make a spout, and poured the powder into a small tin bowl.
"Good," Monique said, in her teacher's voice, directed, praising, expecting the best. "Now, we put three handfuls of powder into the water."
"Stir it until it thickens, like a sauce." She handed Mawa the spoon, "almost like the consistency of hot tǒ."
Mawa approached the pot, stirred it from her side, and spoke to Monique in Minianka.
"Fatumata," Monique said, "Mawa has an idea. And I think it is a good one. She said it is difficult to get beans and peanuts this time of year. That it will be difficult for women to use peanuts for baby food and not for the family sauce. That perhaps, if the village agrees, and if the women wish it, each family could bring a few beans and peanuts to plant, in a field, together."
"A communal field? Just for growing baby food?"
"What a great idea, Mawa, a kanyi, i hakili kadi," I said, expressing my enthusiasm for the idea.
"Aw ni ce," a husky voice greeted us. Korotun appeared in the compound doorway.
She shuffled across the yard. She had lost weight since the birth. Her cheeks were hollowed bowls and her skin was sallow. I could not tell if the yellowed shadow under her eyes was lack of sleep, lack of nutrition, or healing flesh.
"How are you? How's little Ami?" I asked.
"I have come for aspirin," she said listlessly, not lifting her gaze from the ground. She turned sideways so I could see her daughter bound to her back. Little Ami was as cute as the day she was born, with a symmetrical face, trim features, and lips that curved into a natural smile. Red threads hung delicately from her freshly pierced ears.
Monique strapped a now sleepy Basil onto her back, opened her bag, counted out two aspirin, walked to Korotun, and placed them in her open palm. She uttered small thanks and turned to go. Monique blocked her exit.
"Korotun, new mother, where are you going?" Monique said. "Are you so busy that you must take your aspirin and run?"
Monique smiled at her, trying to ignite some spark of the familiar in our friend.
"I can't today," she said and brushed past Monique. Her eyes were still and cold.
"Hey, the first months with a baby are not easy. Stay a while with us."
Her sentence was phrased politely, but was also an unmistakable command. Korotun did not look back, but drifted out.
"Something's wrong," Monique said, tightening her pagne and taking a bunch of tiny ripe bananas and a plastic bag of salt out of her bag and placing them on the ground. "Fatumata, can you finish with Mawa?"
"Yes," I said and watched Monique disappear after Korotun. Please let it be anything but Dramane, I thought to myself. I turned back to concentrate on Mawa, who was still stirring the pot.
"Maintenant, we will cut up the bananas, and add them." I tore off two bananas, peeled them, and dropped them in. Mawa, arms now cradling the twins, did the same.
"Now we put in two fingers of salt," I said, adding a pinch. "Voila."
Mawa said something in Minianka, which I thought indicated the porridge was done.
"How does it taste? It looks ... ah ... good," I said, looking at the thick, brownish goo.
Mawa dipped her finger in, put it to her mouth, and nodded. She dipped it in again, blew on her finger, and thrust it into Lassine's mouth. He frowned, his first expression since my arrival, and spat it out. A fly landed on a glob of food stuck on his bottom lip. Mawa then swung Fousseni off her back and into her lap to give him a try. He was no more impressed with the menu than was his brother. She continued balancing them in her lap, dipping her fingers, blowing, and feeding them while they pushed the food back out of their mouths with their tongues. My mother always said that a child would eat anything if he was hungry enough, but now I had my doubts.
"Little by little they will learn to eat it," I said, trying to sound confident. "Now Mawa, you can take bean flour or peanut flour to make this, and add any kind of fruit: mango, papaya, guava. When they are a little older and are used to eating this food, we will add sunbala and leaves."
Sunbala is ground-up néré tree nuts used to flavor sauces and is rich in vitamins and minerals.
"The water must boil before you add the flour. Try and get water from the pump; it's cleaner than the well water. Make the porridge for them twice a day. I know it's hard to do, but it's the only way they'll get their strength back."
Mawa clicked her tongue in understanding.
"I'll be back tomorrow," I said, "to make another porridge with you."
Neither of the twins had eaten much. Lassine was falling asleep and Mawa covered his face with a light cloth to keep the flies away. Fousseni stared at the wall, managing enough energy to fend off his mother's occasional attempts at feeding. For now, we needed to concentrate on getting food into the boys, but I realized that we needed to tackle sanitation issues as well. Mawa must cover her food, the kids must use a nyegen, and everyone needed to wash their hands with soap. If I had learned one thing from my year in Nampossela, it was that the most mundane habits could separate life from death.