“This girl must have had a previous pregnancy, the one that produced the fistula.”
“Yes, I was pregnant before,” says Barakat. “But the child was born dead.”
“Nobody attended to you?”
“My mother-in-law.”
“And you’ve been injured since then?”
“Since then.”
“And how can it be that you didn’t come seeking help before?”
“I live far away.” She gestures with her hand, because she’s losing her breath.
Zahra Bayda tells me that dozens of women in rural places suffer from this, above all those who got pregnant very young, like this girl Barakat. They end up isolated, impaired. They stir disgust and are almost always abandoned by their husbands and rejected by their community, because of their inability to work, the stink of their infections, and the constantly dripping urine and feces. Suicide is common among them, as it can seem like the only way out. The cruelest part is that fistulas are preventable. They can be avoided with adequate medical attention during childbirth, and if they dohappen they can be cured with surgery, as long as there is access to a hospital. Oh, Barakat, I’ve known you before, you’re the Madonna of the Almond!
It’s already midmorning and Barakat’s child remains stuck. They’re a little charging bull, tired of seeking escape by butting their head against a wall. They’re not struggling as much anymore, having lost their strength. This young woman should immediately be admitted somewhere for a cesarean, but the road blurs in the rain and we can’t drive forward.
“You’ll give birth through pain,” says the Bible. Butsomuch pain? So much torment? So much preventable death of mother and child?
And weren’t you pondering just a while ago that there are too many of us already and we don’t need to keep reproducing? I say to myself. True, I thought that, I’ll admit it. But here and now, all that matters is that this baby make it. This baby, this one. For this baby to come out alive, and for this young girl who’s the mother to reach an end to her suffering and survive, for her horrific wound to be closed, for her to be healed, so she can continue her life and so her child can grow up, study, know happiness, become a good man. That’s all I care about. For the truck to get out of the quagmire and for us to arrive in time, good God, may we arrive. And may Mother Earth figure out this overpopulation thing as best she can, right now that’s just a bunch of statistics and demographic calculations.
The MSF health clinic doesn’t only see to births; it also does abortions, which in Ethiopia are semilegal, and has a birth control program.
“We educate women, we persuade each one to plan her family and see to her needs so she can do it,” said Tsegaw, the Ethiopian coordinator of this project. “Planning is something fundamental for us, we’re well aware of the overpopulation issues in this region. But none of that means that, when we attend a birth, we don’t do everything in our power for mother and child as if they were the only two humans on the planet.”
We pass a procession of people dressed in white tunics edged in green, the men in ceremonial caps and the women with beads draped around their necks and down their foreheads. It’s as surreal as a dream: a river of white souls moving through mud beneath the rain. They’re singing, or praying, and heading toward a lake, they tell me, for an annual celebration of fertility. They belong to Oromo lineage, and pay homage to God for plentiful harvests, give Him thanks for sending many animals, beg Him for their women to be fertile. It couldn’t be any other way: Rural life depends on abundance. Scarcity and death go hand in hand. Children are needed as a labor force. So where do we land, then—with fertility or population control? How to deal with the dilemma?
“I know several women who participate in that procession, there they go, look at them, I could point them out. I’ve personally treated them,” says Zahra Bayda, who frequently visits these camps. “I know that several of them use family planning. But that doesn’t mean they’ll stop attending the fertility festival, it’s a great occasion and they wouldn’t miss it for anything in the world. You see, they have a Solomonic way of resolving the dilemma.”
It’s already nine thirty, the health clinic is out of reach and Barakat’s vital signs are weakening. Zahra Bayda knows she can’t wait anymore. She inserts her index and middle fingers into the birth canal, moves them apart, and turns them, confirming the ten necessary centimeters of dilation. The child is in the third stage, that is, in the expulsive phase, ruling out the option of a cesarean. Even if we arrived on time, they’d no longer be able to do it. The young woman’s pains grow unbearable, and in the baby, the heartbeat of life fades.
At ten twenty, we finally arrive at the clinic. I don’t know how, but here we are. Barakat is rushed into surgery, the medical staff flutters around her, there’s noise and tension... and for a few moments, an abysmal silence, when all seems lost. Everything is at play here; it’s cosmic and brutal, this duel between life and death.
I make note of every clamp, contraption, smell, color, gesture, scream. Yellow tiles frame the drama on a sterile stage. Barakat grips my hand hard, she’s found a source of support in me, or in my hand, and Zahra Bayda asks me not to leave. I’ve never witnessed a birth, this is the most ferocious thing I’ve ever seen in my life, my pulse races and my legs falter. But I still hold the young woman’s hand and don’t let it go for even a second while she struggles at the blade’s edge, sometimes lost, sometimes safe.
I don’t dare move, not even to blink, as if the outcome depends on my vigilance. But Zahra Bayda is who it really depends on, and I witness how much sureness and calm she brings to her vocation as a midwife, to which she’s devoted her life. Suddenly, a new maneuver of hers works, and as if by miracle the baby comes out: a tiny girl, so gray she seems made of wax. She doesn’t move, nor cry, nor maybe even breathe.
“She’s alive,” Zahra Bayda declares, and a sigh of collective relief ripples through the room.
She’s alive, but exhausted from a colossal fight, and she still doesn’t know she’s won the battle. Those minutes are tense and agonizing. As if she suddenly understood that she now has to be alive and inhabit this world, she finally begins to cry, first softly, as if trying it out, and then very hard, a victory cry. You’re here now, brave little bull, our champion, you’ve crossed the Rubicon, welcome, invincible opener of holes with that oh-so-tenacious head, to which any obstacle will yield!
The mother relaxes, asks about her daughter.
“She’s fine,” they say. “We’ll take care of her, you rest. Sleep, Barakat, you can sleep if you like.”
It’s over: We’ve come through to the other side. I did my part too, and now I’ve got no strength left. As if I’d suddenly been unplugged from an electrical socket, my legs won’t obey me, blood drains from my face, and the lights go out. Before I fall to the floor, someone notices and holds me up. I’m ashamed for my weakness to be seenbut it can’t be helped, I must be pale as a corpse and limp as a puppet. Two people hold me up by the arms and lead me outside for some air.
“You weren’t even the one in labor,” they say, and laugh.
They sit me down in a corridor with fresh air, open to the outside, and bring me sugared water. They’ve saved me from the spectacle of fainting, which would have been especially ridiculous with a large man like me.
The baby is well, the mother too, Zahra Bayda and the team have outdone themselves and I’ve done my part; at least I didn’t start fainting until the end. Here, outside, the fresh air, clean after the rain, fills my lungs with gusts of life. It’s done. It’s over. “All’s well that ends well,” Shakespeare says. All that remains of the downpour is a light drizzle, and I, sitting on my bench under the eaves, sip sugared water and can linger, now, to gaze at the landscape.
The scent of freshly roasted coffee reaches my nose—someone must be grinding it nearby—and I take in the beauty of the fertile mountains where coffee grows. Look at that, it’s just like my native country, I think, and I feel right at home. The aromatic steam of wet earth is familiar to me. I know this feeling of being in humidity. I recognize the dark green of the coffee trees and the way it blends, in the rise and fall of hills, with the yellowish green of banana trees. I’ve lived all that, and long for it. If blindness makes us forget the color red, as Borges says, the desert makes us forget the color green, and what joy invades me now, on finding it again. Who knew that in southern Ethiopia such sweet coffee lands shone green, so similar to my native lands but on the other side of the world. Through the drizzle, a white sun glows, and the midday landscape is framed by a rainbow.
At night, we have dinner with the local team, composed of expats and Ethiopians. Over a fire, they prepare shiro, a garbanzo stew, and we celebrate the success of our day’s work with tej, a honey wine. Then we begin one of those nights around the fire, so traditional inEthiopia, during which people tell old stories about horseback warriors and break out in spontaneous rounds of poetry and music. Of course, the butt of the jokes at that party is me; I’ve been nicknamed Gizufi, the giant who faints at the sight of blood.
