this is where the people come out.

yes.  even here.

yes.  even here.

I have had a tough time sleeping lately, and by lately I mean the last few decades.  After a couple of years of success, things have worsened here, and i lie in front of a blowing fan blowing blowing sand, and watch circles' seams twist into impossible scenes in the blackness behind my eyes.

Yesterday, I passed by our maternity ward and saw a crowd of people pushing themselves in. I used a line privilege unavailable outside of MSF projects to cut the queue, and wedged through the wooden door to find several women sprawled on a concrete floor slick with chlorine.  34 women in the ward, labouring, and the staff hurried, harried, from one to the next then back.  A concerned group of elders came to the hospital later that day, worried about our capacity.  Keep sending them, we said. We'll deliver them all.  Better here than the bush.

"This is where the people come out", Annie Dillard wrote in reverence, from the delivery floor of a hospital.  So too in Dagahaley, blue or bloody, screaming or silent, one after another, life effervesces through women into the cold, clear air, and so it goes.

If the earth was a ship carrying humans, pregnant women would be our most precious cargo. That is why those of us  care to compare health statistics between nations look to maternal mortality first. It tells us where our fastest leaks are. Countries like Somalia lose women, and the life that bubbles through them, a hundred times faster than a country like Canada.  a hundred times more.

(figure: proportion of maternal deaths/1000 population, courtesy of worldmapper)


I left the crying chorus in maternity for a more familiar one in the pediatrics ward.  I moved slowly down the growing rows, and listened to my translator recite each mother's rolling woes, then edge slightly closer to her child who had never taken her suspicious eyes from me.  i would talk to her like and adult, though she might be only one.  "pleasant weather we're having.  a bit hot?  agreed. me, i like the cold.  you?  no preference?  what do you like?  sleeping.  i get that.  eating?  no kidding. me too!  how's that going?" and if our conversation goes well enough, i can pat my stethoscope from the bed, to her knee, then her mothers wrist, to where it belongs on her rail thin chest and its fast beating heart. bumpbumpbump.

i don't have any kids, but i get it.

halfway down a row, i came to a woman with one blind eye, her globe white where the dot of her iris once was.  i sat on her bed, and she set her child in front of me.  he was in no condition to cry. ass I turned his lolling head to the side to search for nodes, I noticed a necklace of carefully threaded white buttons ringing his neck.  i held it between my fingers. she smiled and said something to my translator. she shook her head.  the family was so new, from so far away, they didn't speak Somali.

It didn't matter. I knew what she said. She loved this one so much, that she saved what she could to get buttons better used for something else, and made him this so it might keep him safe.  I said I would do my best.  she nodded.

I've heard it said, from people at home, that women here, because they have ten children and lose 4, must suffer the loss less deeply, that they get used to it, their love hedged like a bet.  These people haven't sat in front of rows of women fanning one child, the rest hungry at home, or with the woman in the maternity who delivered a tiny, tiny child, small as a bird, and who was angrily refusing to stay in hospital where he might be fed.

She sat, resolute, arms crossed and adamant, until I said how hard it must be to have walked so far, in such heat, with so much hope inside her,  to now be sitting beside it, watching it fade, and her eyes became glassy with tears.  it was no abdication of love, but generations of hard truths of the land she came from, and she was taking her baby back to her stick house to die.

life is precious cargo, even here.  Especially yesterday. Bunch of people came out, in dagahaley, hope manifested, all healthy, and today, is quiet so far, a third as many new humans as yesterday.  we’ll see if we have become victims of our own success, if all of our entreaties to send women to the hospital, day or night, have worked.  if it is a trend rather than a solitary spike in birthday parties from a particularly amorous may night, we’ll put up tents while we build another ward.  better here, on the clean chlorine floor than in the blackness of the bush.  this is a beautiful world.  may the people that come into it live to see it through their bright eyes.

from some of JR's work in kenya.  beautiful.  blessings. j.