The Heartbeat of Life
It’s been hours since we left Addis Ababa, and yet its crowds still surround us.
Both sides of the highway hum with hives of people, donkeys, cows, and goats, as if we were moving through a very long line of market stands selling or bartering improbable goods, brass objects, battered chairs, medals, shirts from Barcelona’s soccer team, pieces of hose, yesterday’s newspapers.
What’s already been reused is used again, as is what’s never had a use.
Animals take over the asphalt; we duck around cows who doze unfazed in the midst of traffic.
It’s rained a lot, people slosh through the mud and the youth working as boot cleaners make a killing.
The outskirts of Addis Ababa spread their tumult out for miles, blocking our view of the great silent savannas of imagined Africa.
What a crowd! It is clear that Ethiopia, a country with one of the highest birth rates, has tripled its population in the past forty years to surpass the hundred million mark.
Wherever you look, you see women and children; Lucy and Selam have evolved and multiplied at an exponential pace.
But their lives remain short; if the growth rate here is alarming, so are the rates of maternal and child mortality.
Graceful, slender women, crowned with tall cloth headdresses, move with the slow majesty of Queens of Sheba.
With good reason it’s said they might be the most beautiful women on earth.
Elegant in and of themselves, without brands, or fashion, or trends, yet gifted with a natural poise and imperial dignity they claw from poverty with their fingernails.
And children with doll’s eyelashes and the gazes of adults, and people of all ages with that well-known feature of large teeth: a Borgesian paradox, that the Creator would give them so much tooth and so much hunger too.
It’s pouring rain, as it does in tropical places, and the rural paths are full of mud.
In the middle of nowhere a drenched woman emerges from the rain, trembling with cold, very pregnant.
In reality, she’s almost a girl. In a whisper, she says her name is Barakat, she doesn’t know how old she is, nor how long she’s been pregnant.
What she does know is that she can’t go on; she’s exhausted.
She’s walked from her village in search of help, and her soul can’t take it anymore.
We lay her in a cot and carry her into the back of the truck.
An unbearable smell invades the vehicle. What’s going on with this girl, who’s giving off that intense scent? Zahra Bayda examines her.
“Look at me, Barakat,” she asks. “Answer me, for how many days have you been having contractions?”
She replies with her fingers, gesturing two, three, or two, and she seems to verge on fainting.
The bursts of pain bring her back to herself, but when the contractions ease she goes weak again, as if giving in.
Do something for me, I can’t take it anymore, her eyes say, speaking on her behalf, because she won’t actually say a word, just murmurs—as if uttering a rosary—oh, oh, oh, in a way that’s deeply ancestral, almost primal, the same in every human tongue.
“She’s about to give birth and she has a fistula,” Zahra Bayda says. “We have to take her to the clinic immediately.”
But the mud makes our return agonizingly long; the truck gets stuck and won’t advance.
Zahra Bayda explains to me that it’s an obstetric fistula: a wound between the legs that stays open, like a stigma.
It’s the consequence of long, unproductive periods of labor without medical attention, sometimes lasting entire days, causing the fetus great suffering.
The baby, unable to come out, presses against the pelvis with their head, elbow, or buttocks, pressing and pressing until it rips the mother open from the vagina to the anus: three holes made into one.
A true curse. There’s little chance that the child will survive, and if the woman does, she’ll face infections and permanent incontinence.
“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 do happen 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. But so much 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.