Authors: Susan Froetschel
As a young mother, Mari had ventured into the canyon during the coldest month of winter, an infant strapped to her back. The baby took ragged breaths, punctuated by sharp coughs. The mother handed the infant over to Zahira and wept. “She is my first. I tried everything.”
Zahira's gratitude for a patient was mixed with annoyance over being regarded as a caregiver of last resort. She loosened the child's covering and listened to the baby's chest, then asked what the others had advised. The woman wailed, and Zahira understood. The villagers had urged the woman to take the child far from the village and walk away. They didn't want the baby near their children.
The baby let loose with a ragged cough and then tensed, her sweet eyes widening over the struggle to suck in air. Zahira asked if the child had lost much weight and Mari shook her head. The baby had
siyah solfa
but showed no signs of dehydration. Zahira placed the child on the scale, documented the weight, and bundled her tightly. Handing the child back, Zahira told the woman to hold the baby upright against her chest, head against her shoulder.
“Rub her back firmly,” she ordered. Zahira then filled her largest pot with water and placed it on a stovetop. She covered the pot, turned a switch. After waiting for propane to drip into the line, she lit a match. A flame flared on the stovetop, and Mari jumped backward.
“Hug her tight.” Zahira pointed toward the stove. “Move close to the stove, and let her breathe. The idea is to get her to take in warm, moist air.”
Clutching the infant, Mari ventured close to the stove. Zahira opened a drawer and grabbed a thick towel. She had to convince the woman to drape the towel over the child's head and trap the steamy air. If not, Zahira would take the child and do it herself. She went to a large walk-in closet filled with boxes and jars of medications. The labels were in English, French, Dutch, and more. Directions in those languages were crossed out by aid agencies overseas and replaced with names and brief directions in Dari or Russian. Zahira studied the rows before removing a large jar of off-white powder.
“
Aard
?” the mother asked.
“Not flour. Medicine.” Zahira did not want to confuse the woman by explaining an antibiotic. As the water neared a boil, Zahira turned the flame down and explained how the steam would help the baby breathe easier. She held out the towel and asked to cover the child's head to capture the steam.
Mari complied, bending close to the pot. Zahira draped the towel over them both, hiding the fearful eyes of mother and child. Then Zahira stood back and waited, feeling protective of the young mother and child. She wanted to start the child on erythromycin, but dispensing the antiÂbiotic would be easier once the mother saw a hint of improvement.
That didn't take long. Moments later, the mother's muffled, excited voice called out: “Her breathing is better! She is calming down.”
Relieved, Zahira leaned against the counter and advised them to stay under the towel. “As long as you can stand it,” she said.
Mari stood still over the steaming water until the exhausted baby fell asleep. Only then she stepped away, her face red and sweating. She thanked Zahira, who warned that the child was not out of danger. “Can you leave the child here for ten days so I can give her complete treatment?” Zahira asked.
Mari thought a moment and gave a quick nod. Zahira asked for the child's name, and Mari said Leila. Zahira measured powder and placed it into a container and added water halfway. She applied the lid and shook well before extracting 2.5 milliliters with a syringe. Zahira gently lifted the baby's head from her mother's shoulder. Her dark hair framed skin that was like the freshest milk, and the sparkling eyes locked onto Zahira's.
“She is precious,” Zahira murmured. Using one hand, Zahira pinched the rosebud mouth, and with the other hand, aimed the syringe toward the back of the baby's throat and squeezed. The baby swallowed and then wailed. A harsh cough interrupted. “Keep holding her tight,” Zahira advised. She added more water to the pot and turned up the heat. “It won't be long before the coughing subsides.”
“I can wait and take her home?”
Zahira shook her head. She did not trust anyone in Laashekoh and would not risk a lapse in a full course of antibiotics for the child. Otherwise, the coughing would return with renewed force.
Mari reluctantly left the child behind, and the girl's health improved steadily over the next few days. Mari visited almost daily and asked how she could repay Zahira. But Zahira advised that there was no need for payment.
Mari was grateful, and Zahira had expected more patients to arrive after hearing about the successful treatment. But no one came. Later, Zahira learned the other villagers did not ask where the child had stayed for the ten days, and Mari kept her visit a secret. Zahira wondered if Mari resented others in Laashekoh, too, refusing to share a resourceâor did she fear being ridiculed for panicking and seeking help from an outsider?
Zahira did not mind. If swelling numbers of patients arrived, many would have been less fortunate than baby Leila. She did not have to please the villagers. One difficult case, one setback, and the families would have despised Zahira even more.
Mari had visited sporadically over the next few years, seeking treatment for her children when they were younger for ailments less serious than the whooping cough. They didn't have to stay overnight, and Zahira handled the cases quickly. Several years went by without Zahira seeing Mari. Until one night when there was desperate knocking and cry from outside. Aza opened the door. Panicked, the rain mixing with her tears, Mari asked to speak with Zahira alone.
Zahira wrapped a wool shawl around her shoulders and advised the woman to follow her to the clinic. Mari promised to return, but first hurried toward the path. Moments later, Mari and an older girl entered the room, removing their shoes at the doorway, Zahira handed over warm towels so they could dry themselves, and Mari introduced her oldest daughter, Leila. Near adulthood, the girl was stunningly beautiful, poised, and healthy. Zahira was struck by how much time had passed since the infant had been treated for whooping cough.
Zahira suddenly felt old. She had accomplished so little as a health provider since the girl had been born. She blamed the villagers and their ignorance. She was still disappointed that Mari did not talk about the treatments.
Embarrassed, the mother explained. Her daughter had conceived a child. She was not married and needed help. Zahira asked how many menstrual cycles had been missed. “Just one,” Mari responded for the girl. Zahira handed over a cotton sheet and pointed to a small room, advising Leila to undress for an examination.
Once the girl left the room, Zahira sternly asked what Mari expected.
“She is not married,” Mari whispered. “You know Laashekoh. They will ostracize our entire family!”
“I do not know Laashekoh,” Zahira retorted coolly, directing Mari to wait in another room. By then, Leila had returned to sit on the edge of the examining table. She did not keep her veil on or hold the cover close to her chin, trying to hide her nakedness. Instead, the white sheet stretched tight across her breasts, twisted into a knot at the center.
Zahira directed the girl to lie back and lifted the sheet. Hovering over her, Leila asked questions about activities, eating habits, and daily routines. The responses were curt, with no hesitation. The girl's abdomen was lean and firm, suggesting she probably was truthful about how far the pregnancy had progressed.
Finally, Zahira asked about the father of the child. The girl drew back. “Why do you want to know?” she asked flatly.
Zahira was not surprised. The village women considered basic care as prying. “You came to me for help,” she said. “The detail should influence your decision and could influence mine, too.” She waited a moment and then turned for the door.
“Wait!” Leila shouted. Zahira paused. “There is no convincing the father to help me. He is dead.”
“So it shouldn't be a problem to tell me who he is.” Zahira stood tall, in no mood for nonsense.
At last moved by some feeling, Leila turned her head away. “Ali, the oldest son of Parsaa and Sofi. He was leaving for school, and I didn't want him to go.” She covered her face with her hands. Her voice was bitter. “We were together that way only once. He refused to touch me after that.”
Zahira quickly turned, facing the counter and pretending to look for an instrument. She did not want the girl to see the reaction. Thoughts about what she might do next pierced her mind like slivers of glass.
Returning to her patient's side, Zahira was gentle. She lifted the sheet and examined the girl's pelvis once again. Leila would not show for another three, maybe four months, depending on what she wore and how she carried herself. “You are sure about the father?” Zahira questioned.
“There was no other man,” the girl insisted.
Zahira kept her voice soft. “And what do you want me to do?”
Leila was upset. “You must know! The women have talked about you. They say you can remove the baby. That no one needs to know.”
Zahira wanted to know what else the women said, and the girl bit her lip before replying. “That you are lonely and angry. They think you have ended pregnancies for women in nearby villages, but no one knows who the women are. They say you charge high fees for this service, but that you keep our secrets.”
“What has your mother said about me?” Zahira asked.
“My mother said you provide good care.” Leila had no idea that Zahira had treated her before. “Nothing more.”
“Don't believe all that you hear,” Zahira said sharply. She waited until she had the girl's full attention. “What else have you tried before coming to see me? And do not lie.”
Leila was embarrassed and explained how her mother had forced her to chew on fistfuls of cumin and wild sage, as much as they could find, until she became sick to her stomach. Later, she had tried punching herself in the stomach and asked her younger sisters to help. “None of it worked,” Leila admitted.
The rest of the examination did not take long. Zahira told the girl to dress. Plenty of mifepristone and misoprostol waited in the storage area. The pregnancy could be easily ended.
Instead, Zahira went into the next room and advised Mari that there were complications. She could not take steps to end the pregnancy. “It would be dangerous, and you could lose your daughter.”
Mari moaned. As soon as Leila entered the room, her mother took her by the arm. “I must think of something else,” Mari said softly.
“I will leave Laashekoh.” Leila was flippant. “I do not want to stay.”
Furious, Mari struck the girl, and Zahira stepped between the two.
“You must accept this,” Zahira noted. “Give up trying to swallow herbs or striking yourself. The baby is strong, tightly attached, and you will only hurt yourself. You need care and may have missed more menstrual cycles than you think.”
Mari frowned as the girl protested.
Zahira apologized. “I cannot help you, and it's best that you marry quickly.”
“I told you the father is dead!” Leila snapped.
“Find someone else, his brother or another man, and soon,” Zahira pressed.
Blushing, the girl howled. “The father was younger than me. And it's not Laashekoh's way for the women to marry village men.”
Mari agreed. “Such arrangements take time.”
Zahira wondered if Parsaa knew about the relationship, if that was why he had not visited in a while. She spoke kindly. “Perhaps your mother can help find a willing man.” She paused. “Or you could return in another month or two, before you show. You could stay and I could care for you. No one needs to know.”
“I do not want this child.” Leila moaned, turning away from the two women. “I thought Ali would change his mind about leaving. I hate him and want nothing to do with this child!”
Mari and Zahira glanced at one another. “The months will pass quickly,” Mari promised.
“It's safer for you to give birth and keep the baby healthy.” Zahira was direct, even offering to let the girl stay at the compound after the birth. “Can you do that?”
The girl did not answer, but stared at Zahira, deeply skeptical.
“Other villagers would ask too many questions.” Mari prepared to leave. “I will handle the child,” she said in parting.
Zahira was not sure whether Mari meant her daughter or Leila's child. The mother and daughter walked away, shoulder to shoulder, and Zahira felt lonely.
Zahira sat at her desk and studied the calendar, counting days and recounting them to estimate when Leila might give birth, and she anticipated Leila's return to the compound.