Red Jacket (26 page)

La Sage-femme or The Midwife

“You look tired, Jimmy.”

“I am, for sure. But I'm good for the discussion, as promised.”

“Do you always say Sunday Mass in more than one place?”

“Almost always.”

“So you're never back here before nightfall on a Sunday?”

“Not often. But I made you a promise.”

“You spend most time in the Tindi centre?”

“I visit one other centre two days each week. I'm in Tindi otherwise, except of course on Sundays.”

“Are all the centres like this one? The domed brick structures are beautiful, but they're not typical, are they?”

“Certainly for Mabuli, these days, typical enough. But it's so in other places too. Perhaps a decade ago we realized we couldn't afford to build with adobe and timber anymore. We had too few trees. The Mabenke gives mud; we can fire clay as well as anyone. We must use what we have wisely. That includes time. What can I tell you?”

“I've big and little questions. Maybe we could tackle both?”

“This is entirely business, then?”

“Yes. If I can't be up and about, at least we can talk. I've learned a lot from your book.”

“Not a book yet, but God willing, soon. Shall we start?”

“When you consider how to deal with HIV/AIDS in Sahelian Africa, what first comes to mind?”

“Political will.”

“You mean strong government policy?”

“I mean it much more broadly. Every citizen. You. Me. Our parents, our siblings, our families.”

“Has your family played a part in this work, Jimmy?”

“I'd certainly not have got involved, were it not for my family.”

“How come?”

“I won't tell you the whole story but it began with our discovering, after one of my brothers-in-law died, that my sister was also HIV-positive. She died too.”

“I'm sorry to hear that.”

“Thank you. It was just after my ordination. It led me to this work.”

“You've been very successful in implementing community-based education and treatment here, through the MATE Centres. You know they are our primary interest at WHO.”

“I do. But ours is a small effort and Mabuli a small country, so I wonder why you ask me big questions. I'd do better with little ones, like how much easier delivering babies would be if we had running water through Harmattan!”

“
Let's compromise. I'll accept your quirky definition of political and look forward to hearing how Mabuli's citizens made a difference, if you'll admit that the folks we usually call political did come on board. They must have.”

“Okay. I admit it. They did.”

“What made them so discerning? Many African countries haven't addressed the disease with enough seriousness. Did Mabuli policymakers know a lot about HIV/AIDS? Did they know of the studies using Tanzanian data, for instance?”

“I knew of them, and a few other people, but that's not what made the difference. I'd say God's grace is what did it.”

“Well, I'm all for God's grace, but please tell me how it showed itself.”

“The chiefs of our largest clans lost their eldest sons, one this week, one the next, one the week after.”

“Good grief, Jimmy! How awful! That's hardly grace! Sounds like Old Testament vengeance, with first-born sons slaughtered and similar horrors.”

“Clan leadership passes through eldest sons. The deaths of those three had a profound, immediate effect. It was a bad thing out of which came a good one. That can be grace too. And number three is very significant in our culture.”

“But did they know it was HIV/AIDS?”

“There's knowing and knowing. The three princes' deaths forced people, the Oti included, to admit the fact of the disease and to recognize it as HIV/AIDS.”

“Aaah! The Oti! Mabuli's umbrella council of religious leaders.”

“Forgive me! I've not asked how you are feeling. Are you okay?”

“I'm fine. Excellent.”

“For sure, Grace?”

“For sure, Jimmy.”

“Good. We can go on, then. Back to political, in your sense: I suppose, ironically, we could say the Oti fit the political bill.”

“You mention the Oti often in the book.”

“The Oti need a book to themselves. They include imams, shamans, priests, and marabouts from many belief systems. The organization is quite unique.”

“That's a pretty motley crew.”

“It is. Nature bound them together, long ago, or God, if you wish.”

“Bound them together how?”

“It's a long story, myth some would say, involving our Kenbara Stone Circle, perhaps best saved for another time.”

“Tell me more about the Oti.”

“The Oti account for much of our success. Their wisdom extends to all aspects of life in Mabuli: the relative advantages of growing millet over sorghum; habits that make for good hygiene; water conservation; sound agricultural practice.”

“That's most unusual.”

“The Oti also have strong influence on our ruling classes — chiefs, elders, elected officials — politicians, as you say.” The priest smiles, lifting his chin, raising his eyebrows, blinking, St. Chris style.

“Your father is a clan chief, isn't he?”

“Yes. It's a small clan. He was frantic after Alleme's husband died. When AIDS took Munti, Pa and I insisted my sisters and their families be tested. Some tested positive. His frenzy galvanized him. All of us.”

“I'm very sorry about your family, Jimmy.”

“Thank you. As I've said, Alleme died. The others are doing well.”

“So your focus on person-centred therapy arises from your family's encounter with the disease?”

“I've not thought of it that way, but for sure it's influenced my approach.”

“What about prevalence? How do you keep track?”

“Our systems are basic. Many come to the centre, but many others ignore their symptoms for as long as they can, so we like to use Amitié and her daughter as examples of the advantage of early diagnosis, especially for pregnant mothers. Even health workers, ashamed or in denial, fail to come forward. My father had to ride roughshod over our family.”

“I'd like to meet your father.”

“Don't be so sure!” He pats his knees, rocking his upper body from side to side. “Aisha's a nurse, and she was hardest of all to persuade. She told me that she was a medical professional and would know if she were ill.”

“Taciturn health workers? That's a severe setback.”

“I'd say. Plus, where prevalence is concerned, things look different bottom up, from top down.”

“Meaning?”

“We don't have resources for testing at the centres. There's now an excellent facility in Benke, but it's overworked, and in some ways, in the worst possible location. We diagnose from symptoms, and then we try to have persons encourage their sexual partners to come to MATE too. Like my father with his sons-in-law, though we use a lighter hand.”

“A light hand with HIV/AIDS, huh?”

“The disease is heavy-handed enough. While we're talking to people about who they've had sex with, agencies consider prevalence. It's not that data isn't crucial, but it's individuals who have the disease. We teach people to be alert to symptoms, aware of their health, and the health of those around them.”

“So your method is incremental, beginning with the individual, building out from there?”

“Yes.”

“And is your emphasis on treatment? Or education?”

“The treatment par excellence is education, whether to prevent or to live with the disease. You need to come to one of our sessions, see the twins do their ‘Pat-a-Cake, Take Your Pills' handclapping song!”

“What about money, Jimmy? Where would it be most useful?”

“Well, God forgive me, but maybe some well-greased palms here and there, to make gatekeepers do the right thing!”

“You mean, bribe governments to come on board?”

“No. Bribe executives in corporate boardrooms so they vote to make drugs available and affordable.”

Something alters just then, she isn't sure what. It has nothing to do with what the priest is saying. Almost everyone agrees about the need for affordable drugs. It's as if she is suddenly aware of the vulnerability of every person, a weight so heavy the struggle to keep going seems pointless.

“Jimmy, this is to switch direction for a moment. What actual medical training do you have?”

“Some.”

“In what?”

“CPR.”

“Anything else?”

“Bit of bush medicine.” He is teasing her.

“Is that it?”

“I'm a certified midwife.”

“You're joking.”

“I can show you my diplomas. On top of which I've delivered scores of babies. I'm especially trained to deliver babies at risk for HIV/AIDS, and to teach other midwives. You must have read the background documents?”

“We probably mislaid some pages.”

“It's hard to believe that you put your well-being and that of your child into my hands without being satisfied that I knew what I was doing.”

“You said you'd have to do when I asked for a specialist, remember? What choice did I have? No offence, but we're somewhere behind God's back. I arrive, fall flat on my face, and the next day you inform me that I'm pregnant and that I could lose the baby. The evidence supports this, so I assume you know what you're doing.”

“You might have asked me to show you my bona fides.”

“I was half-awake a lot of the time. Plus, you might have laughed in my face.”

“May I take your hand?”

“Of course. You needn't ask. You're my … doctor.”

“You're in my care but you're also clearly in excellent health. You probably don't realize how rare it is to see a pregnant woman thriving. That guarantees nothing, where AIDS is concerned, but still. It's not for me to ask if you're at risk for the disease, although I'd be lying if I said I've not thought of it. But just seeing you hearty reminds us of what we work for each day.”

“Well ... that's good, Jimmy. I'm glad to be here, then, and pregnant, if only for that reason.”

“One more thing. Have you decided about telling the baby's father? I'm interfering, I know, but I think you should.”

More Wordplay

Gatekeepers. Their visitor misunderstood about the gatekeepers and the palm greasing. G words — gatekeepers, grease. Is it narrow, western, stupid? Why is the greed always in African governments, never in the European lust for gold, oil, diamonds? Why is it never in the foreign letch for immoral local partners in depredation? Perish the thought! That's good business, not greed.

God. The G word of g words. Word of words. G force. Gravitation. Gravity. The Gravitas of God.

He is playing Mapome's dictionary game again.

She wasn't the gushing type, but they galloped along from the get-go.

“When you were about three months old, James, your ears used to wiggle when you heard singing.”

“But ears don't wiggle, Mapome.”

Her wiggling ears opened up a new world for him.

“Don't assume, James. Don't swallow anything because someone says so. Never behave as though the world is a small place. It isn't. Never be scared if someone is different or something is new. That's the whole point of creation. It would be very boring if all grass were green.”

“But all grass is green, Mapome.”

“Go outside now into the garden and bring me back grass in six colours.”

Go. Garden. Grass. Green.

Some philosopher says that if you call a man a communist, killing him becomes easy. What names are people calling Africans so that they die in droves without anyone lifting a hand … well … a glove, for the sake of the game? (He is playing well. It is the first time he's deliberately chosen a g word.) Gorillas? Gibbons? Goons?

God grant to Simeon, his graceful, God-fearing brother in Christ whose life of generous service was gutted, God grant him rest, and in good time, glorification. Simeon Lubonli would not have harmed a gecko. He shudders to think of AIDS drawing down Simeon's body, already starving so there was not a spare ounce on it, rendering it ghastly, ghostly. He was a skeleton when they found him, barely alive, in his tiny, isolated, God-forsaken parish in the Gambisi — another G! He'd thrown himself into work, but some monster, no good Muslim for sure, put it about that he was a giaour, infidel, threat to the community. Abandoned by his small flock and bereft of their modest support, Simeon sweated it out in his lonely Gethsemane, he who never did ill to anyone. Even Jesus had the three to keep him company in his grim garden. There are gibbets and gibbets: Simeon's cross was a grass mat on the tamped-down ground that constituted the floor of his tiny rectory.

G for Gethsemane, grim, gibbet, ground. G for Gospel, the good news, the spreading of which constitutes the reason for his life and Simeon's.

Enough! Mapome's game sometimes makes him dizzy. Dizzy! He is running out of Diazepam. He must get some on their next trip to Benke. Anyway, time to leave the game and address the dilemma of what to do about his special patient.

It is as well they talk easily. Not that he is intimidated, never mind she is an important bureaucrat who might prove enormously valuable to their work at MATE. Sometimes in their conversation, he is reminded of his first interview with J.J. Perhaps it is a matter of cultural difference.

He grew up in a household where New World black folks were regarded with cynicism. His father had no patience with so-called Afro-Americans who claimed pride in Africa, but were unapologetic about their ignorance of the continent's history, geography, languages, weather, cultures, and customs. One October, talking to a businessman from Atlanta, his father remarked that Harmattan was just round the corner. He was stunned when the man asked if there were good roads to get there.

Is the xenophobia about which Mapome warned him dictating his reaction to their visitor? Or are his feelings not at all what they seem? Why had she suddenly ended the conversation, saying she was tired when she'd assured him she was fine? He prayed for her, prayed for all those under their care. MATE stood for Mabuli AIDS Treatment and Education. Angélique thought of the name, a perfect fit, since much of the success of any HIV/AIDS intervention depended on mates, whether they were partners, friends, brothers or sisters, grandmothers or grandfathers. He hopes Grace Carpenter has a mate.

G. For Grace.