From Chapter One

"How long has the woman been in labor?" I asked.

"Since early this morning." Monique's flashlight traced a yellow stain on the dark earth. A scorpion moved under a rock. "I have been with her at the birthing house most of the day."

"So, will she give birth soon?"

"Ah, God willing. You will see; there will be no rest for your Monique tonight."

"How old is she?" I said, jogging a couple of steps to stay next to her.

"Seventeen."

It was a struggle to keep my footing on the rough path through the maze of huts that made up the village of Nampossela. I knew the general direction to the birthing house on the outskirts of town. But the layout of the village remained a mystery, and unless I was accompanied, I tended to run into dead ends or wander in endless circles.

I was glad to be with Monique. In fact, since coming to Nampossela a month before, I was almost always with Monique. She was not only the village's midwife and sole health care worker, but she was also my assigned host. At twenty-four, she was only two years my senior, but I was in awe of her knowledge and ability. As she was one of the few people in the village who spoke French, I constantly peppered her with questions.

"You're sure it is all right if I come along? You know, I have never seen a birth."

"Of course, of course," she said, smiling up at me from beneath her blue sequined headscarf. Her voice always seemed poised to break into a belly-rich laugh. "A woman is always welcome at a birth, Fatumata," Monique explained, using my newly acquired Malian name. "And I am glad your first will be here with me."

Monique's face was youthful, sweet really-a brown symmetrical disk with arching eyebrows, widely spaced eyes, and a slightly upturned nose, making her look like a kid. She was stocky and walked with confidence, her green plastic flip-flops barely visible beneath her wide flapping feet. Strapped to her back with a wide cloth tied over her breasts was her three-month-old son, Basil, fast asleep.

We arrived. Monique opened the door and an overpowering stench made me wince and pull back. Monique went straight in, but I needed to linger outside for a moment in the fresh air. The pale and bloated moon was surfacing through the leaves of a mango tree, casting a faint light on the decrepit building. Above the termite-ridden beams of the doorway was the word Mùsòjiginniso. I deciphered the Bambara, "woman come down house"-woman's birthing house. The structure's cement veneer was chipped and failing, revealing mud brick. A corner of the corrugated tin roof gaped, ripped open by a violent storm. Monique had told me that women could no longer give birth here in the rainy season. For the three months that rain fell, she helped women give birth in their huts, sometimes walking many kilometers to get there. I wondered if repairing this place would be a project the Peace Corps would fund.

"Fatumata, where are you?"

I took a deep breath and crossed the threshold, the tin door wobbling as I shut it behind me. I felt as if I was drowning in the smell of flesh, body fluids, and leftover food. Shut tight, the building was like an oven, baking all the secretions and juices into a rank casserole. But here, despite the oppressive heat, women found a rare taste of privacy in an otherwise communal world. In fact, the birthing house was one of the few hallowed grounds where men were not allowed to tread.

Jutting from the left wall and dominating the birthing room was an immense concrete block that served as the delivery table. Its gray bulk, illuminated by a single lantern, suggested a sarcophagus. On top of the bare scrubbed surface a naked woman crouched, strained, and pushed, her black skin shining in the dim lantern light. Another woman sat beside her on the slab, supporting her. The wall behind them had a large, worn, greasy spot where countless backs and heads had writhed and reposed. Monique stood near them, watching. Folded carefully on the floor lay a large square of colorfully decorated cotton cloth-a pagne, the traditional garment that Malian women wrap around their waists as a skirt. Set out beside the dented trunk that served as a supply cupboard was a plastic tub for the afterbirth, a medical kit in a tin box, and a frayed birth ledger. So this was childbirth in rural Mali in the late twentieth century.

Monique came over. Raising her chin toward the woman in labor, she said in a whisper, "Fatumata, this is Kadjatou, and her sister, Alima. She has attended many births."

Alima and I greeted one another in Bambara. Kadjatou did not reply.

"Now you will see the real work of a woman," Monique said, as a contraction seized Kadjatou. "If a woman cries with her first child, she will cry with every other child," Monique had said, more than once. To give in to the pain would be a sign of opposing God's will. This was Kadjatou's first child. Her face was contorted and she swallowed with effort, but she was barely audible. A faint moan slipped from between her lips as her body pushed through the contraction. This had been going on for hours. So much work for such little progress.

Monique stepped outside with a teapot of water and soap. There was a minute of splashing and she returned, shaking her hands dry. With no rubber gloves, she had to keep her hands clean. Her fingers housed rocky outcroppings of knuckle that tapered to carefully trimmed nails. She gradually inserted her right hand into Kadjatou's swollen vulva. Kadjatou grimaced as Monique announced that the cervix was fully dilated. "A be se k'a na-The baby can come," she said. She pushed a few items aside in the medicine trunk and emerged with a hypodermic syringe and a vial.

An injection. Watching Monique at her clinic over the past weeks I had noticed that the villagers loved shots. To many of them, shots represent the pinnacle of Western medicine, and Western medicine is good. Almost immediately, Kadjatou's contractions began coming with increasing frequency. They possessed her body and her orifices burst forth water, vomit, and diarrhea. I was alarmed. Was this normal, this sending out of liquid scouts in advance of the baby? How could a woman's body survive? It seemed as though she had expelled all she had, until there was only one thing left inside.

The top of the baby's head began to appear. Little by little, with each contraction, more and more bulged forward. A grimace stretched across Kadjatou's face as her lower half swelled with energy. Oh my, this is simply not going to work, I thought. Really big peg, really small hole. I will never, never have children.

Monique's face was calm, her eyes focused. She began talking Kadjatou through each contraction, with Alima repeating her words in a whispered echo. "Akanyi...I be se, I be se-Good...you can do it, you can do it." Monique's tone and Kadjatou's pushing were in sync, building up and falling down like surf stroking a beach. Her voice seemed the only connection between them and the outside world. Finally, Kadjatou bore down as if pulled by an invisible force. Monique's voice grew stronger and louder, the words stretching out as Kadjatou's body surged forward and birthed the head. A big, slimy globe covered in dark, wavy hair. It hung there. I held my breath. We waited. Another contraction came, and another, each revealing more of the baby's body, until finally the whole child slipped out. I exhaled deeply and stared at the ginger-colored newborn.

Monique quickly took the baby boy and cradled him in her long, muscled arm. She gently massaged his chest with the palm of her hand, leathery fingers sliding over his fragile skin. Finally he opened his mouth, took his first gasp of air, and wailed. Monique cut the blue umbilical cord and began washing him as he sputtered loud protests. Monique's son Basil awoke on her back and began howling, a fine baritone to accompany the new arrival's soprano. Monique wrapped the baby in a towel and placed him beside the medical kit. As Kadjatou pushed out her placenta, Monique caught it in the plastic tub and began inspecting it to make sure that nothing was left inside the new mother. The babies continued their deafening duet. My mouth hung open. I didn't know what to say or think. My dress stuck to my back, wet with perspiration.

Like smoke, I drifted to the corner of the room and down to my knees. I felt overcome with awe and fatigue. I couldn't believe we all got here this way. I couldn't believe that here, in this dilapidated box, Monique, with a sixth-grade education and nine months of medical training, was birthing babies. Lots of babies. She was responsible for the future of this village. No electricity, no running water, no safety net of ambulances and emergency rooms. I knew that Mali had one of the highest rates of maternal death in the world. I'd read a sobering statistic that placed a Malian woman's lifetime risk of dying in pregnancy and childbirth around one in twelve, compared to a U.S. woman's risk of one in over three thousand. Even if one accounts for the fact that Malian women have many more children than American women, and thus are at risk for more years, the difference in the death rate is still huge. Monique was constantly battling the odds. It was so awful, so miraculous. I wanted to get up and help out, but I couldn't do a thing.

Alima climbed down from the cement block and whispered something to Kadjatou, who pushed herself into a sitting position, then heaved herself off the concrete. Hunched over, she picked up her pagne from the floor and shakily covered herself. She walked past me and out of the room. A thin stream of blood trickled down her inner thighs. Alima walked with her, gripping her arm.

"Monique," I said in desperation, finding the strength to rise from the floor. "Where is Kadjatou going? Isn't she going to take her baby?"

"She's not leaving," Monique explained. She bounced Basil on her back to quiet him. "She must go wash herself now. Her bucket of water is already outside." The bathing area was adjacent to the birthing house-in an old nyegen (pit latrine), with a floor that was caving into the hole below. I pictured Kadjatou sitting on a small wooden stool, in the corner, rinsing her body back to life with handfuls of cool water.

"But what about the baby?" I asked, looking at the now-peaceful face peering out of the towel by Monique's kit. He was so small, you could almost forget that he was the reason we were all here.

Monique turned to me patiently. "The mother is tired and she must wash herself, Fatumata." Noticing my worry she added, "She will go into the resting room, and we will give the baby to her."

Monique scrubbed and mopped and straightened. I stared at the lantern's flame twitching behind dirty glass as if it were looking for an escape. A hint of kerosene hungin the air. This was Monique's fourth birth this month; the room would be needed again soon. It was hardly sanitary by Western standards; it was made of mud after all, but she kept it as clean as possible. She moved carefully around the baby, stopped momentarily, and looked at him.

"Really, it's very good," she said. "One doesn't know how a birth will turn out, only God does. Allah k'a balo, k'a nankan di yan. We just thank God that we have a new baby."

I heard Kadjatou and Alima going into the adjacent resting room.

"Fatumata, take the baby and give him to his mother," Monique said, gently lifting the tiny bundle and offering it to me. I did not move. "Hey, Fa-tu-ma-ta," she smiled, "you can do it. Your hands were made to hold a baby." She helped me cradle him. I grasped him awkwardly. Yet he felt good. Don't drop him, I cautioned myself.

Carefully, I made my way into the resting room. Moonlight had begun to filter through the ripped tin roof. I could see the outline of Kadjatou. She was on her side, resting on a straw mat placed over the iron frame of the bed. Alima was perched on another rusted bed frame.

I placed the baby at Kadjatou's side. She said nothing, but rested a hand on his body. Monique came into the room with her lantern, wrapped a blood pressure cuff around Kadjatou's arm, and began pumping it up.

Kadjatou looked so young. She was so young. And if she didn't die, she might have twenty more years of this, of birthing babies. It might be good in God's eyes. It might be good for the village, and good for the baby. But was it good for the mother?

As the air hissed out of the cuff, Kadjatou finally spoke, her dry voice a scratchy whisper.

Monique translated. "Fatumata, they want you to name the baby."

"What? Me?"

"Yes, they are Muslim and will wait for seven days to name him, but because you are here they also want him to have a Christian name."

"I don't understand."

"They want it, that is all. It's okay." She touched my arm. "Don't worry yourself, Fatumata. Just name the baby. You will give it the right name."

How could I come up with the right name? I knew so little about the culture, about what names mean to people. It seemed like such a responsibility. I thought of the most responsible person I knew.

"I would like to give this baby my father's name, a name from my family," I announced. "William."

Monique translated, pronouncing the name "Weelayum," as if she was speaking through okra sauce. She scrunched up her face, smiled, and said "Weelayum" again.

"Weelayum," repeated Kadjatou and Alima, and they both began to laugh. Monique cackled with pleasure and I joined in, happy and relieved. I had not been much help tonight but knew that as long as I was here, I would help Monique in any way I could.”