Thursday, November 14, 2013

We Suffer Into Knowledge

There is a woman in Mandama who came by my house several times in the last few months.  Each time as I came to the door, she would untie her baby from her back and hold it out towards me in mute appeal.  The reason was clear; the baby was the most severely malnourished infant I have ever seen.  Her limbs were desiccated, the skin sagging down, far too big for her emaciated frame.  Her tiny ribcage stood out starkly, fluttering in and out with every breath as though it contained a trapped bird.  Her eyes were enormous in her shrunken, febrile face.  Her mother told me she was three months old, but she could have been born the day before, judging by her length and the size of her hands and feet.  Most children have disproportionately stubby limbs and large heads for their overall height, part of what makes them seem so cute; evolutionary biologists think this is part of why human mothers maintain a maternal instinct much longer—years longer—than most other mammals, whose offspring attain regularly distributed size fairly quickly.  This baby was the exception to that rule.  Her limbs and face were so impossibly thin that she seemed proportioned like a miniature adult, as though she were Faust’s grim homunculus rather than an infant.

I tried to talk through a diagnosis with the mother, probing gently with questions about breastfeeding habits, HIV status, birth weight, anything I could think of that might be relevant.  She mostly answered my questions with an impatient shake of the head or the sharp inhalation of breath that indicates “yes”; it quickly became clear that she was not interested in the root of the problem.  All she wanted was a solution.  I obliged the first few times she came by, sending her home with bags of sugar or a bottle of oil and instructions on making enriched bouille as a weaning food; although babies should optimally breastfeed exclusively for the first six months, this was clearly an exceptional case. 

Nothing is a secret in a small village, and it did not take my neighbors long to cotton on to what was happening.  After the third time she came and left, a flock of headscarved Hadjas descended, clucking biddies with ruffled feathers, eager to gossip and instruct.  “This woman is not good,” I was advised.  “She has had three other children, and they were all like this, too small.  All have died.  She does not have milk problems, so what is going on?  Why does she keep her children like this?  Why does she disgrace her husband by begging?”  She was probably using the sugar and oil I gave her for her husband’s beignets, one suggested.  She was assuredly not giving it to her child.  Another warned me that I was being taken advantage of.  This woman, I was told, went around to get as many handouts as possible—I should ask the Catholic sisters, it was certain she had been there too.

I did casually bring it up the next time I was at the Mission for a women’s group meeting, and sure enough, Soeur Agnes immediately knew the woman to whom I was referring—she had come to the dispensary in the nun’s cloisters several times.  “I don’t know how that baby is still alive,” marveled Agnes.  Vraiment, elle se bat à deux poings, eh?” She was indeed a fighter.

I used to try and assume the best of people, but a year here has cured me of that habit.  My neighbors’ malicious whispering wormed its way into my subconscious, and the longer I thought about it, the more convinced I became of the woman’s subterfuge.  I began to feel uneasy about encouraging this woman to expressly keep her child malnourished to aid in her begging; this is a common problem encountered by food supplement programs like the one at my health center, but the first time it had been aimed so personally at me and my perceived wealth. 

And yet total inaction did not sit right, either.  I had ensured that the mother was registered in the malnutrition program at our health center after the first time I laid eyes on her daughter, but now I went a step further: I enrolled her in the nutritional tracking program I’ve been slowly working on for the last few months with the help of volunteer health mobilizers.  In theory, we should already be in Stage 3 (Monitoring) of what was to be a six-month program.  We were to take a month for Stage 1 (Enrollment), locating and registering mothers with severely malnourished children; a month for Stage 2 (Education and Distribution), going house-to-house to instruct these mothers in making soy bouille and soymilk and distributing soybeans and flour; and three months to continue re-visiting the homes to monitor the children’s growth before spending the final month in program evaluation.
In reality, we are still in Stage 1.  It is hard to find times during which my volunteer mobilizers are free to work which coincide with times when women are at home, instead of out working in the fields.  Furthermore, educating the mobilizers to conduct the preliminary surveys and registration has been painstaking.  I have re-written the format several times and pablumized the content, but to no avail.
And so despite my good intentions (which do, after all, pave the road to Hell), registering this woman in the tracking program brought no actual relief to her situation.  Two weeks after I had conducted her initial survey, she showed up at my house again, begging for soy.  I refused.  In large part, this was for legitimate programmatic reasons: one of the biggest weaknesses of Peace Corps (and one of the reasons we spend 50+ years in a country like Cameroon, instead of working ourselves out of jobs much earlier than that) is a lack of quantifiable monitoring and evaluation.  My predecessor led a similar program with verbally confirmed success, but the notes that were left behind were minimal, and there was no thorough assessment done after the fact, leaving me to design a new program all over again.  Hence the axiom: Peace Corps hasn’t been in Cameroon 50 years, we’ve been in Cameroon two years, 25 times.  To combat this, I would like to leave those who follow me with a statistically sound demographic survey comparing rates of malnutrition before and after the program, as well as a thorough evaluation of the program content and recommendations for improvement.  To do this, I need to have my act together organizationally, which (unfortunately) means waiting until we’ve finished Stage 1 before moving on to the distribution phase so that growth can be carefully monitored.  All this overly specific detail to say: I didn’t want to start giving out soy right and left until everyone working on the program was on the same page and ready to move to the next stage together.

But if truth be told, I was also suspicious of the woman’s intentions.  The idea that I had had the wool pulled over my eyes still smarted, and I didn’t want to be perceived as a soft touch, only to have the woman turn around a sell the soy I gave her in the market.  I truly wanted what was best for the baby—but I also wanted to protect myself, and do what I saw as responsible and sustainable.  An awful resentment, coupled with undeserved judgment, guided my actions more than I would like to admit.  I hid my reluctance to give her a handout behind bureaucratic bluster about The Program.  “Two weeks,” I told her, thinking at that point that we were still on schedule.  “In two weeks we’ll be coming by your concession, and we’ll give out the soy and do a lesson to make sure you know how to give it to your baby.”  I told her the same thing a week later.

The week that was slated for distribution came and went in the usual paralysis of inaction that plagues my work here, and I guiltily avoided the woman.  The next week I headed south to Yaoundé to train the newest batch of volunteers for a week in soy and moringa initiatives, and when I got back to Mandama I had enough on my plate for the next two weeks to put the tracking program on the back burner until I had tackled a few other things. That brings us to the present, a month past the date when help was supposed to arrive, when my program was supposed to pull through and justify my personal inaction regarding the begging woman and her skeletally thin child.

Yesterday I was walking home from my lamido’s compound and passed the woman on the street.  I stopped to greet her.  “How are you?  Your health? And the baby?”  She shrugged.  Bingel am ma’i,” she stated, a fact, emotionless. “Sey asaweijey didi.”  I froze, sorrow and guilt twisting my stomach.  Her baby died two weeks ago.

I spent last night in a funk, chain smoking Gold Seal cigarettes and trying to come to terms with what has happened and why.  Grappling with myself, trying desperately to convince myself, I have rehearsed all the excuses that exempt me of responsibility until they sound trite even to my ears.  I did everything I could have been professionally expected to do.  Doing otherwise would have both diminished the long-term effectiveness of the tracking program as a whole and sustained cultures of dependency created by white people like me giving handouts in places like Mandama.  It would have been unsustainable; it would have been irresponsible; I cannot think that I have power over the life and death of every child in this village—

And yet all that rings hollow in the face of the simple fact: her baby is dead.  Forget professional responsibility, I had a personal responsibility to see another human being with eyes of compassion, to redistribute the resources that have been granted me through no merit of my own, to see a fellow traveler in need and help her out—and I blew it.  I let myself be pulled into petty village drama, and inadvertently took sides, in this case with deadly consequences.  How did I know this woman was misusing what I had given her?  It is entirely possible that she was, but where was my evidence?  And even if she had been, so what?  I constantly tell villagers that I’m not wealthy just because I’m an American and that I’m paid like a Cameroonian, which is true—but I’m paid like a Cameroonian bureaucrat.  I can certainly afford to lose a few bags of soy flour and a bottle or three of oil on the off chance that it might have made its way to helping that baby stay alive.  How much do I spend every month on beer going out with other volunteers when I go into the capital to bank?  How much did I spend on a mini-fridge so that I can be comfortable and drink cold water in the heat? 

I’m trying not to descend into weltschmerz, but the fact remains: I could have given that baby the world.  More to the point, I could have given her life.  Instead, I chose to sit on my hands and do nothing.

Pathei mathos, Aeschylus writes, “we suffer into knowledge”—in this case knowledge of myself, knowledge that I wish I could un-learn.

Perhaps more personally disturbing: this would have destroyed me had it happened six months ago.  It’s still bad, don’t get me wrong, but I can already sense that it’s not going to be my Stalingrad (and yes, that metaphor makes me Nazi Germany, which feels apt).  I’m going to move on.  A year here, and I’m becoming—what?  The more charitable word would be “resilient”; the more frightening one, “harder”.  I don’t always like what I’m becoming here, and I’m sometimes afraid there’s no going back.  An old friend recently advised me to take care not to lose my kindness.  The advice was good, and much needed.  Here’s hoping this knowledge acts as a check, to bring me back to what matters, and the moral core that impelled me to come to Cameroon in the first place.

1 comment:

  1. You came...and stayed...and made mistakes...and I'm sure reached out and helped many people...and found out about things that other people either ignore or don't care about...and learnt about yourself and the world around you...OK so there's no going back...but you've gone further forward than most of us go in a lifetime. Thank God there are people like you out there who actually do something rather than nothing. Your experience will make you stronger. Knowledge of ourselves is something most of us avoid because we aren't brave enough to decide how to use that knowledge and make hard choices rather than taking the easiest most selfish paths all our lives. The outcome for that baby would have been the same whatever you had done,but she has probably played a more important part in ensuring you keep your kindness and moral core than anyone else you will meet in your life,so be thankful that you came in contact with her, not guilty and use the knowledge she gave you wisely