A Girl from Pakau

By Linda Gambill

As I ironed my bra, sweat dripped from my nose and splotched the lace. I set the iron down on the coals to heat it back up and wiped my head with a rag. I hardly ever ironed my clothes in Tennessee, much less my underwear. But in West Africa, where I was working as a health educator, creatures called toombo flies laid their eggs in laundry drying outdoors. If you put on an infested garment, the eggs would slither down your hair follicles and burrow into your skin, feeding off your blood until they hatched right out of your flesh. The only way to avoid all this unpleasantness was to iron every square inch of your clothes, frying the little suckers before they could turn you into their personal incubator.

I’d been told about the toombo flies before I came to The Gambia. The Peace Corps had been very thorough: I would also have to cope with torrid heat, an excruciatingly slow pace of change, and maybe even a mental breakdown. Living in the bush apparently had its risks. Every now and then some poor volunteer woke up, ate breakfast, and proceeded to wander around their village stark naked. None of this information had dampened my enthusiasm. My old life—which consisted of nursing a futile crush, teaching psychiatric patients to make tile trivets, and smoking pot with my cat—needed shaking up.

I was about to pick up the iron, steaming hot after a few seconds on the coals, when I heard a bush-taxi approach and rushed to the door. After four months in my village, the arrival of a vehicle was now as big an event for me as it was for the villagers. Maybe I had a visitor! The battered truck pulled up in front of the imam’s compound, its hand-painted prayers dulled by dirt, its tailpipe tied up with wire. No one got out the back, but the driver, a middle-aged man with a short white beard and sun-strained eyes, emerged from the cab. Seeing me on the stoop, he waved me over.

“Will you look at this child? She’s very sick.”

I inwardly sighed. I could no more diagnose a serious illness than I could launch a rocket. It had taken me months to convince the people in my village that I was a teacher, not a doctor or a nurse—that I could neither diagnose nor prescribe—and word was spreading to the surrounding area. But I was still a toubob, a white person, which in The Gambia meant that I was, by definition, educated and rich. Villagers routinely assigned me knowledge I didn’t possess. On more than one occasion, I was asked if it was true that America had sent men to the moon. When I said yes, the next question was how.

“I don’t know,” I would say.

“But you’re a toubob!”

“Not the kind who knows how to send men to the moon.”

This gave people pause; then they laughed.

I only knew a little more about diagnosing disease than rocket science, but I walked over to the bush-taxi and leaned in the window. An old woman with cataract-clouded eyes was cradling a girl I guessed to be about five. The child was either asleep or unconscious. I asked the old woman if they’d been to the clinic.

“Yes. The doctor isn’t there.”

“The ambulance?”

“Gone.”

“We’re taking her to Banjul,” the driver said. “Will you come with us?” The capital of The Gambia, Banjul was home to the only big hospital.

The girl’s body tensed up, her back arching and limbs spasming, her hands curling into small fists. Then she went limp. I reached into the cab and felt her forehead. Scalding. I looked at the old woman, whom I took to be the child’s grandmother. Both she and the driver returned my gaze with beseeching eyes. With no one at the clinic, I was their best bet. They hoped my white presence would grease the wheels at the hospital, making the nurses rush to full and immediate attention. I doubted that I exercised so much influence, but I wanted to help. If I could speed things up even a bit, maybe the girl would live.

“I’m coming,” I said. I ran back to my house to grab my bag. I stuffed a washcloth in it and filled my canteen. On the way out, I gave my next-door neighbor my house key.

“Go,” she said, “I’ll finish the ironing.”

I got in the cab next to the old woman, the cracked vinyl upholstery burning my legs. The driver put the taxi in gear and we lurched forward.

The woman introduced herself as the child’s grandmother. “We’re from Pakau.”

I soaked the washcloth with water from my canteen and laid it on the girl’s forehead, kicking myself for not bringing another one for her chest. She was unconscious, I realized, so she wouldn’t be able to swallow an aspirin. The grandmother kept trying to feed her condensed milk from a bottle cap, but the pale yellow liquid dribbled out the side of her mouth.

The girl went into convulsions about every ten minutes. I kept soaking the washcloth, alternating it between her forehead and chest. Hanging from the rearview mirror, the driver’s prayer beads banged against the windshield every time we hit a pothole. The grandmother and the driver were muttering verses from the Koran. The longer they prayed, the angrier I got: people waited until a child went into seizures before heading to the hospital—then they begged Allah for a miracle.

I glanced at the grandmother’s seamed and worried face, and my fury left me. She didn’t know. She was a half-sighted old woman who’d spent her last butut on Peak milk, a luxury item from Holland she hoped would make things right. Fevers always came and went, so it was hard to tell which ones warranted a trip to the clinic, which—thanks to the corrupt officials who siphoned funds into their own pockets—was often far away. Taxis were scarce and even when available, often too expensive, especially when money from the last harvest was running out. This was partly why half of Gambian children died before they turned five.

A sharp, angry hiss filled the air. The driver cut the engine and sighed. He got out and lifted the hood. Steam escaped in a cloud, a scorched smell filling the air. The grandmother and I looked at each other, alarmed.

The child was half on my lap, half on hers. The sunlight blasting through the windshield heated the cab up like a sauna. The passengers climbed out of the back, milling around while the driver waited for the radiator to cool down enough to take off the cap. The engine made little clicking sounds. The girl went into another seizure. The grandmother and I splashed water on her straight from the canteen.

“What’s her name?” I asked.

“Neneh.”

“That’s sweet,” I said. Neneh means baby.

The minutes ticked by. At last the driver topped off the radiator and the passengers climbed back in. Now I was praying with the others. Dear God, please let this piece of shit start. The engine coughed and died. The driver tried again; the engine wheezed. We prayed harder. The engine finally caught, the grandmother praised Allah, and the driver leaned over the steering wheel as if that would make the vehicle go faster.        

We turned onto the corrugated highway and picked up speed. The ride was so jarring I was afraid Neneh would go into more convulsions, but they stopped altogether. We reached the outskirts of Essau. Her face was twitching, which scared me more than the seizures had. Something inside her was winding down.

“Stop at the health center,” I said. “We can’t wait to get to Banjul.”

The health center in Essau sat back from the road under a canopy of trees. We pulled into the shady yard and the passengers poured out, praying as the driver lifted Neneh out of the cab. They wished us well and gathered their baggage for the short walk to the ferry. The grandmother and I followed the driver inside.

We were greeted by Mr. Bah, the senior dresser-dispenser. He led us to an exam room, and the driver carefully laid Neneh on the table. A nurse did a quick intake while Mr. Bah felt the child’s forehead, pulled up her eyelids, and palpated her torso with long, gentle hands. The examination took about a minute.

“Cerebral malaria,” he said, filling a syringe. “Neglected, the parasite goes to the brain. She’s also severely anemic. She should have been treated days ago.”

“How can you tell so fast?” I asked.

Mr. Bah sighed. “Her symptoms could indicate something else, but during the rains, malaria’s usually the culprit. I’ve seen too much of it.”

“Will she be okay?”

“That’s up to Allah, but we’ll do our best. I’ll give her a shot of chloroquine, then you must take her to Banjul. She needs more care than we can give her here.”

Mr. Bah explained the situation to the grandmother and the driver in Wolof, offering us the ambulance, but the driver wanted to take us to the ferry. We chugged up the small rise to Barra, passing the chop shops and beteeks, the market and the taxi park.

The ferry was just pulling away from the pier. It wouldn’t return for two hours.

The driver helped us to a bench in the empty terminal. I tried to give him the fare, but he refused, seeming sad to leave us. The waiting room was dank, sweltering, and cut off from the breeze. Water had pooled at our feet, an earlier rain having blown in through the windows.

Two Mauritanian men came in, talking loudly, their flip-flops smacking against the cement, their voluminous cotton robes limp from the humidity. Their eyes were liquid, their teeth stained from kola nuts. They gave us a cursory glance and kept talking.

Neneh’s face was barely twitching now. I felt her forehead; it seemed cooler. The chloroquine was already working. I relaxed. I’d almost drifted off to sleep when the grandmother spoke. “She’s gone.”

I opened my eyes. “What?”

“She’s dead.”

I couldn’t believe it. Mr. Bah’s shot had been working. “How do you know?”

The woman shook her head and gently closed her granddaughter’s eyelids. I looked for the rise and fall of her chest, but it was still.

“I’ll go tell Mr. Bah,” I said.

I ran. The emergency was over, but I ran as if we could somehow revive Neneh if I only got to the health center in time. People stared at me as I passed. I clattered into the clinic. The nurses froze, startled. Mr. Bah was just coming out of his examining room.

“She died?” he asked.

I nodded, catching my breath.

“It was late, but I was hoping she would make it.” He sighed. “The driver is on an errand but when he gets back, I’ll send the ambulance. Tell the grandmother I’m very sorry.”

 “Yes. I’ll tell her.” I left the health center to join the pedestrians on the road. As I walked back to the ferry terminal, the air felt heavy, like water.

The waiting room had filled up. The grandmother was leaning against the wall, her eyes closed. She was still holding Neneh, the small body covered with a sarong.

“The ambulance will be here soon,” I said.

“Thank you.” She opened her eyes, then closed them again.

I took my place beside her, also leaning against the wall. Some time passed, I couldn’t tell how much. The ambulance arrived. The driver lifted Neneh from the grandmother’s lap and placed her on the stretcher. The old woman straightened the child’s clothes, and the driver tightened the straps around the small body.

On the street, people stopped as the driver slid the stretcher into the ambulance. They told the grandmother how sorry they were, that they knew how painful it was to lose a child, but that it was Allah who took her away. Murmuring thanks, we climbed into the back of the ambulance and sat side by side, facing the seat the stretcher was secured to. The driver closed the door. I twisted around to look out the back window. The urban bustle of Barra gave way to the leafy compounds of Essau, which were soon taken over by the red dirt and neon trees of the bush. Rain clouds chased us inland. The grandmother was sat quietly, her sorrow enveloping us. The only sound was the thudding of the tires on the washboard road.

Unlike the grandmother, I didn’t have a spiritual philosophy that made sense of Neneh’s death. There was no solace in Buddhism, the closest thing I had to religion. A little girl who hadn’t done anything worse than chase a chicken around the yard had to take the hit for mistakes made in a past life? If that’s karma, it’s as capricious as chance. But we cling to the idea of cosmic balance. We make up all kinds of stuff to bolster the notion—a God that works in mysterious ways, consequences that leapfrog across lifetimes, irate ancestors who must be appeased—because we don’t want to face the thing that terrifies us most: the random element, the wild card, the loose cannon that smashes us to bits if we’re in the wrong place at the wrong time. Neneh died because she was poor, because a mosquito bit her, and because health care was so sparse in the provinces.

It was quieter after the ambulance turned off the highway. I asked the grandmother if Neneh was her only grandchild.

“Oh no, I have many. Eleven alive, six dead.”

She asked about my mother and father. Yes, I missed them very much. No, no husband, no children.

“Ndeysan,” she clucked. A pity.

The clouds caught up with us, turning day into night. Rain pounded on the roof so hard, we stopped talking. The road was now a creek, the trees tossing in the wind like green flames against the black sky. My African fantasy dried up in that rain. The Gambia was just a piece of river, savannah, and sky, not some magical green cape. Flat as a hand, she killed off half her children before they turned five. What had made me think I was so important that she would give a damn about my future?

As we pulled into the village of Pakau, the sun returned, hotter than before. We stepped out of the ambulance into a clearing surrounded by thatched huts. The grandmother, so silent before, began to keen, and a young woman rushed out of an open door, her hands tearing at her thin face as she screamed, “Sumaa dom! Sumaa dom!” My child, my child.

Other women ran into the clearing, echoing her cry with a skirling lament that sent black birds flying out of the mango trees. A chill rippled down my spine, jolting me out of my numbness and bringing tears to my eyes. I’d never heard keening like this, such a raw outpouring of grief. When a child died in my village—and, as I’d been told, in much of The Gambia—the family quietly submitted to the will of Allah, sometimes so quietly that American aid workers mistook this stoicism for a lack of feeling. I saw plenty of sadness during my three years in this small corner of the world, but until this moment, it had always been contained, visible only in the eyes of people who seldom, if ever, allowed themselves the luxury of tears.

Weeping, the grandmother clasped my hands and prayed that I would find a husband, bear a lot of children, and live a long and healthy life. I wanted to give her something but I had nothing to give, not even a prayer. I squeezed her hands and got in the ambulance next to the driver, who took me back to my village.  

I retrieved my key from my neighbor and opened my door. My laundry was stacked on the bed, neatly pressed and folded. I stared at it, stupefied. I’d been ironing this morning? I sat down and hugged a pillow. I wondered if the women of Pakau would keen late into the night, until the mother and grandmother grew so tired, they could finally fall asleep. I wondered how anyone can fall asleep after someone they love dies. I imagined the grandmother gathering Neneh’s siblings into a big bed and holding them close, comforted by their small, warm bodies as she reassured them that even though Allah had taken their sister, all would be well.