After my three-month rotation in pediatrics, Dr. Mohamed Ali Nur assigned me to a rotation in the obstetrics and gynecology department. There, I discovered that I had to fight women’s attitudes as much as I had to fight for their lives. Many women, after all, took their first breaths in the hands of their own mothers, who had been working when it became time to deliver and who came back from the pasture that night with the goats around them and an infant in their hands. These women waited too long before coming to us—some were already dying from labor complications by the time they were admitted. Many were carried in donkey carts. “The pain began two days ago,” said one young boy as I examined his sister, “but we have no roads, no transportation.”
Most Somali people trusted traditional healers more than doctors or hospitals; many insisted on waiting for a natural birth against all medical odds. “We cannot watch you and your child die,” we would tell these women. “You have to have a Cesarean section, or you have to leave here.” Many preferred to go, to read the Holy Qur’an at home; we had no choice but to wish them luck and to tell them that we would pray for them. Awaiting a life, says one of our proverbs, also means awaiting a death.
On my first day in the maternity ward, I was working alongside a young midwife who was planning to become a doctor. The midwife had just delivered a child when I turned my back for a moment and heard a loud noise, as if a pipe had burst. “Dr. Hawa! Dr. Hawa! Look here!” she shouted. When I came over, I saw the young mother bleeding like a faucet, a brilliant red.
Some bleeding during and after childbirth is normal. If a tear happens somewhere away from the uterine artery, the blood is manageable; the body expels the placenta, and healing happens quickly. As I saw this rush of blood, however, I feared there was a tear in the uterine artery itself, which could mean heavy, even life-threatening bleeding. But I had no time to think about where the tear occurred; I had to do everything at once.
I called for the other doctors and ordered the midwife to inject the patient with medicine. Still I feared that if she continued bleeding for even a few minutes, she would die. I spoke with the woman and told her calmly that I would enter the vagina, to stop the bleeding. I put one hand inside and one on the top of her abdomen, to try to stop it mechanically. I stood there for a few minutes, reassuring her that she would be okay, pressing down as hard as I could. Finally, the danger subsided.
“You are lucky,” I told the woman several hours later when I saw her resting comfortably with her baby girl.
“I know,” she said, looking down at her daughter, not understanding, most likely, how close she had come to death.
That midwife quit her job soon after, giving up her dream of becoming a doctor—the sight of that blood, the feeling of fear, was too much for her. But I was energized. While I had known that medicine is a fight against disease, against mortality, I learned in those days that you cannot always wait for a scientific or chemical solution. Sometimes there is another way to stop the bleeding, to calm the body, to soothe the fever: A strong will and the weight of your hands can aid the body in times when chemistry is slow.
Sometimes medicine is also a fight against other doctors, but since I was the most inexperienced, I couldn’t argue with my supervisors. One night I was called into a delivery room to examine the wife of an influential Somali man, a good friend of one of the highest-ranking doctors at the hospital. “What is the trouble?” I asked the doctor who had been on duty.
“There is heavy bleeding, but there is no laceration,” he said. “I’m trying to stop it.” He nodded to the bag of solution pouring into the woman’s arm.
“May I see?” I examined the woman. “I see the place, the laceration,” I told the doctor and the nurse-midwives. “Prepare sutures for me. Although—” I looked at my supervisor and the woman’s husband. “May I continue?”
The two men looked at each other; as they walked into the hallway to talk, I tried to reassure the woman, to talk nicely to her. They returned ten minutes later, followed by a nurse with a different type of solution. “We will continue on with the plan we have discussed,” said my supervisor, who thanked me for my time. While I knew I was expected to leave, I wanted to argue. I took a deep breath to talk but then stopped. Instead I continued with my rounds, to the surgical ward and then the pediatric ward, frustrated that I couldn’t act on what I thought was best.
The woman died at four thirty that morning, in the best hospital, surrounded by the most highly qualified professionals. The nurse who had administered the solution told me the news and that I had been right in my diagnosis. She thought I’d be happy somehow.
I walked out of the hospital’s main gate as the sun was rising, and I heard the sound of someone crying. It was the woman’s daughter, about fourteen years old, whom I’d seen in the waiting room. I imagined that she was walking home to tell the rest of the family that her mother had already died. I fought the urge to go to her and comfort her, as I knew no words would help. If we’d saved that life, we would have saved the family. I continued on to my home, walked through my door, and slipped into bed with my clothes still on.
My mother became pregnant with her seventh child when I was eleven years old. By then she’d had Faduma Ali; then me; then a boy, Mohamed, who had immediately died; then she had my sister Amina, as you know; and then Asha and little Khadija, who was only two years old at the time. Somali families are often this large, you see, as many children do not survive.
This seventh time, as my mother’s stomach swelled, she felt weakness and pain. Thinking the fresh food and fresh air would help her condition, my father sent a car to take her, my sisters, and me to Ayeyo’s home in the rural area of Lafole. There my half sister Faduma Ali tried to distract me by teaching me to milk the goats, but I refused to leave my mother’s side. Maybe Faduma Ali could sleep deeply in the room where my mother was suffering, but my mother and I were friends—I told her everything. Even then we talked late into the night while I stayed up, holding the place on her abdomen where she was feeling pain.
So many nights we sat that way together; I cried to see her turn her head from side to side, saying ah-ah-ah-ah. We tried to bring her under the trees in the afternoons, and one day, at about two o’clock in the afternoon, she lost consciousness. Amina ran to get water, to splash it on her face, but while she was gone, we could see heavy blood spreading from under my mother’s robes. Ayeyo tried to keep us away, but we saw that she held in her two palms a small, small child, dead, the size of just one of her hands.
This was my brother; he had been in my mother’s womb for just a few months. My grandmother sent me to find a white shroud, or karfan, to cover him in the Muslim burial tradition. Then I dug a grave somewhere, where we would put his small body.
My mother’s pain continued after the burial, and we all sat inside for the rest of the day, sobbing as she moaned and cried. Listening to Ayeyo’s orders, Amina and I carried the blood-soaked cloths out to scrub; by the time we hung them and returned, there were more. That night I lay on the ground next to my sisters, hoping to hear the steady breath of their dreams, praying that my mother wouldn’t die in the night.
The next day a group of my strong, young cousins came to our place with a stretcher made from big sticks. They carried my mother, and Ayeyo and I followed behind them along the dirt paths out to the main road. There my father was waiting for us with a car, to take us to Mogadishu’s biggest hospital, Martini. My younger sisters remained in Lafole with Faduma Ali.
I cried on the road to Martini hospital, remembering that one of our neighbors in Mogadishu had died there, while her family was asleep at home. “Hawa, you must believe in these doctors,” said my father, after my mother was placed in a ward of forty-five beds. “They are trained to help.”
I defied their orders immediately, crawling into bed with my mother. “I will stay with you,” I promised, and for the three months she was there, I did. Every morning at seven o’clock, I would bring her some tea before I went off to school, updating my friends on her condition before losing myself to the lessons of the day. I would come back after school, around 4 p.m., and stay as long as I could. Since she loved films, I saved my small spending money to buy her magazines—beautiful photos of Italian and French women; from her pillow, she had fantasies of a glamorous faraway life.
Sometimes the Italian doctors tried to explain to me that they were going to give my mother injections or draw her blood; otherwise they ignored me unless they were asking me to leave—my least favorite time of the day. I earned the pity of two Somali nurses whose eyes looked past my small body, hidden under my mother’s blanket, as they continued their rounds. These women, I discovered, knew everything—how to measure blood and medicine, to listen to the heart or hold the abdomen in order to identify where my mother’s problems lay. Though there was no pain medication at the time to help, they seemed pleased when they could tell us something to comfort us.
When the hospital staff finally cast me out each evening around nine o’clock, I scooped up the tea containers and began my walk home through the quiet streets, searching and searching my mind for some small way to help. I could think of none.
When my mother didn’t seem to improve, the doctor discharged her. “Take her to your house, read some Qur’an to her, get her to eat more,” he said. “When she gains weight, you can bring her back here, and we will try to treat her again.”
The neighbors and relatives came to our home from all over, bringing food and incense, reading the Qur’an around the clock, and separating into small groups in our courtyard to talk or to pray. Without my sisters, I was alone, forced to make one pot of tea after another, and to listen to my family’s false reassurances.
Although I prayed always, always asking for an answer from my God, God was not hearing me. Ayeyo prayed as well, crying, “Leave this daughter, God, I want that she will bury me!”
One early morning, a week after we returned, I crawled onto my mother’s bed and touched the part of her stomach she had been rubbing. I knew she had been growing weaker; I gripped on to the place she felt pain and pressed down, hard, which had worked in the past. “Oh Ma,” I said, realizing that my best efforts did not make any difference. “I’m afraid I won’t be able to sleep even one more night with you.”
Our cousins came into the bedroom around eleven o’clock that morning, to read the Qur’an. “I’m not going to die in this room,” my mother said weakly, “I want out.”
“Dahabo,” said an uncle, “you have to stay in your place.” As I was a child, I couldn’t say anything.
“Please bring me outside to the courtyard, where people can sit.” So a group of my cousins, strong and young, prepared some kind of bed and carried my mother through the door.
“Where is Hawa today?” my mother asked when she was first set down. I was beside her, but I could not answer, I am here, Mama. I began to cry, but my voice made no sound. She looked up to one side, and I ran around her bed, to stand between the wall where she was looking and her eyes. But she immediately closed them, and without opening her mouth, she took her last breath.
There is some part of the Holy Qur’an, when a person is dying, that is read; they say it helps people pass away. My voice returned in a big cry—waaaaaaah!—and the uncle reading the scripture slapped me hard across the face. I saw a bright light and fell down. “Don’t cry,” he said to me while Ayeyo cried with a loud voice. Still I remember that voice.
We didn’t have a telephone, but the news of my mother’s death traveled fast on the wind of a dozen gossiping aunties. Six people held my mother’s body as we walked to the gravesite, an hour away from our home in Mogadishu.
On the way, we passed an old woman of Ayeyo’s age, who stopped us on the road. “Who are you carrying?” she asked.
“Dahabo,” said my cousin.
“You are carrying Dahabo, and Salaho is left alive?”
Hearing her given name, Ayeyo spoke up for the first time. “God is deciding who will die first,” she said, “and who will die after.”
I did not return to school for some time after that, but when it was finally time, I arrived very early, holding a few coins for my breakfast and waiting for the gates to open. My teacher at the time was young and active; before I’d left, we had begun to study biology. “I want to study the human body,” I told him when he finally opened the door. “I want to find out what killed my mother.”