Kwashiorkor

‘Here's another interesting case …’

My sister flicked over the pages of the file of one of her case studies, and I wondered what other shipwrecked human being had there been recorded, catalogued, statisticized and analysed. My sister is a social worker with the Social Welfare Department of the Non-European Section of the Municipality of Johannesburg. In other words, she probes into the derelict lives of the unfortunate poor in Johannesburg. She studies their living habits, their recreational habits, their sporting habits, their drinking habits, the incidence of crime, neglect, malnutrition, divorce, aberration, and she records all this in cyclostyled forms that ask the questions ready-made. She has got so good that she could tell without looking whether such-and-such a query falls under paragraph so-and-so. She has got so clinical that no particular case rattles her, for she has met its like before and knows how and where to classify it.

Her only trouble was ferocious Alexandra Township, that hell-hole in Johannesburg where it was never safe for a woman to walk the streets unchaperoned or to go from house to house asking testing questions. This is where I come in. Often I have to escort her on her rounds just so that no township rough-neck molests her. We arranged it lovely so that she only went to Alexandra on Saturday afternoons when I was half-day-off and could tag along.

‘Dave,’ she said, ‘here's another interesting case. I'm sure you would love to hear about it. It's Alex again. I'm interested in the psychological motivations and the statistical significance, but I think you'll get you a human-interest story. I know you can't be objective, but do, I beg you, do take it all quietly and don't mess me up with your sentimental reactions. We'll meet at two o'clock on Saturday, okay?’

That is how we went to that battered house in 3rd Avenue, Alexandra. It was just a lot of wood and tin knocked together gawkily to make four rooms. The house stood precariously a few yards from the sour, cider-tasting gutter, and in the back there was a row of out-rooms constructed like a train and let to smaller families or bachelor men and women. This was the main source of income for the Mabiletsa family—mother, daughter and daughter's daughter.

But let me refer to my sister Eileen's records to get my facts straight.

Mother: Mrs Sarah Mabiletsa, age 62, widow, husband Abner Mabiletsa died 1953 in motor-car accident. Sarah does not work. Medical Report says chronic arthritis. Her sole sources of support are rent from out-rooms and working daughter, Maria. Sarah is dually illiterate.

Daughter: Maria Mabiletsa, age 17, Reference Book No. F/V 118/32N1682. Domestic servant. Educational standard: 5. Reads and writes English, Afrikaans, Sepedi. Convictions: 30 days for shoplifting. One illegitimate child unmaintained and of disputed paternity.

Child: Sekgametse Daphne Lorraine Mabiletsa, Maria's child, age 3 years. Father undetermined. Free clinic attendance. Medical Report: Advanced Kwashiorkor.

Other relatives: Sarah's brother, Edgar Mokgomane, serving jail sentence, 15 years, murder and robbery.

Remarks (Eileen's verdict): This family is desperate. Mother: ineffectual care for child. Child: showing malnutrition effects. Overall quantitative and qualitative nutritional deficiency. Maria: good-time girl, seldom at home, spends earnings mostly on self and parties. Recommend urgent welfare aid and/or intervention.

Although Eileen talks about these things clinically, objectively, she told me the story and I somehow got the feel of it.

Abner Mabiletsa was one of those people who was not content with life in the reserves in Pietersburg district where he was born and grew up. He did not see where the tribal set-up of chief and kgotla—the tribal council—and customs, taboos, superstitions, witchcraft and the lackadaisical dreariness of rotating with the sun from morn till eve, would take the people and would take him. Moreover, the urge to rise and go out to do things, to conquer and become someone, the impatience of the blood, seized him. So he upped and went to Johannesburg, where else? Everybody went there.

First, there were the ordinary problems of adjustment; the tribal boy had to fit himself into the vast, fast-moving, frenetic life in the big city. So many habits, beliefs, customs had to be fractured overnight. So many reactions that were sincere and instinctive were laughed at in the city. A man was continually changing himself, leaping like a flea from contingency to contingency. But Abner made it, though most of the time he did not know who he was, whither he was going. He only knew that this feverish life had to be lived, and identity became so large that a man sounded ridiculous for boasting he was a Mopedi or a Mosuto or a Xhosa or a Zulu—nobody seemed to care. You were just an African here, and somewhere there was a whiteman: two different types of humans that impinged, now and then—indeed often—but painfully.

Abner made it. He was helped by his home-boys, those who had come before. They showed him the ropes. They found him a job. They accommodated him those first few months until he found a room of his own in Alexandra. They took him to parties, to girls, to dice schools. Ultimately, they showed him where he could learn to drive a car. Soon, soon, he could negotiate all the byways and back-alleys of Johannesburg by himself. He had escapades, fun, riotous living … Until one day one of his escapades became pregnant and bore him a daughter. He paid the lobola—that hard-dying custom of paying the bride-price—getting some of his friends and home-boys to stand for him in loco parentis; he did not even apprise his folk back home in Pietersburg of his marriage; he did it all himself.

But life in Johannesburg was such that he did not find much time to look after his family. He was not exactly the delinquent father, but there was just not the time or the room for a man to become truly family-bound. Then suddenly, crash! He died in a motor-car accident, and his unprovided-for wife had to make do.

His daughter, Maria, grew up in the streets of Alexandra. The spectre of poverty was always looming over her life; and at the age of fourteen she left school to work in the whiteman's kitchens. It helped, at first, to alleviate the grim want, the ever-empty larder, at home. But soon she got caught up in the froth of Johannesburg's titillating nether life. She had a boy-friend who came pretty regularly to sleep in her room at the back of her place of employment; she had other boy-friends in the city, in the townships, with whom she often slept. And of the billions of human seed so recklessly strewn, one was bound some time to strike target.

When her condition became obvious, Maria nominated the boy she liked best, the swankiest, handsomest, most romantic and most moneyed swain in her repertoire. But he was a dangerous tsotsi, and when she told him of what he had wrought, he threatened to beat the living spit out of her. She fondly, foolishly persisted; and he assaulted her savagely. The real boy-friend—the one who slept in her room—felt bitter that she had indicated another. Had he not already boasted to his friends that he had ‘bumped’ her? Now the whole world judged that he had been cuckolded.

Poor Maria tried the somersault and turned to him, but by then he would have none of it. He effectively told the Native Commissioner, ‘I am this girl's second opinion. She does not know who is responsible for her condition. There she stands, now too scared to nominate the man she first fancied, so she looks for a scapegoat, me.’

The commissioner had some biting things to say to Maria, and concluded that he could not, in all conscience, find this man guilty of her seduction. As they say, he threw out the case.

So, Sekgametse Daphne Lorraine was born without a father; an event in Alexandra, in Johannesburg, in all the urban areas of our times, that excites no surprise whatsoever.

First, Maria shed all her love—that is, the anguish and pain she suffered, the bitterness, the humiliation, the sense of desolation and collapse of her tinsel world—upon this infant. But people either perish or recover from wounds; even the worst afflictions do not gnaw at you forever. Maria recovered. She went back to her domestic work, leaving the baby with her mother. She would come home every Thursday—Sheila's Day—or the day-off for all the domestics in Johannesburg. She came to her baby, bringing clothing, blankets, pampering little goodies and smothering treacly love.

But she was young still, and the blood burst inside her once she recovered. Johannesburg was outside there calling, calling, first wooingly, alluringly, then more and more stridently, irresistibly. She came home less often, but remorsefully, and would crush the child to her in those brief moments. Even as she hugged the rose, the thorns tore at her. Then suddenly she came home no more…

‘It is quite a typical case of recidivism,’ Eileen explained scholastically to me on our way to Alexandra. ‘You see, there's a moment's panic as a result of the trauma. The reaction varies according to the victim. One way is that for most of our girls there's a stubborn residue of moral up-bringing from home or school or church, sometimes really only from mamma's personality, and mamma probably comes from an older, steadier, more inhibited and tribe-controlled environment …’ Eileen shrugged helplessly, ‘… and detribalization, modernization, adaptation, acculturation, call it what you like, has to tear its way into their psychological pattern, brute-like. At first, before the shock, these girls really just float loosely about in the new freedoms, not really willing evil, not consciously flouting the order, but they're nevertheless playing with fire, and there's no-one knows how to tell them no. Their parents themselves are baffled by what the world's come to and there's no invisible reality like tribe, or comprehensible code like custom or taboo, to keep some kind of balance. Meanwhile, the new dispensation—the superior culture, they call it; the diabolical shadow-life, I call it—pounds at them relentlessly. Suddenly, some traumatic event, a jail- sentence, a sudden encounter with brute, bloody death, or a first pregnancy, pulverizes them into what we credulous monitors consider repentance. It's really the startled whimper of a frightened child vaguely remembering that in some remote distance mamma or tribe or school or church has whispered, “Thou shalt not,” and the horror that it's too late.

‘But,’ Eileen almost cursed out the words, ‘the superior culture keeps pounding at them, and it's a matter of time before your repentant maiden sings again, “Jo'burg, here I come”.’

I was shaken. ‘Eileen, you know that much and yet you continue tinkering with statistics!’

She pulled herself together with an effort. But though she spoke confidently, it sounded unconvincing: ‘Lad, I'm a social scientist, not a conjuress.’

So we went to that house in 3rd Avenue, off Selbourne Road. A deep gully ran in front of the house but the uneven street did not allow it to function effectively as a drain, and puddles of murky, noisome water and collected waste-matter stood pooled in it, still, thick, appalling, like foul soup that makes you nauseous—as if some malevolent devil bade you gulp it down. On the other side the rotting carcass of a long-dead dog was sending malodorous miasmata from its surface to befoul the air. And on either side of the street, moated by these stinking gullies, lived people.

Eileen jumped smartly over the trench and I followed. We walked into the fenceless yard, round to the back of the house, and she knocked. After a moment a wrinkled old lady opened the door. The plough-shares of the years had wobbled across her face; but then again, you thought it could not have been the years alone that had ravaged her so; something else …

‘Oh, come in, nurse.’ They called everybody ‘nurse’ who came to their hovels to promise assuagement of their misery.

Although it was bright day outside, you had to get used to the dark inside, and then when your eyes, by slow degrees, adjusted themselves, things seemed to come at you. A big sideboard tilted into view first. Then a huge stove whose one grey arm reached into the ceiling hole obscenely, and near it a double-bed, perched on four large polish tins filled with sand. The bed was sunken in the middle like a crude canoe, and the blankets on it were yellow with age and threadbare with wear. In the middle of the top blanket was a great hole from some past misadventure, and through the hole glowered a crimson eye, the red disc of a piece-patched quilt-like thing.

I stumbled into a wooden table in the centre, and in my retreat hit a kitchen-dresser. Dark-brown cockroaches scrambled for cover.

‘Don't be so clumsy,’ Eileen hissed, and in the same syntax, as it were, to the old lady, ‘Mother Mabiletsa, it's so dark in here. You really must open that window.’

I had not known there was a window there, but Eileen swept a piece of blanket aside and in flushed the light of day.

‘How are you, Mother Mabiletsa? How are the legs to-day? Sit down please and tell me how is the baby.’

Mother Mabiletsa groaned into a chair, and I took a bench by the side of the table. Eileen stood a moment holding the old woman in scrutiny. When the old woman did not reply, Eileen lifted her bag and put it on the table.

‘Look, I've brought little Sekgametse some skimmed milk. It's very good for babies, you know.’

I turned to look at the old lady and it seemed to me she was past caring about either Grace or Damnation. She was just enveloped in a dreadful murk of weariness.

She pressed down on arthritic knees, rose painfully and limped into another room. I could hear her moving about, heaving with effort though she sounded alone. Then she came in with a bundle in her arms which she put down on the great bed beside Eileen.

‘Come and look,’ Eileen whispered to me as she unfurled the bundle.

There sat a little monkey on the bed. It was a two to three years' old child. The child did not cry or fidget, but bore an unutterably miserable expression on its face, in its whole bearing. It was as if she was the grandmother writ small; pathetically, wretchedly she looked out upon the world.

‘Is it in pain?’ I asked in an anxious whisper.

‘No, just wasting away.’

‘But she looks quite fat.’

To be sure, she did. But it was a ghastly kind of fatness, the fatness of the ‘hidden hunger’ I was to know. The belly was distended and sagged towards the bed. The legs looked bent convexly and there were light-brown patches on them, and on the chest and back. The complexion of the skin was unnaturally light here and there so that the creature looked piebald. The normally curly hair had a rusty tint and had lost much of its whorl. Much of it had fallen out, leaving islets of skull surfacing.

The child looked aside towards me, and the silent reproach, the quiet, listless, abject despair flowed from the large eyes wave upon wave. Not a peep, not a murmur. The child made no sound of complaint except the struggling breathing.

But those haunted eyes of despair. Despair? I brooded. To despair, you should have had knowledge before. You should have gone through the tart sensations of experience, have felt the first flush of knowledge, the first stabs of hope, have encountered reality and toyed with the shifting, tantalizing promises that shadow-play across life's tapestries, have stretched out, first tentative arms, then wildly grasping hands, and have discovered the disappointment of the evanescence of all things that come from the voids to tickle men's fancies, sharpen men's appetites and rouse their futile aspirations, only to vanish back into the voids. Ultimately you should have looked into the face of death and known the paralysing power of fear.

What of all this, could this little monkey know? And, yet, there it all was in those tragic eyes.

Then I thought, ‘So this is kwashiorkor!’ Hitherto, to me, the name had just been another scare-word that had climbed from the dark caves of medical nomenclature to rear its head among decent folk; it had just been another disgusting digit, a clipped statistic that health officials hurled at us reporters, and which we laced our copy with to impress sensation-seeking editors who would fulminate under headlines like KWASHIORKOR AT YOUR DOOR. It had seemed right, then, almost sufficient that we should link it with the other horrors like ‘Infant Mortality’, ‘Living Below the Bread-Line’, ‘The Apathy of the People’ and ‘The Cynical Indifference of the Affluent Society to the Problem’.

But here in this groanless, gloomy room, it seemed indecent to shriek banner headlines when the child, itself, was quiet. It spoke no protest, it offered no resistance.

But while I was romanticizing, my sister was explaining to the old lady how to care for and feed the child, how to prepare and use the skim milk, how often to give it Cod Liver Oil, how often to take it out into the air and the sunlight, how often to take it to the clinic.

Her mistressy voice, now urgent and straining, now clucking and scolding, now anxiously explaining, thinking in English, translating to itself first into Sepedi, begging, stressing, arguing, repeating, repeating, repeating—that restless voice tinkled into my consciousness, bringing me back.

The old lady muttered, ‘I hear you, child, but how can I buy all these things with the R1.50c that's left over each month, and how can I carry this child to the clinic with my creaking bones?’

I was subdued.

‘Well,’ said Eileen later to me as we returned to the bus-stop. ‘Think you've seen bottomless tragedy? I could give you figures for kwashiorkor in Alexandra alone …’

‘Please, Eileen, please.’

My life, a reporter's life, is rather full and hectic, and I am so vortically cast about in the whirlpools of Johannesburg that no single thought, no single experience, however profound, can stay with me for long. A week, two weeks, or less, and the picture of the kwashiorkor baby was jarred out of me, or perhaps lost into the limbo where the psyche hides unpleasant dreams.

Every day during that spell, I had to traffic with the ungodly, the wicked, the unfortunate, the adventurous, the desperate, the outcast and the screwy.

One day, I was in E Court waiting for a rather spectacular theft case to come. I had to sit through the normal run of petty cases. I was bored and fishing inside myself for a worthwhile reverie when suddenly I heard: ‘Maria Mabiletsa! Maria Mabiletsa!’ My presence of mind hurried back.

The prosecutor said, ‘This one is charged with receiving stolen goods, Your Worship.’

A whiteman rose and told the court, ‘Your Worship, I appear for the accused. I. M. Karotsky, of Mendelsohn and Jacobs, Sansouci House, 235 Bree Street.’

The prosecutor asked for an adjournment as ‘other members of the gang are still at large’.

There was a wrangle about bail, but it was refused and the case was adjourned to August 25th.

It jolted me. After my case, I went down to the cells, and there, after sundry buffetings despite the flashing of my Press Card, I managed to see her.

She was sweet; I mean, looked sweet. Of course, now she was a mixture of fear and defiance, but I could see beyond these façades the real simplicity of her.

I do not know how long she had been in the cells, but she was clean and looked groomed. Her hair was stretched back and neatly tied in the ring behind the crown. She had an oval face, eyes intelligent and alive. Her nose stood out with tender nostrils. Her mouth was delicate but now twisted into a bitter scowl, and a slender neck held her head like the stem of a flower. Her skin-colour was chestnut, but like … like … like the inside of my hand. She had a slight figure with pouts for breasts, slight hips, but buttocks rounded enough to insist she was African.

She wore atop a white blouse with frills, and amidships one of those skirts cut like a kilt, hugging her figure intimately and suddenly relenting to flare out.

But now she was importunate. For her all time was little, and lots had to be said quickly. Before I could talk to her she said, ‘Au-boetie, please, my brother, please, go and tell Lefty I'm arrested. Marshall Square maybe No. 4. Tell him to bail me out. I'm Maria Mabiletsa, but Lefty calls me Marix. Please, Au-boetie, please.’

‘Easy Maria,’ I soothed, ‘I know about you. I'm Dave from The Courier.’

Hô-man, Boeta Dave, man. You we know, man. I read The Courier. But, please, Boeta Dave, tell Lefty my troubles, my mother's child.’

A cop was hurrying them away. ‘Come'n, phansi!—down! Phansi!—down!’

‘Please, Au-boetie Dave, don't forget to tell Lefty!’

‘Maria,’ I shouted as she was being rushed off, ‘I've seen Sekgametse, she's well looked after.’

‘Oh!—’

Phansi—down!’ Bang! The iron gates fell with a clangour.

That night I told Eileen. She stared at me with knitted brows for a long time. Then she said, ‘The main thing is not to panic the old lady. Saturday, you and I will have to go there, but don't do or say anything to make her panic. Leave me to do all the talking.’ But I could see Eileen was near panic herself.

Then I went to see Lefty. He was suave, unperturbed, taking all this philosophically.

‘You reporter-boys take everything to head. Relax. You must have rhythm and timing. I've already got Karotsky to look after her and tomorrow Marix will be out. Relax, and have a drink.’

She was not out that tomorrow nor the day after. She had to wait for August 25. Meantime, Saturday came and Eileen and I went to the house in 3rd Avenue, Alexandra. When we got there we found—as they say—‘House To Let’. The old lady had heard about what had happened to Maria; she was faced with debts and the threat of starvation, so she packed her things, took the child, and returned to the reserve in Pietersburg.

The neighbours shrugged their shoulders and said, ‘What could the old lady do?’

Eileen was livid.

‘Dave, do you know what this means?’ she erupted. ‘It means that child is doomed. In the country, they love children, they look after them, they bring them up according to a code and according to what they know, but what they know about the nutrition of children is homicidal and, s'true's God, they live under such conditions of poverty that they may turn cannibals any moment. That's where goes the child I tried to rehabilitate. And when adversity strikes them, when drought comes and the land yields less and less, and the cows' udders dry up, who are the first to go without? The children, those who need the milk most, those who need the proteins, the fats, the oils, the vegetables, the fruit; of the little there is, those who need it most will be the first to go without. There, indeed, they live on mielie-pap and despair. A doctor once told me, Dave, “Kwashiorkor hits hardest between the ages of one and five when protein is needed most and when it's least available to African children.” Least available! Why, Dave, why? Because the ignorant African does not realize that when milk is short, give the children first; when meat is little, give the children first. It's not as if …’ she wailed ‘… it's not as if my over-detribalized self wants to give grown- ups' food to children, but my Sekgametse's sick. I've been trying to coax her back from unnecessary and stupid child-death. Now this.’

Tactlessly, I said, ‘Come now, Eileen, you've done your bit. Go and make your report, you're not a nurse, and in any case you can't solve the whole world's troubles one-out.’

‘The whole world's troubles!’ She spat at me as if I was a child-stealer. ‘I only wanted to save that one child, damn you!’

Of course, she made her social worker's report, and other human problems seized her, and I often wondered later whether she had forgotten her kwashiorkor baby. Once, when I asked her if she had heard anything about the baby, she gave a barbed-wire reply, ‘Outside our jurisdiction.’ It sounded too official to be like Eileen, but I sensed that she felt too raw about it to be anything else than professional, and I held my war within me.

Then I met Maria. It was at a party in Dube, one of those class affairs where thugs and tarts appear in formal dress, and though none of the chicken flew, the liquor flowed.

‘Remember me?’ I asked her in the provocative style in vogue. She screwed her face and wrinkled her nose and said, ‘Don't tell me, don't tell me, I know I know you.’ But strain as hard as she tried, she could not identify me. So in mercy I told her I was the news reporter she once sent to Lefty when she was arrested. It half-registered. I told her my sister was the ‘nurse’ who looked after her Sekgametse. A cloud crossed her brow.

, man, Au-boetie, man, Africans are cruel,’ she moaned. ‘You know, I sent my child to the reserve in Pietersburg, and every month I used to send her nice things until she was the smartest kid in the countryside. Then they bewitched her. Kaffir-poison!’ she said darkly. ‘The child's stomach swelled and swelled with the beast they'd planted in it, until the child died. The Lord God will see those people, mmcwi!’

Viciously, I asked: ‘And did you ever send the child soya beans?’