by Hawa Abdi
We represented many of the thirty-three African states that became independent in the 1960s. In our orientation sessions, some of our professors acknowledged the differences in our cultures and urged us to form our own opinions. “Please, don’t hate us,” said one professor. “Take the good things that you find in our life, so you can strengthen your country. The bad things? Leave them.”
From Moscow I was transferred to Kiev, Ukraine, for a yearlong Russian preparatory course in which we repeated every subject—anatomy, biology, chemistry—in the Russian language. Although I wasn’t required to attend classes on atheism and scientific socialism, some of the national practices did get into my muscles and my blood. At five o’clock each morning, when the booming loudspeaker signaled the beginning of calisthenics, my two Ukrainian roommates groaned and pulled their blankets over their heads. I, however, put my feet on the floor, splashed cold water on my face, and followed the voice, which told me to, “Open the window. Take in a deep breath of cold air. Now march in place—one, two, three, four.” I will never forget those arm motions—straight forward, out to the sides, up by the ears, down to the thighs, and then back to the start. Even today, I move this way when I want to feel strength and focus.
Some of my fellow Somali students became involved in politics, making speeches, saying, “My brothers and sisters, we are here today, studying in the Soviet Union. Tomorrow, we will be the leaders of the continent.” Still, I remembered what the professors told us from the beginning: I took what I wanted, and I left the rest. Of course I wanted our country to be built well, whether that was through democracy or socialism; what I most wanted to take with me from the Soviet Union was the work ethic and the respect for science.
CHAPTER TWO
Gold Is Made Beautiful by Fire
By the end of my first month in Digfer’s pediatric department, I began to think that my problem was not with the children. They were very straightforward—if you joked with them while poking and examining them, they laughed; when something hurt, they cried. It was not with all of the parents, either—many were caring and careful, even when the situation was most difficult. My problem was with the privileged people in our society, who had the opportunity for the best medical treatment, but who didn’t seem to have concern for their own sons and daughters. The attitude of a society changes every few years, and I had been away for almost eight. When I left, most of Somalia was in the rural area: When you have a small quantity of goats and cows and a small patch of land, you don’t need anything—you live your life. Now, as more people moved to the urban area, it seemed that everyone wanted money and power.
When I was making rounds one day, I walked by a bodyguard standing outside one of the examining rooms. I entered the room later to find a two-year-old child who was convulsing, suffering from a fever of almost 104 degrees. I feared it was meningitis, or maybe another disease just as damaging.
The security guard, I learned, was for the child’s mother—the wife of a Somali minister. She was dressed beautifully and expensively, and wearing heavy makeup. How could she take the time to dress like this, to make herself look so desirable, while her child suffered beside her? Had she dressed this way for her husband, whom she feared was out with his friends, or maybe another wife? Children without a parent’s attention, I knew, were living in an empty vacuum. “You are doing your makeup when the child is in this situation?” I couldn’t help shouting in disbelief. “You are not a responsible mother.”
“Ha, what? What did you say?” She shouted back at me, not expecting such a reaction from a doctor.
I touched the child’s hot skin again, feeling more anger coming up into my chest, from a place too deep to explain. What would become of the child, born to such a careless woman? “You don’t want me to tell you these things?” I asked her, stepping back from the table. “This child is seriously ill. Why should I treat your child if you can’t care for him yourself?”
“You cannot talk to me this way,” she shouted back as the child wailed. I saw the bodyguard come into the room and walked by him; in the hallway I passed one of the pediatric nurses, who raised her eyebrows. “We need another doctor for the child in there,” I told her on my way to the break room, where I poured myself a cup of tea. Mohamed Ali Nur appeared in the doorway a few minutes later. “You have to treat this child,” he said. From the look on his face, he must have heard that his new doctor was trying to kick out the mother of a sick patient.
“Let someone else do it,” I said. “That woman is irresponsible.”
“You don’t know anything about this woman,” he said. “Your only job is to treat the patient that is in front of you.” When I continued to argue, he pulled out a chair and sat down at the table, facing me. “Tell me your complaints,” he said.
“Just because she’s the wife of some high-level official man doesn’t meant she can do whatever she wants,” I said. “I want to teach her a lesson.”
“When you wear a white coat, people appreciate you—they see that you are the highest class,” Mohamed Ali Nur said. “They are seeking from you health—the most important thing that a human being can seek.” It was not for me to say whether it was right for me to treat one child over thousands of others, he said.
Though I resisted, he finally convinced me to go back and treat the child. “Focus on him, so the mother will trust you again,” he said. “But watch what you say to her: The right approach to a patient is as important as the medicine you use.”
When I returned to the room, I did my best to treat the child as though he were my own and the mother as though she were a stranger. I admit that it was uncomfortable for me to work in this way, putting aside my own opinion and listening only to the needs of the body. The child eventually became healthy, but I believe that I was the one most changed by the experience. From that moment on, I would focus on the patient, rather than on the situation.
In medical school, our success or failure was entirely in our own hands: If I didn’t go to my lesson, for example, I would be forced to repeat it. If I didn’t clean my room, I would be judged using the same scale as the one that graded my aptitude for language and history. Everything that we students did or said was measured: A grade 5 was excellent. Good 4, satisfactory 3. We were told that a 3 meant that you didn’t want to study, and if you didn’t want to study, you would be sent back to your country.
One day, in my internal medicine class, I was asked a question, and I didn’t know the answer. “You see Hawa before you? Her government sent her to study,” said my professor, Petrov, as I stood awkwardly before the entire class. “Hawa, if you don’t want to study, why did you come here?”
I went home that afternoon and cried, thinking of the hard road I had taken to get to medical school and the sacrifice I had made by leaving my family far behind. Petrov’s harsh words echoed in my ears that night as I stayed up, bent over my textbook, reviewing the same lesson again.
“Why did you come here if you don’t want to study?” My reading lamp heated up my shoulder, burning down to my book as the clock read three, and then four. “Go back! Don’t cheat your government, don’t cheat us.”
My eyes had not closed for a moment by the time calisthenics began. On my way back to class, I took a cardigan from my closet, buttoning it as I ran for the bus. A fat old Russian woman passed me on the street and yelled, “Stoy! Stop! Why are you doing these things?”
She poked her finger to my chest, and I saw that the pullover wasn’t buttoned correctly—the top of the wool sweater flapped up on the right, while on the bottom, the left-hand side hung lower.
“Don’t you have a mother?” the old woman asked me.
“My mother is dead,” I told her.
“Oh my God,” she said. “Bo-zeh moy. I’m sorry. Where did you come from?”
“I’m from Somalia,” I said.
“Correct your buttons and go straight like that,” said the old woman as I fumbled. “Not like this, no.” Finally, after a struggle, I dropped
my hands as she took the sides of the cardigan, correcting the buttons herself. Then I went on to class, where this time, Petrov was satisfied by my response.
Like Petrov, like the old woman, the people of Ukraine felt responsible for our well-being; they wanted to see us walking straight and performing well. Having lived through the World Wars, having seen so much trouble in their lives, they were unafraid to ask a harsh question of skinny young foreign students like me. Sometimes their words were like sticks, beating us—very difficult, very painful—but they wanted to understand our purpose and our hopes for visiting their country. At first, I hated Petrov, but now, looking back, I can see how I loved him.
Some of my colleagues in the hospital didn’t appreciate the strict and honest philosophy I’d brought with me from the Soviet Union. “Hawa is very hot,” they said. I didn’t care that I wasn’t liked then; I only saw the goal in front of me. One day a very malnourished child was brought to the emergency room with severe dehydration from watery diarrhea. Although he was eighteen months old, he was so malnourished that he looked much younger. He was semiconscious; his eyes were open and completely dry. I walked up to the examining table, but was stopped by the pediatric nurse who had been watching him. “Dottoressa, this child is dying,” she said. “You should leave him with me and focus on a different case.”
For the first time in my career, I made a decision alone—to stay. I worked swiftly, steadying the child in my hands, which seemed so strong compared to his tiny body. I examined his small arms for a place to put in an IV, but he was so dehydrated, it was impossible. I soothed the child as I made a small incision into his skin, found a small vein, made another incision, and inserted into the vein a small, small plastic tube. I made a few sutures around it, and put some plastic over his arm to protect it. I felt the eyes of the nurse and two other doctors, and the fears of the boy’s parents, as a hydration solution flowed into his veins.
An hour later, the child’s eyes became wet, and he became more active, crying and thrashing as his mother steadied him. She cried as well, and when I came back later to check on them, she thanked me for saving her son.
The Russians say that gold is made more beautiful by fire. Over time, I began to love pediatrics. You see a mother and a father, who are so sad when their child is sick. If you can help that child, you can feel the parents’ happiness coming to you.
CHAPTER THREE
To Stop the Bleeding
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.