I Am a Girl from Africa

by Elizabeth Nyamayaro

  “It is very upsetting, you know. My sister didn’t deserve to die,” Ana says, and I can see the pain swallow the youthful sparkle of her eyes. “When she went into labor, she didn’t have enough money to go to hospital. She was forced to labor at home and bled to death, killing herself and the baby. She was only twenty years old, you know.”

  “The government doesn’t care about us. Everything is too expensive: the hospital, the medicine, the treatment, everything,” Elene chimes in, her voice heated.

  I think about the death of Gogo and how losing her has changed everything. I felt so lost in the world without her. Her death and Julia’s before her prompted me to reevaluate my life and purpose. One early morning, unable to sleep, I stood in the kitchen holding a cup of peppermint tea and thought, Gogo and Julia are gone But I’m still here. I wanted to do more, to make more of a difference for others in their honor. I enrolled at the London School of Economics and Political Science (LSE), which would have been impossible a few years before. My degree at the London College was the stepping stone for a master’s degree in Political Science at this prestigious school, and this education eventually led to a position at the World Bank, where I work now, in 2009. Based in Washington, DC, I am part of a small pharmaceutical policy team charged with ensuring that underserved communities around the world—like Ana’s and Elena’s—have access to affordable healthcare services and lifesaving medicine. I report directly to the head of the unit, Dr. Andreas Seiter, a tall, efficient German man with a serious, angular face and wispy blond hair, and in my role I support governments around the world in developing pharmaceutical policies to improve the availability, affordability, acceptability, and utilization of essential medicines.

  Yesterday, on the car ride toward the Tbilisi city center, Ana, acting as my local Georgian translator, said, “We have the best hospitality in the world, because the word Tbilisi comes from the old Georgian word Tpili, which means ‘warm.’ ” She invited me to have dinner at her home, which I happily accepted: spending time with the people the humanitarian programs are designed to serve is the best part of my job. When I am with the people—hearing their stories, listening to their fears and dreams and ambitions and struggles—I experience the same feeling of community and deeply shared humanity that I knew growing up in Zimbabwe. Visiting people in their homes and having frank conversations, witnessing how they live and seeing the intimacies of their day-to-day lives—all create opportunities to learn about the real issues impacting ordinary citizens. It is on the ground, in the field, in homes and kitchens and community centers, where I can see firsthand what’s at stake, and what’s working and what needs to be changed. All of this is completely different from the other aspects of my job, which include highly sensitive diplomatic negotiations in official meetings; talking to government bureaucrats and other power brokers; and developing policy recommendations to create systematic and structural change. Here, with the people, is where my heart lives and belongs, and what motivates me to do the other part of my work.

  Elene stops eating, places her bowl of soup on the floor, and continues, “I lost my son three months after he was born. He had a rare heart disease, and my husband and I couldn’t afford the surgery which could have saved his life. There is not a day that goes by when I don’t blame myself for failing to save my own son.” She looks suddenly pained, her face hollowed out by grief, as if the loss happened just the day before.

  As Elene blinks back tears and Ana puts a comforting hand on her friend’s back, my head begins to spin with emotions and ideas. Elene and Ana are only two of so many others who suffer globally from lack of access to healthcare and lifesaving medicine.

  I heard so many stories in so many countries during my time working for and traveling on behalf of WHO, the largest institution of its kind in the world. What I learned is that access to healthcare is not just a problem in what are often referred to as “developing countries” in Africa, Eastern Europe, Latin and South America, as well as parts of the Middle East and Asia. Health inequality exists everywhere, on every continent—even in countries with great wealth, like the United States.

  In Chicago, Tina, a young college student, explained that “there are the ‘haves’ and the ‘have-nots.’ I mean, us African-Americans are often seen as the have-nots because we can’t afford healthcare. It is almost as if our lives are valued less; as if we are expected to feel less pain.” When Tina rushed her mother to an emergency room at the nearest hospital, she never expected that it would be the last time she saw her. “My mother was having complications with her breathing due to high blood pressure. I mean, we sat in the ER for four hours, and every time I went up to the counter to ask for assistance, the nurse told me to sit down and wait to be called. I mean, hours went by and they never called us, and during that time I saw them attend to other patients who were clearly the ‘haves.’ They knew that my mother didn’t have private health insurance, and so we were not a priority. At one point the nurse even snapped at my mother and told her to ‘control’ herself as she groaned in agony on the floor. I mean, can you even believe that?” Tina pauses, and then says, “Eventually my mother drew her last breath and died right there on the cold ER floor, clutching my hand. I had just turned eighteen and still blame myself for not having been more forceful with the nurse. I mean, can you imagine that we were just right there inside a hospital, a place that was supposed to save my mother’s life, but instead took her life?” Tina’s voice was hollow with pain. No, I couldn’t imagine losing a parent under such circumstances. Tina’s mother had died not because there were no healthcare facilities close by, or because medicine didn’t exist that could treat her condition; it wasn’t an issue of not having qualified healthcare specialists, as is sometimes the case in rural hospitals and clinics in the developing world. No, Tina’s mother died a terrible death because she was a disadvantaged woman of color. She died because she didn’t have access to the resources that should be available to all people.

  Her story was painful to hear, and I knew as I opened my mouth to say the same thing I had said over and over again to numerous grieving families—“I am so sorry for your loss”—that as heartfelt as my words might be, they were both too late and fell drastically short of what Tina and her mother deserved.

  All across the African continent, I witnessed people’s unbearable suffering from treatable diseases like malaria, cholera, and measles, despite the availability of safe and effective medicine. In the Republic of the Congo, a francophone county in central Africa with a population of five million, I spoke with a bereaved father, Tony, two of whose children had died from measles. He explained, “Huhhh, this one is very-very difficult, my sister. We have enough money for food or for medicine, but not for both. When the children got sick, we had to choose. I said okay, is it better to buy food, but then they die from disease? Or it is better to buy medicine, but then my five children die from hunger? God knows, my sister, that is not a choice, that is a punishment,” Tony said, sadness consuming his eyes. I exhaled and searched for the right words to say. “I am so sorry for your loss, Tony,” I said, remembering how a South African economist had once described it to me: “The situation is dire. Most developing countries, including here in Africa, don’t have price regulation policies in place for pharmaceutical products, and as a result the cost of medicine is now the second largest expenditure after food for most African families.” Tony’s was one of those many families impacted, and choosing between food and medicine, as he pointed out, is not a choice, it is a punishment—one that no parent or person should have to endure.

  * * *

  I stop eating my soup now and look up at the sad, drawn faces of Ana and Elene. “I am so sorry for both of your losses,” I say, getting choked up, knowing full well that just like Tina, Tony, and many others, Ana and Elene weren’t looking for my sympathy; what they wanted, what they all deserved, was equal access to healthcare services for themselves and their families.

  I feel determined to set
right the health inequality that led to Ana and Elene’s great suffering and grief. I know I must do more, just as my aunt Jane always endeavored to do more at the HIV/AIDS clinics in Zimbabwe, where she worked tirelessly to alleviate the suffering of her patients, especially those in impoverished areas like Epworth. I explain to Ana and Elene that my work here in Georgia on behalf of the World Bank is to support their government in providing accessible healthcare to all Georgians. Three years ago, the World Bank helped the government of Georgia launch a medical insurance program for impoverished and underserved communities. My job over the next five days is to evaluate the impact of this program, to measure its successes and failures. “Hopefully our work will be able to create meaningful change and save people’s lives, here in Georgia,” I explain to Ana and Elene. They nod, but of course any of these changes are too late to save Ana’s sister or Elene’s child. Those losses, as I know far too well, are forever.

  When I finally meet with the Georgian government officials the following day, they tell me they are making significant progress. However, my visits to communities over the course of the week paint a slightly different story, one not in keeping with the official report. For example, I learn that medicine is still too expensive for most Georgians. “We self-medicate with cheap, unsafe medicine that we find on the black market, which is dangerous, but we feel we have no choice,” I’m told. At Tbilisi Central Hospital patients express a similar concern—that even when they are admitted to the hospital, they still can’t afford the medicine. The physicians I talk with are equally frustrated, citing long hours and old hospital equipment as unsustainable conditions of care. Clearly, more must be done.

  As I depart Georgia, the heartbreaking stories from all the people I met stay with me. It is clear that there is much more that the government needs to do to accelerate progress. The idea of risking one’s life with counterfeit medicine in order to try and save one’s life is unjust and unnecessary. It is heartrending to realize that most of the medical tragedies that impact ordinary Georgians every single day reflect the continuing disparities in healthcare globally.

  As soon as I am back in Washington, DC, I make recommendations to Dr. Seiter. I advocate for the allocation of more resources to the government of Georgia in support of the rapid scaling of the medical insurance program.

  Dr. Seiter is not afraid to challenge the status quo and demand that systems do more, or at least make an ardent attempt. Just after he hired me, during our first weekly meeting, he said, “Every citizen deserves the right to affordable and quality healthcare services, ja. Equally, those in the developing world must have access to the same quality medication and healthcare services as those in the developed world. Ja, this is fair. Even if it means naming and shaming governments to deliver those services.”

  After my experiences in Georgia, I lean into Dr. Seiter’s passion to create change and make a plea on behalf of Ana, Elene, and the many women and girls in similar positions. “The new system needs to work for women, which is currently not the case. We must invest more funds and work closely with the government to ensure universal provision of free reproductive health services to all women in Georgia as part of the country’s new insurance program,” I suggest as part of my recommendation. Over the next three years, the government of Georgia, with the support of the World Bank, makes huge investments to improve the quality of neonatal care; more than 750,000 Georgians are able to access healthcare as part of the medical insurance program; and policies are put in place to ensure access to quality and safe medicine, with the country eventually expanding its insurance program to all Georgians, even covering drug purchases.

  * * *

  Shortly after my return from Georgia, I learn that one of our World Bank partners in the private sector has announced the establishment of a philanthropic initiative that will invest half a billion dollars toward combating maternal mortality globally. And it is desperately needed, as the statistics are alarming: one woman dies every two minutes from complications related to pregnancy and childbirth globally. Knowing that more than half of these deaths occur in Sub-Saharan Africa alone is devastating to me, and I know I must find a way to advocate for my home continent in the crucial distribution of these resources. I join the team as director of external affairs and policy for Africa, traveling to several African nations, meeting with communities and government leaders to identify countries with the greatest needs. I am energized, but also troubled; as we visit each country the story remains the same: there simply aren’t enough affordable and accessible healthcare services to meet the demands of citizens or prevent maternal mortality.

  * * *

  In Zambia, a southern African country bordering Zimbabwe, I travel to a small town, Mumbwa, in the Central Province, three hours from Lusaka, the vibrant capital city. During community meetings with women’s groups, I hear about the challenges faced by women within the country’s limited healthcare infrastructure. “Us, we are suffering, my sister. Sometimes we have to walk for ten hours to find a clinic while in labor with our child. And then when we get there, we can’t even find a midwife,” they tell me.

  At one of the local clinics, Grace, a nurse, says, “Eeee, my sister, one of the biggest challenges in our village is maternal and child mortality. There is a lot of teenage pregnancy, which as you know is causing many young mothers and their children to die. I have witnessed girls die from complications during delivery because their bodies aren’t strong enough; some bleed to death, some have obstructed labor, some end up with life-threatening infections post-delivery.” Grace pauses; she looks sorrowful and tired. “Eeee, my sister it is hard; even the girls who make it, sometimes their babies die of illness, or because the young mothers don’t know how to take care of them, or they are so poor that they have no food to feed them.” As I listen to Grace recount story after story of young children dying, I am reminded of the fact that even though the world has made remarkable progress in child survival in the past few decades, over five million children under the age of five still die annually, with half of those deaths occurring in Sub-Saharan Africa. I almost became one of those statistics myself.

  * * *

  The first time Gogo saved my life, I was only a year old. Amai had abandoned me with Gogo when she ran away from the village with Baba. Gogo says I was so malnourished that death came looking for me. Death, she said, made my head swell until it was the size of a large pumpkin; my arms and legs looked tiny-tiny, like baby tree twigs in the bush. Death made my liver big-big until my belly looked like it was about to explode and a burning rash covered my entire body.

  Panicked, Gogo threw me on her back and trekked to the nearest clinic. By the time she arrived, I was extremely weak. I could no longer open my eyes or respond to Gogo’s words. When the clinic nurse saw me, she burst out crying. “Huhhh, you are too late, Gogo. The child is no longer with us.” Gogo did not cry and she did not flinch. Instead, she stared at the nurse and said, “Nurse, please give me medicine.”

  The nurse shook her head. “Uuuu, it is too late. The medicine will not work. The child has severe kwashiorkor [acute malnourishment].” Gogo said nothing, but her eyes filled with tears. The nurse placed a comforting hand on Gogo’s back and said, “Gogo, please take the child back home. Please pray for the safe return of her young soul back to the heavenly father.”

  Gogo stared at my nearly lifeless body, lying so still in her arms. Her tears cleansed my face, blessing me with her pain. “Nurse, please give me food for my dear child, please,” Gogo begged. The nurse looked down and said, “The food is too expensive, Gogo.”

  Gogo did not have any money. She felt so ashamed for not having the money that she needed to buy the food that would save me, her dear child. Gogo had only ever begged God, but never a person, never like this. This time, she was desperate. This time, her spirit was broken. This time, she knew what she had to do to save my life. And so she begged. She hung her head down and looked at the ground. “I am begging you, Nurse. Please help me.”
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  The nurse saw Gogo’s shame and felt ashamed herself for having any part in creating it. She went inside the clinic and returned quickly with a bottle of powdered milk mixed with water; she handed the feeding bottle to Gogo.

  “Thank you, Nurse. May God bless you,” Gogo said, her head still hanging low.

  Gogo never made it back to the village that night. Instead, she slept underneath a tree when night fell, afraid of disturbing the lions in the forest with her movement. That night, Gogo prayed, but she did not pray for my young soul’s departure to the heavenly father as the nurse had suggested. Instead, she prayed for a miracle, and God answered her prayer. God opened up the heavens and it rained all night, blessing us with his tears. As soon as she got back to the village, Gogo went to every ambuya’s home, asking for extra food to feed her dear child. People gave generously, and the kwashiorkor, which would have stunted my growth and learning abilities, was stopped in its tracks. With love and determination, Gogo nursed me back to health. With the help of everyone in our community who gave when they were asked to give, in the spirit of ubuntu, she chased away death, and I survived. I lived because my community committed to uplifting one another, even in the most difficult and life-threatening situations.

  * * *

  In 2012, I return to Zambia after many months of hard work crafting legacy projects for the maternal mortality initiative. It is winter in Lusaka, and the air is crisp, but nowhere near as brutal as the winters in Switzerland, where the wind from the Alps makes the cold settle deeply in your bones. Together with my colleagues, the delegates of our donor partners from the United States and Norwegian governments, as well as the Zambian government delegates, we are launching our inaugural pilot project, Saving Mothers, Giving Life, a five-year public-private partnership aimed at dramatically reducing maternal and newborn mortality in Sub-Saharan African countries.