My return late yesterday from Arusha to Bacho left me to do a lot of catching up, since Marianne had kept busy all day with meetings. We decided right away not to worry about bringing the other three hundred forty-five mosquito nets to the village until we get back to the U.S. in twelve days. We had wanted all six hundred forty nets immediately, but from here we have no way of quickly accessing the Karimu funds stored in our California bank.
One of Marianne’s meetings had included Dr. Susan Hughmanick, a gynecologist. They met with the village midwife, the tall, regal Veronika Mosha, whose knowledge impressed Susan. Susan wanted to know how women undergoing childbirth emergencies reach the nearest hospital, several miles away. Too far to walk under the circumstances but a drive of no more than ten minutes on a paved road—merely a dream around here, of course. The news disturbed us: once somebody in the village with a cellphone calls for a car, it usually takes over twenty minutes to arrive, then at least that long to get to the hospital. Most drivers will charge sixteen thousand Tanzanian shillings or about eleven American dollars, which comes to better than two weeks’ wages for somebody living on under a dollar a day. Bad luck can bring a driver who charges twice that amount.
How shall we address this? We thought of creating a fund, maintained in the village, for paying the drivers. But this would bring the drivers no closer and, once they got wind of the fund, could even encourage them to raise their prices. We thought of buying the village a four-by-four, but wondered about the difficulty of maintaining it in a place as remote as Bacho. How far would spare parts need to travel to get there? And we thought of a bicycle-ambulance—or even a fleet of them because of their affordability—for which the villagers could also find other uses besides answering medical emergencies. However, a bicycle-ambulance would find the roads impassable during the rainy season.
So the four-by-four option looks most plausible to me as long as we can solve the maintenance problem—and raise the money, which I don’t take for granted. By next year we might see the road from Babati, most likely a good enough source for spare parts, paved all the way to nearby Dareda. Yet then we would need who figure out who in Bacho can drive a four-by-four, never mind work on one. Given the total absence of cars and trucks there, maybe Bacho has neither a driver nor a mechanic. But now I think I’ve started inventing obstacles to cover my worries about raising the money for a four-by-four. That challenge, the real one, renders these other concerns moot.
Veronika also told Susan and Marianne that female circumcision or genital cutting, whose presence we knew of, occurs far more often than we had thought. It affects almost every woman over eighteen in the village, according to Veronika. She said that at one time the Tanzanian government had waged a vigorous campaign against the practice in the villages, before relaxing its efforts in recent years. This failure, though disappointing, should not come as a surprise. Coercive efforts to end genital cutting, dating back at least to Britain’s postwar campaign in pre-independence Sudan, have a history of forcing the practice underground and thereby making it harder to eradicate. In 1946 the revolutionary Muslim thinker Mahmoud Mohamed Taha, publicly executed four decades later by Sudan’s harsh Islamist government, warned the British that forbidding the extreme form of genital cutting called “pharaonic circumcision” would serve to identify the practice with resistance to a despised colonial regime and thus end up harming more women than it helped.
Although the colonial regimes left Africa long ago, any government popularly thought distant and unhelpful—more or less the norm in sub-Saharan Africa—will provoke a backlash when citizens watch it meddle in their intimate lives. As the anthropologist Ellen Gruenbaum, author of The Female Circumcision Controversy, points out, one “will not change people’s minds by preaching to them or telling them they are primitive. They undertake the risks for reasons important to them.”
Veronika seemed to know all the risks, or those linked to pregnancy and childbirth, anyway: vaginal or urinary-tract infections that can contribute to miscarriage, higher likelihood of chronic pelvic infections leading to infertility (“a socially disastrous condition throughout the regions where circumcision is practiced,” Gruenbaum notes), and life-threatening obstructed labor. In the latter case, the need to cut inelastic vulval scar tissue to permit delivery, a formidable challenge even for the most skilled midwives, poses significant risk of death for women in childbirth throughout much of rural Africa.
We don’t yet understand the reasons, important to them, behind the willingness of elder village women who do the cutting to impose such risks on the young. We could of course pretend to understand by applying a general model of a patriarchal Africa, prefabricated in rich countries, to the particular lives of Bacho’s Iraq people. But this suggestion deconstructs itself and implies that we—or Susan and Marianne and not me, for obvious reasons—should take the time to talk more to Veronika and the other women of Bacho.
Unfortunately, Susan and Marianne might have no more time this year and then they will return to California and the women of Bacho will stay right here and they’re not on Facebook. So for now I don’t know how, or whether, Karimu can reduce genital cutting in Bacho, although we want to. Still, I know that its prevalence creates greater urgency for swift transport of women in childbirth to the hospital. Therefore as much as the difficulty of raising the money tempts me to do so, I can’t quite let go of the idea that we may want to supply Bacho with a four-by-four.—Don Stoll