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Column: Mali’s Most Lethal Enemy Is Its Extreme, Unabating Poverty

Djenne, Mali

Albert Ganou, an unemployed tour guide with an ailing heart, prostrated himself on a thin cotton blanket in his musty room and refused to eat. His limbs swelled. His breath grew shallow. When his pregnant wife and four daughters spoke to him, he could barely whisper back.

Friends pooled money and helped Ganou through the sewage-sluiced snarl of narrow adobe alleys to Djenne’s district hospital, which employs a handful of general practitioners and some nurses. The doctor prescribed painkillers and a salt-free diet. Then night fell and the spongy, low sky dribbled a billion stars over the millennial town, and Ganou died. Men buried him quietly at daybreak in the town’s walled cemetery by the Bani River, where tamarind trees contort their baroque trunks over generations of the dead, and Djenne’s world-celebrated skyline gives way to the immense pale horizons of thorny and flat Sahelian wilderness.

Ganou was in his early 40s. In the postmortem the doctors stated the cause of his death as “heart failure.” They should have written “neglect.”

From time to time, humanitarian crises push Mali into the world’s distracted eye. The latest example is the French intervention to force out of Mali’s north a hodgepodge of radical Salafis, Tuareg rebels and drug traffickers linked to al-Qaida, who had established there a punitive and grotesque theocracy reminiscent of Hieronymous Bosch paintings, keeping order through amputations and lashings. The day Ganou died, French and Malian troops wrested free of the Islamists’ control Kidal, the last insurgent-held city in Mali’s north. Months earlier, three successive coups and counter-coups in Bamako and the simultaneous insurgent expansion in the north briefly grabbed international attention. The year before, drought and famine throttled Mali, and networks broadcast the stereotypical images of Sahel’s dying, bloat-bellied babies — a painful echo of the famines of the mid-1980s, when a million skeletal people wasted away on this hardscrabble, laterite savanna.

The creeping systemic health care crisis that allows Malians like Ganou to perish daily is harder to capture in made-for-TV snippets. Aid workers agree: War notwithstanding, the country is in no outward emergency. There are no throngs of matchstick-limbed children with protruding stomachs, no AIDS victims scooped into shallow graves. Simple poverty makes the problem as endemic as it is routine.

Most Malians cannot afford to seek even perfunctory health care in the country’s limited medical facilities, which, like so much infrastructure in this impoverished country, are propped up by international development organizations and relief groups whose budgets now are stretched extra-thin by the needs of more than 300,000 people who have fled the fighting in the north. Even in peacetime, the country has the second-highest infant mortality rate in the world, after Afghanistan, and 13th-highest death rate overall. One in three children under 5 suffer from chronic malnutrition. Relief workers in Bamako, Mali’s capital, told me this is normal, a habitual, unabating catastrophe.

The calamities fold onto one another, double and triple up, mostly unexamined and unassisted, invisible to the rest of the world. For example, no one can guess how many people will be hungrier, sicker and more destitute than usual because they have welcomed into their homes families of relatives who have run away from the war in the north. Aid organizations expect 660,000 children under 5 to suffer from acute malnutrition this year, one of the aftershocks of last year’s severe food crisis. Since Mali’s impoverished, putschist government is bogged down in its own stalled political process, the burden of providing health care for them will fall on international NGOs. And what about men like Ganou, who could not afford even an electrocardiogram, because the clinic in Djenne has no EKG machines and to reach the nearest one that does, in Mopti, would have cost an unaffordable $150?

Of course, the people of the Sahel have been navigating attenuated resources forever. The 15 million Malians are persevering, bantering in the shade of mosques, watching the Africa Cup of Nations on television sets outside shabby mercantiles at dusk. In Djenne, they share dinner leftovers with neighbors. They parcel out their children among various relatives to avoid starvation. My host here has taken in two.

After Ganou’s widow and children complete the 40 days of mourning, she probably will move into her parents’ crowded and beggared house, and my host probably will take in two of Ganou’s daughters, as well. But doctors haven’t been able to tell him why his own 22-month-old son has been cranky and feverish for more than a week now, despite the malaria medicine and painkillers prescribed by the same district hospital that could offer no succor to Albert Ganou.

Ganou had been ill for a year. His friends say he had a weak heart, but how weak exactly no one can say. It is possible that last February he had a heart attack; but then he got slightly better, even got his wife pregnant. It is possible he had a second heart attack last month, when he suddenly became too frail to move. There was no one in Djenne to diagnose him, no one to recommend treatment, let alone perform surgery.

For the last week of his life, Ganou lay in the stuffy room of his oblique clay house. When friends visited he whispered, sometimes in the English he had learned to guide Western tourists: “I really don’t want to eat,” and “God knows best.”

The day Ganou died, I sat with a primary school teacher of French under a thatch awning in the square before the Grande Mosque of Djenne. The awning belonged to a goldsmith who, like many men here, has been unemployed for two years. Once, Djenne was a center of trade and Islamic learning, and an important resting point for trans-Saharan caravans of salt, slaves and gold. After the great famine of the 1980s, UNESCO designated it a World Heritage Site. Since then, much of the town’s economy has depended on tourism. But tourists stopped coming two years ago, kept away by the combination of the global financial crisis and the fear of kidnappings by Mali’s Islamists. Now much of adult Djenne sits under thatch awnings, stringing together beaded necklaces no one will buy, smoking cigarettes, drinking tea and waiting for better times. They are the parents of perpetually hungry children. They are the adults wasting away invisibly from sickness, like Ganou.

“Everybody here,” said the town mayor, Bomoye Traoré, “is very, very poor.”

Anna Badkhen is the author, most recently, of Afghanistan by Donkey.” Her new book, The World Is a Carpet, comes out in May.