by Geoffrey Clarfield (December 2012)
Elizabeth was born in 1964. She is a tall, high cheek boned Shona speaking daughter of farmers in the central plateau area of Zimbabwe. To get to her house you walk five kilometers from the nearest city centre. Her one room house beside the beehive kitchen/reception room is set among green farms and rocky brown outcrops, streaked with dark black lines and perforated with tufts of trees. Chickens and chicks run around her compound. That is her “income generating project” as it is labeled in development jargon, as she farms about four acres with maize and vegetables, some which will be eaten and some which will be sold in the local market.
As a young girl she started school at the age of seven. Her parents are still alive. She is the first born of eight children, five from “one stomach” (that is one mother) and three from the “other stomach.” Her father has two wives. She would not say, but it is possible that as she is the first born and that is why her father sent her to school.
She managed to finish seven years at the Howard Primary school and she speaks basic English well. She remembers that she liked to learn but had to stop because there was not enough money for school fees. She tells us that to go to school she would wake up at four, while the stars were still out. She would help her mother prepare breakfast for the younger children and depending on the time of year, she would also work the fields. Then she would walk to school. She fondly remembers that period of life.
The next three years were spent on her family farm and then she was married. She had four children from her first husband who died in 1996, “of a cough”, she says, probably of heart failure. When I ask myself what I was doing in 1996 I think; working for a scientific institute, writing proposals, raising two boys and paying off my mortgage. Elizabeth was contemplating her future as a single peasant farmer mother of four but who luckily had some land, supportive brothers and sisters and a roof over her head.
By two thousand and four Elizabeth had a partner. She soon discovered that she was pregnant. During a routine visit to the local mission hospital she discovered that she would be having twin boys. The only problem was that they would be born conjoined, what we used to call Siamese twins. When her partner heard the news he disappeared, leaving her to her fate. As they were not officially married there was nothing any authority, either civil or religious could do. Such is the nature of individual freedoms in a developing African country where traditional communal solidarity is weakened by social change.
When Shona women suspect a birth abnormality they often deliver at home and then decide to let the child die or, help it live. In the past, all albinos were left to die as were one of any two twins. One twin would be put in a traditional pot near the river and left until it was sure that he or she had passed on. Elizabeth could not give birth at home and so was taken to the local missionary hospital. There she gave birth to two boys named Tinotenda and Tinashe.
It is said that one gave nourishment to the other and one flourished while the other did not. Eventually, such an unequal sharing of joint life fluids would lead to their deaths. Luckily a Canadian Jewish medical resident that worked with a Jewish NGO in Toronto was at the Howard during the ultrasound diagnosis of conjoined twins and during the twins’ birth. She and the resident Chief Medical Officer, Paul Thistle, a Christian missionary (Salvation Army) from Toronto began to implement the complex bureaucratic mechanisms that would take the twins, their mother Elizabeth and a bubbly and somewhat urbane Shona nurse named Grace Chirinda, to the Sick Kid’s hospital in Toronto for an operation that separated the twins and gave them a new lease on life. After the operation the Canadian papers were filled with dramatic and emotional stories about this miracle surgery, how it saved the boys life and also saved their mother from certain tragedy. It was a great piece of PR for the hospital, less so for the NGO that had committed so much time and resources to get the mother to Toronto in the first place.
As we sat in Elizabeth’s compound and watched the chickens being chased by a young boy we noticed that she smiled more than when she had been in Toronto. She told us that she did not miss the cold one bit, not at all. She was happy to be in her house, on her farm, among her people but, she added that she did not miss Shona in Toronto because there were many Zimbabweans there. She regretted that the local name for the last three years in Shona means “war over land” and if you read news of Zimbabwe you will know what she means. On the positive side she said that there have been years of hunger but that was now in the past. The twins squirmed in her arms, wanted to get down and we realized that our visit was coming to an end.
Elizabeth was one of the lucky ones. She was assisted by visiting doctors from abroad with connections and access to resources. One immediately asks, “Why could this not be done in, Zimbabwe? Are there not the necessary facilities and doctors to do such an operation? If not, why not?”
The answers to these questions are not medical. In the short term they are economic, in the medium term they are political, in the long term they are cultural and they lead to complex arguments about the nature of technological advance, public health and citizens rights to treatment. While it is now common wisdom to argue that all citizens have rights, most governments in the world act as if they have no obligations other than hostility towards neighbouring countries and indifference towards the needs of their citizens. This is and remains the context for most of what call “international development.” Not surprisingly it is one of the most contentious issues of the early 21st century.
Geoffrey Clarfield is an anthropologist at large.
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