Hamale’s sister Maryamu is the first to cry. She’s only nine and has none of the shame at tears that comes with age. Her soft, tentative sobs echo around the dead-silent compound  much louder than they should,  as the grown women gathered around the hut stare ahead, at anything, at nothing.  And I know, in Maryamu’s cries, that we’ve lost him.

Hamale’s grandmother arrives, her wise, aged face all but obscured in a shawl tied tightly underneath her chin. She was the last to see him, having taken his fragile body in her arms, held him tightly in the long hours it took to get him to the hospital, far too late. She sits down on the wooden plank next to the hut’s door, and everyone is silent, waiting. Even Maryamu’s sobs have quieted.

The old woman lets out the first real cry, a high pitched wail, and that is all the signal the women need– they are permitted to cry at a death, and it is dignified to do so, as a community of women, together. Soon all the women of Sekoya, the girls, and a few of the smallest, toddler boys  (confused and displeased at this sudden  and rare display of sorrow) have joined in the cacophony, their tears falling and their wails echoing up into the sky, gray and cloudy from last night’s rain. Cries for Hamale, who wasn’t ready to die.

From the first time I saw him in village, Hamale was small and sickly. His mother had died shortly after delivering him, of complications that might have been avoided had she received medical attention during birth. Here, a motherless child automatically has a more difficult road to health ahead of him, since substitutes to breast milk are too expensive, unavailable in most places, and difficult to keep under good hygienic conditions. Motherless children are usually the fastest to become malnourished, the quickest to fall sick with malaria or infections, and the most difficult to treat. Early on, Hamale showed signs that even with his grandmother doing her best to nurse him, he wasn’t thriving, wasn’t growing as he should. The caramel colored baby had his mother’s eyes, which peered out from in increasingly thin and bony face, and always had an anxious, listless quality. He cried constantly, a soft whimper that became a howl when someone moved him too quickly . It seemed that the only time he would cease crying was with his small body wrapped tightly to his grandmother’s back. He had a brother of about the same age (with his father’s second wife), named Hakana, and Hamale could only sit and watch as Hakana reached all the normal milestones of the first year of life–crawling around, pulling himself up, finally walking. Hamale’s body was already wasting, and he didn’t have the strength to play along with his brother. Hakana would grab a ladle from his mother’s hands and spill porridge all over the ground, giggle, take off his clothes, hit his big sister, and all the normal mischief a growing child should be able to get into. Hamale did none of these things, always sitting, watching, looking nervous, scared.

All the signs were there. Hamale had been to the health center, a few times. We’d given his grandmother meal supplements and special, enriched peanut butter that helps undernourished kids to gain weight. We’d given his grandmother advice about feedings and asked her to continue to bring him in for weighings, for monitoring. He wasn’t getting dramatically worse, but he certainly wasn’t getting better–his weight had reached a plateau despite these efforts. A visiting doctor doing quality control for a vaccination campaign happened to notice Hamale on his rounds in the village, and asked the manager of my health center to talk to the family and convince them of the need to send Hamale to the district hospital for intensive feedings and special treatment.

The family decision maker was not Hamale’s father, but rather his brother, my host father. As the only person with any sort of income in the family and thus the one with control over all funds, the decision to send Hamale for treatment was his and his alone. The health center staff paid a visit to their compound, explaining the severe state of Hamale’s illness and the necessity of treatment at the hospital–he simply wasn’t going to get better staying in the village, no matter how much they tried to feed him.

And yet, for reasons I am still struggling to understand, my host father stalled. Two, three, four, five days passed, and Hamale still had not been sent to Bafoulabe. It was not an issue of money, not for a school headmaster with enough money for a moto and to send all his children to school. As I listen to the women’s cries, I contemplate what made him wait. Did he believe, erroneously, that Hamale could recover without going all the way to the big hospital? Or, and this is a possibility I simply don’t want to accept, did he think that, because his mother was gone, Hamale would always have some sort of curse, would never find health,  would be a drain on the family’s resources? I don’t know, I can’t know…

It was nearly a week after the doctor’s visit when I finally got up the courage to appeal to my host father on  Hamale’s behalf. In that week, his grandmother had brought him to the health center again, exhausted, overwhelmed, and worried–Hamale had stopped eating entirely. He wouldn’t eat porridge, he wouldn’t eat the enriched peanut butter, and now he was refusing even breast milk. Afraid of what would happen if we waited any longer, I talked with my father that afternoon, prepared to offer to take Hamale myself if he had excuses as to why he couldn’t. He assured me that Hamale would be going to Bafoulabe the next morning in the first car they could find going that way, and I slept a little easier knowing that he’d come around, that Hamale would be receiving treatment.

He did go to Bafoulabe, and he did receive treatment. But for Hamale, as for so many babies and young children in this country, it was too little, too late. After a day and a half in the malnutrition unit of the district hospital, Hamale passed away in the early hours of the morning,  with his grandmother his only companion. By the time the news reached Marena, she was already on her way back to the village, this time empty-handed and brokenhearted.

And now she leads the old women in their prayer-cries, sharing the sorrow of  losing the child she fought so hard to nourish, to keep alive, with others in the village, many of whom have had the experience of losing at least one child themselves. But my thoughts have turned to the circumstances. What if Hamale had gotten to the hospital soon after the doctor saw him? Maybe he would have had a chance. Maybe he’d be alive.

And the tougher questions: what made my host father choose to wait? And why didn’t I push him more to make a decision? The doctor tells me afterwards that we’d done everything we could, that in the end the family has to make a conscious choice to treat their child, and that we can’t make that choice for them. That may be true, but I’m not entirely convinced we couldn’t have done more, that we couldn’t have been more persistent. Though I remind myself that fatalism, apathy and mistrust sometimes placed on modern medicine are significant barriers that cannot be overcome by one person’s efforts, the loss of Hamale nags at me, as do the tears that roll down Maryamu’s cheeks as she sits in the doorway of the empty hut, the same place she used to sit with Hamale , bouncing his small body on her hip, trying to get him to laugh.

There were many deaths in my village over this past year, and not a few of small children. But Hamale’s touched me. This family is my family. I’ve shared times of joy, baptisms and births and homecomings and religious holidays with them. And now, the sorrow that they feel sitting under this grey-blue sky is mine too. It fills me as it fills them.

Before I even realize it, tears are falling from my eyes.

Ala ka Hamale dayoro suma, Ala k’a somogow tooro dogoya.

May God cool Hamale’s final resting place and ease his family’s pain