Maggie O’Kane in Niger
They are sitting in a corner of the hospital, shaded by their compound wall. She is three years old, with dark, dusty ringlets and a buttercup yellow dress with faded pink tulips. They are on a wicker mat, apart from the others, him rubbing her shoulders and smoothing her hair.
The sieve-maker’s daughter, Zeinabou, has half a face, the rest has been eaten. She has been visited by the sickness the ancient Greeks named the Grazer, for it grazes steadily through the muscles, the tissue and the bones. It came first as a small black spot six months ago. Her father, Ali Abdou, thought it was an abscess and treated it with the leaves of the lemon tree. He had never heard of the Grazer or its African name, Noma. The Grazer was last seen in Europe when it visited the children in the Nazi concentration camps.
In Niger there is no war, famine or pestilence, but the Grazer is kept supplied with children by the starvation diets and a collapsing health system caused by the pressure of international debt.
In Niger, the poorest country in the world, three times more money is spent paying off the international debt than on health and education. The country has no choice. No repayments means no more loans, means total collapse.
Ali Abdou doesn’t know much about the World Bank or the International Monetary Fund (IMF). He doesn’t know many things: how to read, his age, why his other daughter, Della, died of measles when she was two years old, why the common germs everyone has in their mouth turned so cruel with his daughter. A child so weakened by a starvation diet of corn and poverty that her body had nothing to fight the Grazer.
He had to make 150 sieves before he had the money to take her to hospital. When they finally got to the regional hospital at Galmi they waited for 20 days to see a doctor. The pressure of debt repayments means that the public purse is empty. Salaries have not been paid for three months, the hospitals have no wages to pay their doctors and nurses, so Zeinabou waited while the Grazer worked on her face.
In the beginning all she needed was antiseptic cream and a mouthwash. But without them the Grazer ate through her young face; first her lips and gums, then tugging her eye out of shape, sucking on the edge of her pupils, threatening to steal her sight. One day the rotting flesh fell away, leaving her baby teeth and her pink, healthy tongue exposed. The Grazer likes children around two years old: gentler skin, softer layers of tissue, easier to settle in. It’s carried by ordinary bacteria in ordinary mouths and could be kept at bay by the sort of medicines a child in the West is given for a cold.
But in Niger, where one in three children dies from long-term starvation diets before the age of five, nothing is ordinary. In villages where there is no money to invest in seeds and fertiliser they live on maize; where there is no local clinic and fathers don’t have the small change it takes to get their only daughter on a bus to hospital.
“When I look at her it breaks my heart, I don’t forget it, don’t get used to seeing it, it breaks my heart every time,” Ali Abdou says.
The temperature in their special isolation compound is more than 40C, and the other children with no faces lie sleeping in the shade with the blast of wind gusting like the heat of an oven across the concrete.
“When I sell my sieves I buy maize, about a bowl a day. That’s what my family eats. I had five children – one’s dead. I don’t have money for other kinds of food. I feel terrible because she is the only one in our village who has it, and people won’t say to me that they are afraid of catching it from her, but I know they are. But I didn’t go to the market and buy it – God sent it. In our village she is apart from the other children. Not that they beat her or say anything to her, but she seems like she chooses to be apart for herself,” Zeinabou’s father says.
Every year in the world’s poorest countries the World Health Organisation estimates 80 000 children die because there is no antiseptic cream or mouthwash to fight the Grazer.
Close to half a million children are scheduled to die in Niger before 2000, according to Oxfam assessments based on financial repayments to the IMF and the state of Niger’s finances for investment in health care and prevention. Given the size of the population, that’s the equivalent of three million children dying in Britain from curable diseases.
Half of them will first be prepared for death by a starvation diet that will break down their body’s immune system before they are killed by measles, malaria, meningitis and diarrhoea. The hungriest and weakest are those most favoured by the Grazer, which goes only for the face.
Ali Abdou and his daughter Zeinabou have been in the compound for 28 days. It has been two years since a German schoolteacher visited Niger and began a campaign to help the children. They have brought 250 children out of their villages for treatment. “This is the face of International Debt in Niger,” says Leo Sibomana, the co-ordinator of the project.
In Niger the 13 children in this compound were found by a German aid organisation which organises trips to find children hidden by parents who are ashamed of the ugliness of the disease.
“We have no idea how many of these children there are because they are hidden. I’ve lived in Niger all my life and never heard of the Noma children. There are doctors and nurses in this hospital who don’t know what it is. Eighty to 90% of them starve to death fairly quickly within a year because the muscles in their jaw are eaten away, and they can’t eat, so they just disappear,” says Sibomana. “In one village we found a 25-year-old woman who was a Noma and had survived, but she had lived alone in her hut for more than 20 years because of her face.”
The centre has been open for five months. First it feeds the children out of their malnutrition, treats the spreading disease and twice a year will carry out operations with foreign volunteer doctors to reconstruct their faces.
Dr Degrey Hubert is the head of the children’s hospital in Niger’s capital, Niamey, but his head nurse is impatient with him. “I told you already there are no needles for vaccinations left,” she says when he asks about an 11-month-old girl who needs to be immunised. The government’s central medical store house has run out of needles, the way it runs out of most things most of the time.
There are nine children on the paediatric ward this morning. All need urgent infusion of glucose and water for malnutrition and dehydration. “I have only four infusions,” says Hubert: “How do you choose? Some of these children will be dead by Monday, and I have to decide which one gets it.”
In his hospital are four wards of peeling paint, dirty mattresses and the sweet, sad smell of dried urine.
On the floor of one of the wards is a two-year-old girl called Assitou, with the face of an old woman. She weighs the same as three bags of sugar and her legs are as thick as celery. She is the third-born, and her mother Fatima looks, perhaps, 16 years old, but doesn’t know what age she is – only that she has already lost her first two children.
“There was something sick in their stomach,” she says. “The teacher in the village gave me the money to take her to hospital on the bus.”
Assitou is silent. All the babies in the ward are silent, in the heat and the dirt and their sickness, there’s no energy left to cry.
There is no famine, no flood, no war. This is as good as it gets in Niger, a former French colony of almost 10-million people on the west coast of Africa that many have never heard of.
Niger owes Britain $13-million. The country pays it off at the rate of $1,2-million a year. If Britain cancelled the debt for the millennium, the money saved would be enough to inoculate three-quarters of a million children. One in three children born in Niger will die before they are five years old from hunger, measles, diarrhoea, meningitis, or some obscene mixture of the four. “In the last five years I’ve seen the number of children dying from infectious diseases related to malnutrition creeping up from around 30% to 50%. It’s getting worse,” says Hubert.
“The hospital gets no credit from the government because they have no money to give us. The people can’t breathe under this debt.
“At consultations, when I write out a prescription for a mother she is crying before I finish writing it. She’s saying, `What will I do with that? My husband is not working and I have nothing.'”
In the compound they are sleeping. The Grazer children and the parents have no idea when their children will be operated on.
Ali Abdou says it doesn’t feel comforting to be here with his daughter among the other children with no faces: “I look at the others and I feel their pain. We are all waiting too long.”
The sieve-maker says he prays only that Zeinabou will get better. In the mustard- coloured wards, among the sterilised gloves and antibiotics that look so out of place in the dirt of poverty, Ali Abdou says he wants the people from Germany fix her face.
“I want her to be educated and get a good job. I would like her to have a beautiful house with a car.”