infant mortality

Dear Family, Friends and Colleagues,

Please join me in bearing witness.

Last night I went to the wake for a little baby girl who died
yesterday. She was three days old.

A wake in Nicaragua usually takes place in the family's house the
first night after the death occurs, and lasts all night. The baby's
mother lives about fifteen minutes' walk from where I stayed in the
campo last night and is a cousin of my hostess. My hosts and I waited
until after dark, and walked over with flashlights.

When we arrived, the small concrete house was already full of people.
We ducked into the doorway and were in a dark room, lit by
candlelight. People were lining benches which filled the room,
talking in low voices. At the front of the room was a small table.
On the table, something very small was covered with a sheet of white
lace. Red flowers were scattered around the edges of the lace, and
two candles were burning nearby.

My hostess, who had been uncharacteristically quiet on the walk over,
found me a place to sit and then ducked through a curtain into the
back of the house. Last week, she had told me that her own first
child had died as a newborn, too.

I asked some guarded questions of my hostess's children. The problem,
they told me, was that the baby came early by about four weeks. When
the mother started to feel pains, she set out walking for the nearest
health clinic, which is a stiff hike of about five kilometers from her
house. They told me she fell or fainted twice on the road. When she
got to the clinic, the doctor was not there, so she was taken back to
her house, and the baby was born there. It was her first child.

After sitting quietly in the main room for a while, I was beckoned
through the curtain at the back. It turned out that this led, not to
the back of the house as I had supposed, but out a door. I was led
through a small yard and into the kitchen of another, much smaller
house—instead of concrete, this house was constructed with pieces of
wood, with a piece of corrugated zinc for a roof and a dirt floor. It
turned out that the wake was being held in the house of a relative,
since there was no space here in the mother's house. I was given a
mug of coffee and a sweet roll which I ate on a wood bench in the
kitchen, listening to other visitors making desultory conversation.

The infant mortality rate for Nicaragua was 31 in 2004, according to
the United Nation . This means that for every thousand babies born
alive, 31 die before the age of one year. For comparison, the rate in
the U.S. was 7 in 2004, and in Sweden it was 3. In Nicaragua,
breakdowns shown that the rate in the campo is about twice that in the
city.

Once we returned to the concrete house, I watched my hostess gently
lift the white lace sheet. Several other women approached the table,
and we all looked down at a tiny face with round baby cheeks. Her
eyes were gently closed, as if she were sleeping. But she wasn't.
One woman stroked the tiny cheek with one finger. Then my hostess
replaced the lace. Her face was expressionless as she carefully
rearranged the red flowers.

We stayed another hour or so, sitting in the bench-lined room in the
candlelight, and then walked home. My hostess told me that the mother
had not received any prenatal care. Since it was her first baby, she
hadn't known anything was wrong when the child's hands started turning
purple. When her grandmother saw the child's hands, she set out to
find a remedy. But when she got back, the baby was already dead. And
the mother hadn't yet noticed—she was cradling the tiny form in her
arms.

I asked what the baby had died of. But nobody knew. And nobody is
ever likely to know. The baby was born without a birth certificate,
and will be buried in the campo without a death certificate.

Carolyn Fisher