藏精阁

In a small, dimly lit office in Birni N'Gaouré, a town in the Dosso region of southern Niger, are a desk, a laptop computer, a lamp, and a ceiling fan. Occupying one wall are square cubbyholes brimming with colorful binders. It looks like something one might see in a kindergarten classroom.

Those cheerful binders belie the tragic lessons they hold. Each one contains multiple “verbal autopsies” of Nigerien babies and young children who have died within the time frame of a two-year international health study. There are hundreds on this wall, more yet on another wall, and still more stacked on a hutch in the hallway.

These reports are part of a three-country replication study that corroborates a strong link between mass drug administration (MDA) of the broad-spectrum antibiotic azithromycin, which Carterand other organizations routinely give out to treat the eye disease trachoma, and a subsequent sharp decline in mortality among children under 5 years old. University of California San Francisco’s Francis I. Proctor Foundation coordinated the study, referred to by its French acronym MORDOR, partnering with Carterin Niger.

It takes a special kind of person to gather the information about a child’s death from bereaved parents. Mariama Tiemogo is one such person.

Tiemogo, 32, is a professional nurse from Niger’s capital, Niamey. She works on the MORDOR field team, taking swab samples to monitor babies’ and children’s health over time in an area of the country that up until implementation of the study had not received azithromycin MDA due to the area’s low prevalence of trachoma.

In addition, she has the awful duty of tactfully interviewing the heartbroken families of children who have died, in order to help researchers understand what children are dying from and what fatal illnesses the antibiotic may be preventing. It’s not an easy task.

“It’s sometimes quite painful to see the family’s sadness, but as a nurse I have a job to do,” Tiemogo said, her face framed by a long scarf.

Tiemogo said she usually starts the conversation by respectfully acknowledging the family’s loss and offering the traditional Muslim condolence, "To Allah we belong and to Him we return." (Niger is about 90 percent Muslim.) She then gently inquires what the parents think caused the death. Using her nurse training to seek diagnostic information, she asks whether the child had shown symptoms such as fever, diarrhea, or rash, and for how long.

Frequently, Tiemogo finds herself playing the role of grief counselor. Bereaved mothers will often wail at the very mention of the child’s name, she said. She recalled interviewing a woman who was unable to bear children but had been given one to care for. When the child got sick and died, the woman’s grief was compounded by her fear of being judged: “Now no one else will ever entrust a child to me,” Tiemogo remembered the woman sobbing.

Tiemogo is understanding and empathetic, but she also is focused on her task.

“You just have to be patient, let them express their grief, comfort them, and get the answers you need,” she said, wiping sand from her eyes.

In Niger’s male-dominated culture, Tiemogo is aware that little girls have their eyes on her and perhaps are dreaming of careers for themselves.

“It’s a good feeling to be a woman doing important work,” she said, adding that grown women pay attention too. “Women say, ‘The work you are doing, even the men cannot do it!”

Tiemogo and everyone else involved in MORDOR hope they can prevent too many more of those colorful folders from piling up in that dimly lit office.

“We in this program are very happy to know we are helping reduce child mortality,” she said.