Monique and the Mango Rains: Two Years with a Midwife in Mali (review)

Heat, flies, friendship, cultural difference, and acceptance—and the unremittingly common rhythms of daily births and deaths—are the images and stories told in this memoir of a former Peace Corps volunteer's two years in a rural village in Mali. The story is told as a first person narrative with engaging dialogue, though occasionally overly purposeful metaphors and descriptions remind us that she is all too aware of her audience. However, when the storytelling moves apace and the multiple minidramas unfold, the reader is drawn in and begins to share in the rise and fall of the narrator's own excitement, frustrations, joys, and pains.

The multiple themes and issues voiced in this narrative provide a useful point of dialogue and reflection for many audiences. Although the subtitle and a great deal of the story focuses on midwifery, and infant and maternal morbidity and mortality, the narrative goes further. For students or teachers of African studies or anthropology, Holloway incorporates information about kinship systems, religion and witchcraft, familial and traditional power relationships, and decision-making processes that affect marriages, jobs, women's status, child-bearing, and community self-help projects. Along with Holloway's own learning and appreciation for these cultural differences, we see her occasional impulse to rebel and challenge these cultural norms when she identifies a perceived injustice. Her actions allow us to reflect on our own personal narratives in the context of living or working in another culture: when do we interfere and "impose" our own cultural values and expectations of justice? Is cultural relativism more important than our personal moral codes? Are we cultural imperialists when we choose to speak out? How do we balance our impatience to see projects done quickly, on the one hand, with the community need to process and debate, on the other? Though not as ethnographic in its telling, this book is reminiscent of many of the struggles described by Elenore Smith Bowen in her classic anthropological novel, Return to Laughter (Harper, 1954).

As the title suggests, this book is also about public health. We are immediately confronted with the environmental challenges to maintaining good health—lack of access to clean water, basic sanitation, and latrines; the dietary restrictions imposed by limited rainfall; and exposure to infectious diseases such as malaria, hookworm, and cholera. Through the story of Monique's midwifery training and practice, we learn of the limited number of well-qualified health personnel, of the paucity of prophylactics for birth control or sexually transmitted infections including HIV, of the insufficient supplies of vaccines, and of the near absence of drugs or diagnostics for most diseases. The birthing hut—as a place of life and death—begins and ends the narrative. Heartbreaking stories of malnutrition and disease that cause many children's death are juxtaposed against evidence of women's social and economic vulnerability. As one mother says, "I cannot have more children.... Please.... I lose them. I had nine. Now I am left with five.... Too many have died, and yet my husband, Daouda, he wants to have more." The stories may derive from the early 1990s, but the reality of health-care services in places like rural Mali is little changed today. And not only in Mali: for Nigeria, Buchi Emecheta's The Joys of Motherhood (George Braziller, 1980) captures similar tales of maternal and infant morbidity and mortality as told from within the culture.

Ultimately, this is a story about friendship and bridging cultural boundaries. It is told with an honest self-awareness of the author's own naiveté, her hope for a better future for her friend Monique and Monique's family, and the uncertain path of how to bridge difference, culture, opportunities, and privilege.