DJENNÉ, Mali — Last Saturday, Albert Ganou, an unemployed tour guide with an ailing heart, prostrated on a thin cotton blanket in his musty room and refused to eat. His limbs swelled. His breath grew shallow. When his pregnant wife and four daughters spoke to him he could barely whisper back.
Friends pooled money and helped Ganou through the sewage-sluiced snarl of narrow adobe alleys to Djenné district hospital, which employs a handful of general practitioners and some nurses. The doctor prescribed painkillers and a salt-free diet. Then night fell and the spongy, low sky dribbled a billion stars over the millennial town, and Ganou died. Men buried him quietly at daybreak in the town's walled cemetery by the Bani River, where tamarind trees contort their baroque trunks over generations of the dead, and Djenné's world-celebrated Sudanic skyline gives way to the immense pale horizons of thorny and flat Sahelian wilderness.
Ganou was in his early forties. In the postmortem the doctors stated the cause of his death as "heart failure." They should have written "neglect."
From time to time, humanitarian crises push Mali into the world's distracted eye. The latest example is the French intervention to force out of Mali's north a hodgepodge of radical Salafis, Tuareg rebels, and drug traffickers linked to al Qaeda, who had established there a punitive and grotesque theocracy reminiscent of Hieronymous Bosch paintings, keeping order through amputations and lashings. The day Ganou died, French and Malian troops wrested free of the Islamists' control Kidal, the last insurgent-held city in Mali's north. Months earlier, three successive coups and counter-coups in Bamako and the simultaneous insurgent expansion in the north briefly grabbed international attention. The year before, drought and famine throttled Mali, and networks broadcast the stereotypical images of Sahel's dying, bloat-bellied babies -- a painful echo of the famines of the mid-1980s, when a million skeletal people wasted away on this hardscrabble, laterite savanna.
The creeping systemic healthcare crisis that allows Malians like Ganou to perish daily is harder to capture in made-for-TV snippets. Aid workers agree: War notwithstanding, the country is in no outward emergency. There are no throngs of matchstick-limbed children with protruding stomachs, no AIDS victims scooped into shallow graves. Simple poverty makes the problem as endemic as it is routine.
Most Malians cannot afford to seek even perfunctory healthcare in the country's limited medical facilities, which, like so much infrastructure in this impoverished country, are propped up by international development organizations and relief groups whose budgets now are stretched extra-thin by the needs of more than 300,000 people who have fled the fighting in the north. Even in peacetime, the country has the second-highest infant mortality rate in the world, after Afghanistan, and thirteenth-highest death rate overall. One in three children under five suffer from chronic malnutrition. Relief workers in Bamako, Mali's capital, told me this is normal, a habitual, unabating catastrophe.
The calamities fold onto one another, double and triple up, mostly unexamined and unassisted, invisible to the rest of the world. For example, no one can guess how many people will be hungrier, sicker, and more destitute than usual because they have welcomed into their homes families of relatives who have run away from the war in the north. Aid organizations expect 660,000 children under five to suffer from acute malnutrition this year, one of the aftershocks of last year's severe food crisis. Since Mali's impoverished, putschist government is bogged down in its own stalled political process, the burden of providing healthcare for them will fall on international NGOs. And what about men like Ganou, who could not afford even an electrocardiogram, because the clinic in Djenné has no EKG machines and to reach the nearest one that does, in Mopti, would have cost an unaffordable $150?
Of course, the people of the Sahel have been navigating attenuated resources forever. The 15 million Malians are persevering, chaffing in the shade of mosques, watching the Africa Cup of Nations on television sets outside shabby mercantiles at dusk. In Djenné, they share dinner leftovers with neighbors. They parcel out their children among various relatives to avoid starvation. My host here has taken in two.