When the rains come to Analaroa, the rivers run red with the blood of the land. The hills lay naked as the back of the zebu with the ancient forests now gone, stripped by the vasa who came in their great ships to the Madagascar island and felled the trees and took them away to their lands far off across the sea. The rains cut the deep and ugly lavaka into the naked hills like a fibarana brought down hard upon the back of the zebu, like a dull fibarana wielded by a crazy man who does not know how to kill the zebu properly, but instead cuts and slashes until the zebu falls in great pain, and there is nothing you can do with the hide or the meat for all the destruction he has caused.

Mbolatiana Razafindrandretsa Adriarimanana hears the first drops of rain upon the tin roof of the clinic in Analaroa. It has been a quiet day in the clinic, and no one waits for her services, so when she hears the drops, she runs across the red dirt to the line she has strung up outside and pulls her clothes down before they are soaked by the rain. She bundles them beneath her arm, hurries back to the room they have given her to live alongside the examining room, and lays them across her bed. The Americans give her a good salary, and she pays a young girl, no more than 15 but already with two children
and a third on the way, to wash her clothes for her in the river that runs not 50 meters from the clinic. She gives the young a girl a good wage for her work, and though the washing takes away the smells from her body that she now finds disagreeable after her years in America, the clothes are never clean for the redness of the water.

The rain hits heavier upon the roof, and the hard drumming is nearly as loud as the thunder that echoes outside. She stands on the porch under the awning outside her room, the concrete cool on the soles of her feet that she only bothers to cover now when she is in with a patient, and watches as waves of rain wash over the hills. Already the lavaka are filling with the rushing water, cutting them wider and deeper, carrying with it the hard red clay that once anchored the great forests but now is covered only with the short bozaka grass, which is no match for the force of the water. Soon the all the rivers again will be full with water as red as the blood that comes straight from the heart. She has been well taught in the ways of stopping a hemorrhage and for a moment imagines herself suturing together the lavaka until the land once again is healed, but she looks at the river already running red and high and wonders what it is that will ever stop the bleeding, or whether it ever will stop at all.

The rivers of Analaroa begin high up in the hills, past where the lavaka lay. There are villages in the hills that the trucks of the vasa cannot reach, villages where even the zebu have difficulty pulling their carts. There are people in some of these villages who have never seen the vasa, who know of the vasa only through stories told by the ancestors and repeated through the generations. In many of the villages there is great fear of the vasa, as the stories tell of the French and their guns and how they killed too many of the Malagasy to count.

In the villages where the rivers begin, the famadihana is something that is done by everyone. The people in the villages do not believe that it is possible for anyone alive to talk to God, that such communication is only possible between God and the dead and only will be received by God when the dead are given new vestments appropriate for such a meeting. For this reason, after a number of years specified by the local mpisikidy, the one entrusted to understand the secrets of the dead, they make the famadihana, a great celebration in which the ancestors are removed from their tombs, and with much love and respect, their old burial shrouds are carefully taken from them. They are then dressed in a new shroud and returned to their tombs, carrying with them messages from the living to God.

In the big city of Antananarivo, where Mbolatiana was raised, many do not make the famadihana anymore, as the vasa missionaries have said that it is not a Christian thing to do and is something that is best left behind. In Antananarivo, the old people still make the famadihana as their ancestors did before them, but many of the young people have stopped this, both because of what the missionaries have taught them and because the buying of the new cloth to dress the dead body and the great celebration that happens is an expensive thing to do, and the young people would rather spend their money on the living. Also, in Antananarivo, the poverty is very heavy, and many families live in the car tunnels and in shacks in the swampland along the railroad tracks; there is no money to make the famadihana even if they wanted to.

Mbolatiana’s father is one who preaches against the famadihana. He is a Presbyterian minister and has spent time being taught in a seminary in Baltimore and so has become one of the most important Christian ministers in all Madagascar. When the time came to make the famadihana for his own, Mbolatiana’s father argued strongly against doing this, so it was a great embarrassment to him when his brothers and sisters did it anyway, and it left him very angry. Mbolatiana’s mother’s family also makes the famadihana for their dead, and so her father made her mother promise to leave him at rest in his grave after his death as a condition of their marriage. In her heart, Mbolatiana knows that when the time comes for his death, it is more than likely that her mother will turn to the mpisikidy known to her family, and at the appropriate time there will be a famadihana for her father despite his wishes, for it is very difficult for a traditional Malagasy like her mother to go through the years unable to send a message to God.

Mbolatiana spent many years in Baltimore, so many that her English is very good and her accent is soft and agreeable to the vasa. It was here that she finished her high school, then remained to attend university and medical school at Johns Hopkins. She had not planned to stay outside Madagascar for so long, but her father encouraged her to do so. “Learn as much as you can while you are here,” he had told her shortly before he and her mother returned to Madagascar. “The more you learn, the more you will be able to help when you return.”

It would have been easier to return had it not been for the vasa named Eric Anderson. He was a from a place called Minnesota, where, he said, the land was flat and the winters were very cold. Before coming to America her father had warned her that many of the vasa boys would find her very pretty. As a teenaged girl she thought this quite funny, as she did not see herself as more or less pretty than any of her other classmates in the Lycee Francais in Antananarivo. Like the rest of the girls her skin was dark and her hair black and straight. Her face, too, was like the others, with the wide, dark eyes and the fine features of the peoples of Southeast Asia who were the first to come to her island. She laughed when her father had told her this and said she did not believe him, yet he rarely was wrong about things like this, and so knew that his words just might be true.

It did not take long before she learned just how true his words were. Even so, she managed to stay clear of the vasa boys. She had seen how too many of her friends back home started too early with the boys, and soon had children and could do nothing else with their lives but to look after them. She had not come all this way to start in with the vasa boys, and managed very well not to do so, until meeting Eric Anderson. His skin was as light as hers was dark, and his eyes as blue as the sapphires they take from the mines in the Malagasy highlands. His hair was as light as the bosaka grass in the dry season, and it made her laugh to run her fingers through his short, tight waves. He came from very tall people, and when she stood next to him, her head barely made it to the level of his shoulders.
He was in training to become a surgeon. Before coming to medical school, he had spent two years in the Peace Corps in Western Africa.

He came from a family that had made a lot of money in the investment business, and although his sister and brother had joined his father in the business, he had decided to become a surgeon so he someday could come and help the people in the poor countries of the world. He said that he was in a privileged position, as he, too, had benefited greatly from the skills of his father and so had the freedom to follow his heart in the type of work he chose to do without concern for the salary he might receive. Soon after he met Mbolatiana, he said that he now knew what country it was that he would go to after he finished his training and could be a surgeon on his own.

She was very careful and had not given herself to any man before, as she had seen the consequences to many of her friends. After some time, the desire built up within her that matched his own, but the first time together was hard and left her shaken and ashamed. He felt very bad about this and promised that the next time would be better. The way she felt, she did not want there to be a next time, but there was and she was not sorry for it.

In these times and all the times afterwards, she made sure that they were careful, as she did not want for herself what had happened to so many of her friends. There was one time, however, when the desire overcame everything else, a time when they were not ready and could not be careful. Eric Anderson told her not to worry, as it was very unlikely for one mistake such as they made to have bad consequences. She was a doctor and knew that this probably was true. It was not long afterwards that she realized how wrong they both had been about this. He was sure he knew what she had to do, and she thought she would be sure as well, but as bad as the consequences would be, the other thing weighed very heavy on her mind. After they had spoken about it and grew angry at one another about it and shed tears about it, she finally did what needed to be done.

After this it was very difficult to be with him. He tried hard to make things right between them, and in her heart she knew that she bore as much responsibility for this as he did, but after this a change came over Mbolatiana, and there was little he could say or do make things as they once were.

She returned to Antananarivo a fully qualified doctor, but for all the need of the people in the capital, there was no money to hire new doctors. She lived with her parents in their new house with a nice television and a modern computer and two cars almost too big to squeeze through the narrow, crowded streets, and with all the other things that her father could afford to buy, now that he had become such an important person. She volunteered for a while in a small clinic set up by the health ministry just outside the shanty town by the railroad tracks, and it hurt her very deeply to drive past the new shopping center, not two kilometers away, where her mother and the other well to do Malagasy shopped alongside the vasa from the foreign corporations and the aid agencies, and then to spend her days with those that drink the fetid water and eat the spoiled scraps of zebu meat and dry their rice on the sides of the street where the oil from the cars gather after each rain and have too many babies for even the rich to feed.

Each night when she returned home, there was a message for her on the computer from Eric Anderson. He said how he loved her very much and missed her and was always thinking of her. He said that there was a great loneliness in his heart, an emptiness that only she could fill. He said that someday soon he would like to come to Antananarivo to be with her, that it would not be long until he was a fully qualified surgeon, and then he would come and be with her, and they would work together somewhere, anywhere that there was a need.

She always said no to him. She said no to his coming. She said no even to his writing. She said no, that she did not share the loneliness or the emptiness, that the time had passed for that. She said this even while in her heart she felt something very different, and sometimes she felt that the pull between the words that came from her head and the feelings that were in her heart would someday tear her in half. He said that in something this important, he was not one to take no for an answer, and each day when she returned home, there was a message waiting for her, promising that someday soon he would come to be with her.

One day when she arrived in the clinic, there was a note posted on the cork board outside the examining room. It was an official note, from the health ministry, and told of a collaboration with the Americans to send Malagasy doctors to some of the most remote villages on the island. There had been reports of plague in some of these villages, and the Americans had developed new and cheap ways to both diagnose and treat the disease. They had come to Madagascar to see how well these new things really worked, and the health ministry was very enthusiastic about this program, as the American dollars would not only help in fighting the plague, but would place good young doctors in far-off clinics, many where only midwives now worked.

She chose the village of Analaroa. There were other villages she could have gone to, villages closer in, reachable in less than a day’s journey from Antananarivo, some even with electricity. Some in the ministry were concerned about her choice, as Analaroa was, by far, the most remote village among those selected for this program. They also were concerned because of her father, because of who he was and what would it mean if something bad happened to the daughter of this very important Malagasy. They expressed these concerns to her and told her that, in a village this remote, she would have to remain, alone, for many months at a time, with no opportunity for even a weekend holiday in Antananarivo. She told them that she understood all this very well, and that if she would not be sent to Analaroa, she would not join the program, and so the assignment was made.

When the rains come to Analaroa, the people in the villages bring their grain inside their homes. With the grain comes the rats, and with the rats come the fleas, and with the fleas come the plague. She had seen four cases in the months since her arrival. Two of the patients had been children. Each had been carried to the clinic by their mothers, as the terrible swelling in their groins had made it too painful for the children to walk. They arrived with high fevers and screaming with pain from the hot and tender swelling, and it was all Mbolatiana could do to get them to hold still long enough to take their blood for the American test and to give them the first shot of the American drug.

The plague cases all happened in the first month after her arrival, just after the rains began. At this rate, she thought, she would have much good information to give the Americans, as all of her patients had recovered very well with the drug they had given her. It was also good to be so busy, as the hard work she had to do did not give her time to think about Eric Anderson or her family or anything else she had left behind. But then the cases stopped as suddenly as they had started, and it left her with little else to do but to treat the occasional case of typhoid fever that came from drinking the fouled waters, and to deliver the babies of the very young girls in the village, and to sit and watch the rain fall and fight the ache of loneliness that grew in her heart.

It was sometime in her fourth month that she was awakened by a voice outside her door. The rain was falling heavily, and it was difficult to hear the voice through the sound of the rain on the roof, but when she did hear it, she recognized the panic and so got up quickly and pulled on a shirt and pants and stepped out onto the porch outside her room. There was a woman standing in the rain, her hands gripping the handles of an old wheelbarrow. The top of the wheelbarrow was covered with a piece of plastic but in the dark it was difficult to see what was inside. “Doctor, please, my daughter is very sick,” the woman cried. The waves of rain slapped hard on the plastic and then the thing that was in the wheelbarrow moved beneath it and Mbolatiana realized that this was the woman’s daughter.

Mbolatiana lit a lamp and opened the door to the clinic, then went out into the rain and mud and helped the woman lift her daughter from out of the wheelbarrow. At the first touch, Mbolatiana could feel the fever through the wet skin and clothes. She placed her hands beneath the girl’s arms, and when she did she felt the large, soft lump deep in the pit beneath her right arm, and the girl screamed out in pain, and at that moment she knew the girl had plague. “I’m sorry,” she said, and changed her grip to around the girl’s waist. The girl struggled at first but her strength gave out quickly and in another moment Mbolatiana had laid her down on the examining table inside the clinic.

The girl’s name was Laloa. Her mother said she was fourteen. Mbolatiana removed her wet clothes. The girl lay naked and shivering on the dirty foam mattress on the table. Her fever was very high. There was no other swelling but the one she had touched in the pit of her right arm. When she examined her there was something else, as it was clear to Mbolatiana that the girl was perhaps three or four months with child.

Mbolatiana took blood from the girl and put a drop on the test the Americans had provided, and the test quickly confirmed her diagnosis of plague. She injected the first dose of medicine into the girl’s buttock and then covered her with a blanket. Together, Mbolatiana and the girl’s mother carried Laloa to the room next door and laid her down on the bed nearest the door.

Mbolatiana invited the mother back to her room, but the mother would not leave the side of her daughter, so Mbolatiana spoke with the woman in the doorway to the girl’s room. They came from a village far up in the hills, a day’s hard walk in the dry season. In the weeks before Mbolatiana’s arrival at Analaroa, a worker had gone up into the hills and had alerted the people of the villages as to the coming of a doctor to Analaroa that could treat the plague. The woman had heard the worker and remembered his words, but the journey on the path alongside the river to Analaroa was a difficult one, and she did not start out until the fever was very high and the girl was agitated and could not be spoken to. It was also hard for her to leave as she had three younger children at home, and her husband worked the rice fields all day and was not capable of caring for them all. She had left their village more than a day ago, but their progress was slow with all the heavy mud. They already had spent one night outside, and she feared greatly that her daughter would not live if she had been forced to spend another night outdoors in the rain with her sickness.
Mbolatiana gave the mother some of her own dry clothes and a blanket and offered her the bed across the room from her daughter. The mother took Mbolatiana’s hands and kissed them and then would not let them go. “It is the plague that makes my daughter sick,” she said.

“It is the plague,” Mbolatiana said.

“She cannot die of this,” the mother said.

“The American medicine is a good one,” Mbolatiana said.

“You must not let her die of this,” the mother said.

“I will work very hard to help your daughter,” Mbolatiana said.

The mother kissed Mbolatiana’s hands again, and with tears in her eyes, climbed up onto the bed and covered herself with the blanket.
The American drug had worked very well, and in all her other patients the fever broke in less than a day after the first injection. Mbolatiana awakened with the call of the roosters and quickly went in to see the girl. She lay restless on the stretcher, her head thrashing this way and that, her mother standing alongside her, holding her hand and petting her brow and whispering in Malagasy that yes, Laloa, everything would be all right and soon we will return to our village.

Mbolatiana stepped inside the closed dark room, and in the light of her lantern there was a panic in the face of the mother that needed no words to convey. There was a odor in the room, somehow familiar yet indescribable, and the smell of it set Mbolatiana on edge, as if it were the scent of an approaching animal come to do her harm.
She put her hands on the girl’s head, and, if anything, the fever was higher than the night before. She pulled back the blanket and brought her lamp closer to examine the skin of the girl. She smoothed her hand over the girl’s abdomen and chest but saw nothing. She moved her hand over her shoulder and down her arm, and saw nothing until she reached the fingers. There were small dark spots at the end of the girl’s fingers. She brought the lamp closer, then called over the girl’s mother. “Please, madam,” she said. “Do you remember seeing these on your daughter before?” The mother shook her head, and Mbolatiana knew the heavy fear of watching the hand of death tighten around her young patient. “Everything will be all right, Laloa,” the mother said. “Soon you will be well and we will return to our village.”

The odor was strong over the girl, and in a moment Mbolatiana recognized it and grew sick at the thought. “Please madam, rest for awhile in my room,” she said to the mother. The mother at first refused to leave, but now Mbolatiana insisted that she do so and led her by the arm into her room. “Rest here,” she said, and sat the mother down on her own bed. “I will call you when I am finished.” There was no fight left in her, and the mother laid down on Mbolatiana’s bed and covered her face with her hands.

The girl was quieter now. She lay with her head to one side, her eyes open, staring at the plain concrete wall across the small room. Mbolatiana took the blanket in her hands and pulled it completely off the girl. The blood sat in a small pool between the girl’s legs, and it was clear from the looks of it that there was more than blood that lay on the soggy mattress.

Mbolatiana eased the girl’s legs apart. The flow of blood was strong and steady. She did all she could to stop the hemorrhage, although in her heart she knew there was no stopping it. She worked on the girl through the day, but the fever remained high, and the blood would not stop, and in the hour before nightfall, the girl took her last breath.

They buried the girl the next morning in the empty field just across the river from the clinic. Mbolatiana had offered to pay men from Analaroa to take the girl back to her village, but the mother said that no, that the mpisikidy would not permit a famadihana for those that die of the plague, as the soul of such a one was not acceptable before God, and so it would be best if she were just buried here. Men from the village came and dug a deep grave through the thick red clay, and in a plain wood coffin that Mbolatiana paid for herself, they laid the girl to rest.

When the rains come to Analaroa, the rivers run red with the blood of the land. The rain hits loud and steady on the tin roof of the clinic, where Mbolatiana stands and looks out on the naked hills and the deep and ugly lavaka. Her heart is heavy with the hardness of this place, and the thought comes of Eric Anderson and the warm feel of his arms around her and the broad distance between them. The river alongside the clinic runs red and full, and she thinks of Eric Anderson and of the girl and of her own loss, and Mbolatiana knows there is no stopping it.