Review: "Not One, Not Even One" by Nancy Christine Edwards

Not One, Not Even One by Nancy Christine Edwards
Published February 2022
★★★

In the late 70s, Edwards left Canada to work as a community health nurse in Sierra Leone. It was never going to be a permanent move, but the impressions those years left—those are permanent.

The decades between the experience and the writing of the book are the book's strength and its weakness both. The benefit of that long time, of course, is that Edwards has had years and years to think on her experiences, understand them in context, and think over what was effective and why—and what was less effective and why.

Should we ask women to boil their families’ drinking water? That was a sure-proof way to decrease rates of gastroenteritis, but boiling water required firewood. Firewood had to be carried from farm to village. I consumed almost three litres of drinking water a day, more when I walked to the villages. I did the simple math. A polygamous household of ten adults required at least 30 litres of drinking water daily. That was one and a half jerry cans of water, which had to be carried from water holes to villages or farms. It was beyond unreasonable to expect women to boil that much water on three-stone fires, and in what? They had two communal household pots—one for rice, the other for plassauce. Boiling all drinking water was both the medically right and impossibly wrong message. (128)

Edwards clearly understands the limitations of her work in Sierra Leone, and the book is stronger for it. There are some things that she couldn't answer then and can't answer now, and as much as I love questions with answers...I prefer it when people understand that they don't have all the answers.

Some of the research Edwards did—because she spent time in Sierra Leone not just as a nurse but also as a graduate student doing research—has such unexpectedly sad results. That is...you can expect some sad statistics, given time and place and context (maternal mortality rates, etc.). But there's also this: Paul and I put the completed baseline questionnaires in green garbage bags and locked them in the wooden cupboards of the Bo-Pujehun project office. As far as I know, nobody ever looked at them again. During interviews, families had shared their raw emotions about live births, stillbirths, and deaths of women and children. Responses had been recorded in tick boxes, with a few words of explanation sometimes entered in the margins. Each event had been converted to a single, data-entry keystroke and then anonymously summed and buried in the calculation of health status indicators. Locking the questionnaires in dark cupboards metaphorically silenced the fulsome stories of hope and joy; of sorrow and tragedy. (258)

I so hope that someday such interviews can be done again in similar communities, but with the goal of (with informed consent, obviously!) recording and sharing the full stories rather than just the bare data. No shade to Edwards' research at the time, of course, just that there's so much that can be said in oral histories and personal stories that can't be captured in tick boxes. I said above—and I think this is relevant to this theme about personal stories—that there are upsides and downsides to the long time between Edwards' work in Sierra Leone and the writing of this book—the downside is that it's harder to get full portraits of the people in the story when those memories are decades old. I'd have loved to get a better sense of more of the individuals Edwards lived and worked with, more of a sense of their stories and individual lives. It's a fascinating book regardless, but one to go in looking for more of a broad-strokes, data-driven perspective than one that focuses on individuals.