The day before I left Ethiopia, a well-meaning friend asked if I had a yellow fever certificate for Ifrah. Yellow fever? There isn't any yellow fever within 1,000 kilometres of where we had been living, in the semi-desert plain on the edge of the Ethiopian highlands, next to the neighbouring countries of Somalia and Djibouti.

But how could I have been so stupid? I know Immigration requires certification of yellow fever immunization from many countries, and Ethiopia is one of them -- even if we were a five-day voyage from yellow fever area. And I'm a doctor, for heaven's sake! After all the anxiety, adrenaline, and crossing of every conceivable bureaucratic "t," my newly adopted daughter might be refused entry into Canada because yellow fever had never even occurred to me. Malaria, dysentery, typhoid, murder, traffic accidents, kidnapping, hijacking, civil war, fuel shortages -- yes. Not yellow fever.

Okay, take a deep breath, try not to panic. Try to get Dr. Koki, the wonderful pediatrician with the Organization of African Unity, to write a letter of medical exemption, with as many stamps and seals as possible -- by three o'clock this afternoon. By the skin of our teeth we made it.

Since I set foot in Ethiopia, my life has been lived by the skin of my teeth, or the seat of my pants. The Muslim expressions I initially learned out of politeness -- Insha Allah (God willing!) and al Hamdu Lillaahi(Thanks be to God) -- have become frequent and heartfelt. And to think two years ago, I was Ms. Independence. Oh, I was spontaneous and easy-going, sort of, but a control freak nevertheless, accomplishing impressive amounts of work by juggling 20 tasks with the assumption that the bottleneck was my will or lack of it. I was rather unpleasantly disabused of this notion in the early weeks of my doctoral fieldwork in Ethiopia, where it became painfully clear that I was in control of absolutely nothing -- not my schedule (despite a research protocol of which I was quite proud), not transport, not even my research questions, which could be dismissed as uninteresting by the people I was desperately interested to learn about. And to this I have to say al Hamdu Lillaahi, or Thanks be to God, because when I offered to take home a severely malnourished baby for a couple of weeks' intensive feeding, it was just another change to my Proposed Schedule of Field Research Activities. Except that now I'm her mother.

Anthropology is the study of humanity, its societies and cultures. Working as a doctor over the years led me to believe that knowledge of anthropology could help me treat my diverse patients‹whether miners from northern Ontario or African refugees. I had been trying to treat a number of Somali refugees new to Canada, and often felt stymied. My patients often complained about leg pains, but I could find nothing wrong. Clearly something else was going on. I had become increasingly interested in cultural expressions of distress. Headaches and ulcers for North Americans, leg pains for Somalis? Clearly, the Somalis were not fitting into the standard Canadian model of "health beliefs and practices" and were not so well received in Canadian society, either.

Tens of thousands of Somalis had arrived in Ottawa and Toronto after 1990, fleeing the Somali civil war and famine. Although Canadians see themselves as generous -- with justification --this generosity did not prevent the familiar tensions following large influxes of highly visible immigrants during hard economic times. Add to this an unspoken but pervasive expectation that refugees should be grateful (and quiet), and problems could be predicted. Somalis are not obsequious. Islam in their culture teaches that there is no shame in demanding assistance from the more fortunate -- wealth and poverty alike are in the hands of Allah, though everyone is expected to work if they are able. This clash of values and cultural styles, as well as coping strategies (such as getting as many ID cards as possible) which made eminent sense in a corrupt and unpredictable regime--but were unacceptable in Canada--led to mutual distrust and stereotyping.

I decided the experience of Somali refugees would be an interesting PhD topic, and came to McGill to work with anthropologist Allan Young. I spent the summer of 1995 and most of 1996 researching Somali refugees in Ethiopia. During the course of my work, I met a man who lived through the 1977 war between Somalia and Ethiopia. He was a refugee, and worked with an organization to improve the living conditions of his fellow returnees, former refugees who had returned "home" to lands which still remained in the hands of the Ethiopian government. The former government of Mengistu Haile Mariam had confiscated these lands for a military base in the aftermath of the war, and the new government which replaced his dictatorship had promised restitution. On the strength of these promises, Ethiopian Somalis, along with hundreds of thousands of other refugees, returned home and were trying to re-create their lives. This man's family would be one source of knowledge about "the refugee experience" which I hoped would fill in the gaps left by larger scale political science and highly individual psychological approaches to refugee studies. I didn't suspect I would become more a participant than an observer.

Meeting Ifrah

On my second visit to this man's family home, the grandmother brought out a swaddled infant who was not well. I learned that the two-month-old girl was suffering from diarrhea and the grandmother thought it might be from her diet of goat's milk. A trial of "sugar water" did not seem to help, so the grandmother offered black tea, a traditional remedy for diarrhea. The baby was now malnourished and dehydrated. I volunteered to buy some formula -- which was prohibitively expensive for the family. I'd always been dead set against formula because it is aggressively marketed and here I was, buying it -- Nestle, to boot, after years of supporting boycotts. Breast milk is best for babies. But this baby had no mother, and no other woman offered to breastfeed her. I found out later that her mother, Dehabo, had bled to death after giving birth. The baby had come to live in this house, the house of her uncle, because the grandmother volunteered to take care of her. The uncle named the baby "Ifrah," an Arabic name meaning, literally, "be happy," and for Somalis meaning "she is happy," "she brings joy" or "something wonderful you find."

Ifrah initially did well, but after a few weeks she began the downward spiral of diarrhea and malnutrition so common in poor countries. Although her uncle was considerably wealthier than her father, in absolute terms this was a poor family. The parents, the grandmother, six children, and now a foster child were living in a two-room house with no well or tap water. When I returned with the formula, the baby was in the care of the 12-year-old daughter. We went through the procedures of sterilizing the bottle and the water and preparing the formula. I left, not feeling too confident. Clean water was not readily available. The family cooked over a small fire of twigs and dried eucalyptus leaves. They had only one bottle, and no refrigerator. It was a recipe for disaster, but I thought maybe the child would get enough calories to recover.

On my next visit I discovered that the family had given up hope and was waiting for Ifrah to die. I asked to see her, and was confronted with the dilemma of being a doctor who should intervene, and an anthropologist who should not. It was clear that Ifrah was on the verge of death, from malnutrition and dehydration. It was also quite clear that for this family to save this infant would be equivalent to the most heroic efforts in a North American teaching hospital. I reminded the women that I was a doctor and that I had access to medicine, water, food, and money. I said that if it was Allah's will that Ifrah die, then she would die, but if Allah wished maybe she would live; if they wanted me to, I could take her to town for a few days to see if anything more could be done. They agreed.

I still ask myself why I got involved. Shortly after I arrived in Ethiopia, a man was shot and killed in front of me and I didn't help--my companions said I would be taken for a journalist and that would put us all in danger. Was I compensating by helping this dying baby? At the time I offered to take her to my room, it seemed a simple medical decision. But I had seen and ignored hundreds of beggars in my months in Ethiopia. The difference was that with Ifrah and her family, I couldn't pretend not to notice. All the tactics we use to avoid seeing--look down, avoid eye contact, or tell yourself "it's no use," or "help just perpetuates poverty," that the real solution is "development" or "revolution" -- all were useless to me here. Simply put, since I knew this family, I felt obligated. Since I felt obligated, I was obligated. Both emotion and reason motivated me.

I returned to my lodgings, dropped my research, and fed the baby every two to three hours. It was a painstaking process: by this point she was so severely malnourished it took an hour to take just 10 or 15 millilitres of formula. I desperately wanted to make her eat as much as possible -- at two and a half months she weighed 5 _ pounds. With severe malnutrition babies lose their appetite and must literally be force-fed -- but not too much, or they will vomit. Which she did, wracking her tiny bony body and leaving me in tears of frustration and remorse.

I thought she would die on that first night. She didn't, and after a few days it seemed that the worst danger was past. But round-the-clock feedings and diaper changes continued, with me hand-washing the diapers while she slept. (My sister knew exactly which environmental button to push when she suggested disposable diapers and asked, "Besides, doesn't that country have a water shortage?" But on my budget, $35 for a package of diapers was out of the question.) On the seventh day, Ifrah looked at me and smiled. From that point our relationship changed from doctor--patient into something else altogether. It was only when she first truly yelled -- finally demanding life and attention -- that I was lost.

After two weeks, a friend asked me what I planned to do. I'd been too busy and too overwhelmed with her care to think about the future, although I was beginning to have nagging doubts that the family wanted to take the baby back. The friend suggested I look into adoption, and to see whether another Somali or foreign family could take her, or even whether I could--if it came to that.

The first family

While investigating adoption, I began to find out more about Ifrah's beginnings, and how she ended up in my care. Ifrah's father, Abdullahi, was left with five children after the death of his wife. (Five others had died while the family was refugees in Djibouti.) He had lost his land to a military base during the Ethiopian-Somali war in the late seventies, and was supporting his family by gathering firewood--one step above begging in the local scheme of things. The death of his wife made painfully obvious how limited the actual "employment income" of such a man was: the family had survived because of credit and meal-by-meal support from other women, a network that a man could not access.

The death of Dehabo made clear a fundamental assumption in Somali society: men cannot raise children alone. According to Islam, fathers are required to provide for their families, but care of infants is a mother's responsibility. In case of a mother's death, the next best caregiver for a child is the mother's mother, and then other close relatives of the mother, and thirdly, relatives of the father. Other options are not usually in the repertoire. It is almost unheard of for Somalis to give infants up for adoption. In this case, there were no maternal surviving relatives. Instead, the children went to live with various women relatives on the father's side, in Ifrah's case with the father's half-brother's mother.

The Negotiation

After I had cared for Ifrah for a few weeks, it became clear that this was not a simple case of a foreign doctor treating a child and returning her. A complicated and largely oblique negotiation process went on between me, the uncle, the women, the community, other Somalis, Ethiopians and foreigners. At issue was whether Ifrah would return to her uncle's home when she was well or whether the uncle would pass her care on to a third party, temporarily or permanently. My position was that I came to Ethiopia to do research, not to adopt a baby, and that she should return to relatives. I was attached to her, but disliked the cultural imperialism which is often part of international adoption - the idea that poor children should be rescued from ignorance and poverty (in that order) and raised in "good homes" abroad. My overwhelming experience was that Somali children are poor, but they are well loved and cared for.

But someone needed to care for Ifrah, and no one stepped forward. The family stayed away from us. ("We didn't want you to think we didn't trust you and were checking up on you while you were treating her" was the explanation offered by the uncle; "They didn't want you to think they wanted her back" was the explanation offered by others.)

The family began to say that I was the mother since Ifrah knew me, and so on. Gradually, I, too, became convinced that I was morally and emotionally obliged to act as the mother. But it was still not clear what the family wanted. The uncle had not said or signed anything, and despite the messages passed through the grandmother, the aunt, and other relatives, the bottom line was, as the grandmother put it, "We can't decide anything; the men decide."

The Shir

After a month, I was advised to insist on a shir, a public meeting of clan elders and other interested men, to set the matter straight in public. There was a conflict between two opposing viewpoints within the community.

One position was that the uncle's family had taken this child in because kinship rules required that they do so, that they had done all they could for her, that she had been on the verge of death, that no one else had offered to help, and that I was clearly sent by God to rescue her from the fate of a hard life in Ethiopia. The other position was that it was unthinkable for the larger clan family not to be able to take care of one of its own, and especially unthinkable to offer her to an infidel, albeit one "who understands what humanity is" and who "would be rewarded by God." Although the uncle tried to insist that this was a private matter, there was already confusion within the community. Some suspected me of trying to steal a Somali Muslim child, whether I kept her or facilitated her adoption by someone else.

The shir was held in a simple house with participants sitting on mats. I was able to attend as doctor, therefore an honorary male. It was both highly stylized and quite informal, and though less than a dozen men attended its two sessions, the shir represents a community consensus and obligation.

The conclusion was that Ifrah would return to her uncle's family, that this had always been the family's intention - although it was regrettable that Ifrah would not have the benefits of a "European" life - and that the entire clan was now responsible for her welfare. This conclusion was reached with very little argument, indicating the ideology that taking care of a child is a matter of clan, Somali and Muslim honour. Ifrah was to remain in my home as a sort of rehabilitation centre until she had gained enough weight to have a reasonable chance of surviving the next inevitable infection, but a woman from the household would come to look after her there.

It's hard to remember how I felt then. It was all a bit unreal -- the month had gone by in a haze of fatigue, anxiety, and falling in love. I felt at peace, that the right thing had been done, and that perhaps I could be an indulgent aunt for this child. I felt that nothing had changed because Ifrah would still live with me. I had never fully absorbed the possibility of actually becoming her mother, nor of actually giving her back, which meant fully accepting that she would be raised according to their ways and not mine, and that she would have a 20 percent chance of dying before her fifth birthday. I did know that I had to start letting go, and wrote an academic paper, entitled "Where There is No Mother: Gender, Love and Duty in a Somali Child's Survival," as the obvious way a would-be scholar would let go. I still hope to have the paper published, but if it were accepted now, I'd have to write a different ending.

Ifrah stayed with me after all. No female relative stepped forward to take care of her. Over the next five months, I travelled frequently to Ifrah's birth village to continue my research and to talk with her father about adoption. Villagers were also anxious to see the child, whom they knew only as a newborn at the time of her father's devastation over his wife's death. I was afraid. What if they changed their minds and wanted her back? They were delighted at how well Ifrah was doing: plump, healthy and happy. I didn't want to give her up, but in my mind the issue was still ethically complicated. After exploring many options, including adoption by another Somali family, we concluded the best option was for me to adopt her. On July 22, 1996, I legally became Ifrah's mother.

Now we've survived our first winter together in Montreal, commuting to Ottawa two days a week for work, trying to write a dissertation, and together with my partner, becoming a family with roots extending to Ukraine, Argentina, Ethiopia, Somalia and Canada. Still learning on the fly, by the seat of our pants. Al Hamdu Lillaahi.

A native of Toronto, Christina Zarowsky, 36, is a graduate of the McMaster Medical School and the Harvard School of Public Health, and hopes to complete her McGill PhD in anthropology this millenium.