COVID Across Borders: Dual-Citizenship in a Pandemic
Written in October 2020
Fatou Mambouray can’t recall the details of her first sickle cell attack but can instantly tap into the feeling: “First word ‘excruciating.’ Second word ‘pain’…. it’s not from anywhere that you can feel on the surface; it’s deep within.”
COVID-19 has thrown the entire globe into limbo. We’re all stuck in this moment in time with no certain end in sight. Many dual citizens are also trapped between nations, struggling to determine where to take shelter in the midst of the deadly virus. For the immunocompromised, the stakes are even higher. Fatou Mambouray is an American-born Gambian living with sickle cell trying to find her place in the pandemic.
Fatou, 28, is the daughter of two Gambian-American immigrants who left their country in pursuit of opportunity, but never forgot their roots. Her life has been filled with flights for as long as she can remember: “When you have parents that travel a lot and you’re traveling with them, sometimes you wake up in another country and you just have to adapt.” From a young age, she was deeply struck by the systemic differences between her life in the US and life in Gambia and questioned the vast gaps. This curiosity bloomed into earnest inquiry and led her to study international relations at Richmond University in London. After a stint at the International Committee of the Red Cross, Fatou moved to Gambia in 2017 to get to work:
“That’s always been the goal and the mission. That’s always been the reason why I studied what I studied. It’s always been my purpose in life: to go back home and do what I can do there.”
Three years ago, Fatou founded AFRecycle a social enterprise that aims to build Gambia’s private and public recycling programs. Earlier this year she launched a new initiative to clean up the Atlantic coastline, but COVID-19 brought the operation to a screeching halt.
On March 23, one week after the nation’s first reported case, the Gambian government closed its borders. Ground transportation with their only neighbor, Senegal, was halted and all flights were canceled except for essential services and medical emergencies. Fatou had just chaired an awards committee in the capital Banjul and was already planning to return to the US for a brief holiday. She was now faced with a dilemma — board a repatriation flight and risk being unable to return or stay in Gambia and risk being unable to get out?
While the number of cases per capita in Gambia were (and still are) much lower than the US, the giant specter of COVID was looming. The world watched as it swept China and then Italy in mere weeks. Harrowing scenes of Italian hospitals overrun and understaffed were starting to flood social media and we’d yet to see any country make it over the notorious “curve.” According to the medical journal The Lancet, health systems in West African nations are even less equipped to handle an influx of disease based on capacity per capita as reported by the WHO. The report reveals that Gambia has 11 hospital beds and 1 medical doctor per 10,000 of the population and Italy in comparison has 34 hospital beds and 41 doctors.
As a black woman living with sickle cell, Fatou knows the limitations of West African healthcare all too well. Sickle cell is an inherited genetic disorder that produces abnormally shaped red blood cells. These misshapen or “sickled” cells can restrict blood flow resulting in pain, stroke, and even death. The attack often starts as fatigue then rapidly grows into more intense pain, usually in a centralized location around the blockage.
During her school-age years, Fatou would miss weeks of class every year — her best cases often left her bedridden and the worst cases required hospitalization for opiate pain management. Her first and only attack in Gambia was during a middle school summer vacation and her parents immediately flew her out of the country. They couldn’t chance any serious complications occurring with no access to sufficient medical attention.
Ten years later the Mambourays were living in Ghana along with Fatou’s older brother, Abdul Kareem. Abdul was out in Accra with friends when a sickle cell attack cut off the blood flow to a vital organ. Because of the country’s poor emergency response, he wasn’t able to get to a hospital in time and passed away en route at age 24. This was during the height of the Ebola epidemic in 2014, so his body was unable to be transported back to their family plot in Gambia for a proper funeral. His remains are still in Ghana to this day.
Her entire family was understandably rocked by his sudden death, but Fatou was particularly shaken — Abdul was her closest sibling and a pillar of support in their shared health struggles. This kind of intimate loss leaves an indelible impact on your life. It forever shapes you and your choices. So, when the threat of COVID and its travel restrictions struck in March, Fatou made the decision to leave Gambia indefinitely. She couldn’t risk suffering the same fate as her brother.
The US government repatriated over 100,000 citizens from 136 countries from January 27 to June 10. Of course, each individual had their own motivation for returning to the states: familial, professional, a mix of both. But there was also a general assumption that the US, as a global superpower, would manage the crisis well. Few of us anticipated the disastrous response from the Trump administration that’s resulted in over 9 million cases and 229,585 deaths at the time of publication. According to the Johns Hopkins Coronavirus Resource Center, America accounts for just 4% of the world’s population but has 19% of the global coronavirus deaths.
In comparison to the 70 deaths per capita in the US, Gambia has reportedly fared much better with only 5 deaths per capita. The Gambian Ministry of Health reports a total of 3,660 cases and 199 deaths to date, although Fatou suspects that the numbers are being underreported due to lack of testing. Since she’s arrived in the States, she’s gotten tests “religiously” every two weeks. A deep calm washes over her as she talks about the peace of mind that comes with regular testing:
“Nothing is comfortable, no place is better than the other. We just have to deal with in each different circumstance as they are…but here at least I can go get tested up the street and get my results in two days.” She glances across the room at her young nephew and smiles. Ansumana, 6, smiles back — he recently had a sickle cell attack and was grateful to have his auntie there to nurse him through the pain.
“This environment is conducive for you to do what you need to do for yourself and those around you.” Fatou hopes to return to her sustainability work in Gambia later this year when the borders re-open. But for now, she’s right where she needs to be: “I’m still here in the States because I’m getting spoiled by all the love that I have around me. I’m regaining my energy. I’m being reminded of all my motivations for the work I do back home.”
