When Tanko* was born, some twenty years ago, it was his mother that declared to the world that he was a boy. It was she, who cut the umbilical cord, wiped the baby’s face and pulled her placenta out gently. She, Tanko’s mother. Not a midwife, not her oldest daughter who was also present and certainly not his father. She took one look at the baby’s ambiguous genitalia and decided it was a boy and that he would be called ‘Tanko’. Some of her relatives were sceptical about her decision as Tanko’s scrotal sac was not well formed and was said to be empty as reported by the midwife who came visiting. But Tanko’s mother was adamant. After giving birth to six daughters’ consecutively, she was desperate for a boy and would not allow a mere traditional birth attendant who was unsure of the baby’s sex, tell her otherwise. God had wiped away her tears and given her a baby boy and for that she would remain eternally grateful.
Tanko’s childhood began in a small village in Sokoto, where he chased chickens and goats along with his siblings in their large compound. His father was an Islamic scholar who taught ‘Almajirai’ and also reared livestock which he sold during Sallah periods. Tanko was enrolled in primary school when he was seven years old, after much pressure from his mother on her reluctant husband. All his older sisters had never seen the four walls of a classroom and Maman Tanko, as she preferred being called, insisted that the archaic practice would end with her son. She was determined that he would go to school and learn both Islamic and western education, so that his life would be better than theirs.
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As the last and only male child, he was thoroughly pampered by his mother and his older sisters and so his shy, plump and lovable nature was reasoned to be due to him growing up around women. When his father failed to toughen him up at the age of ten, he was advised by relatives to send him to a boys’ boarding school where he would be forced to become the man he was destined to be.
During the December holidays, after he had just turned thirteen, his mother noticed blood stains on his bed when she went to wake him up for fajr (dawn) prayer. Throughout the day, he continued to complain to her of abdominal pain and a feeling of weakness. His father bought some painkillers and anti-malarial drugs at the local patent medicine store, but when the bleeding resumed two days later, his father was forced to take him to the general hospital. There, the doctor made a tentative diagnosis of Bilharziasis, a parasitic infection that causes people to urinate blood. He was given antibiotics, pain killers and asked to do an abdominal scan and a urine culture. Tanko was not examined. As a typical Nigerian patient, when the pain subsided and the bleeding stopped, Tanko did not return to the hospitals for the tests. And all went back to being normal.
When Tanko began to grow breasts, he attributed it to him being overweight and wore a tighter vest to conceal what he thought was a fat chest. A few months later, the abdominal pain returned and was followed by bleeding. This time, the illness occurred at school and so he was taken to the sick bay. The male nurse accompanied him to the hospital where tests were carried out. Tanko’s parents were immediately summoned.
I heard of Tanko’s case from a colleague, four years ago when he was presented to the hospital. As doctors, we were fascinated at how the case unfolded and how he was going to be managed. His mother had fled from the prying eyes of her in-laws and relatives to Kano in search of answers. She had been told that her beloved son was, in-fact, a girl. The scan showed a uterus and ovaries and the absence of a testes.
Tanko had begun to have his monthly periods. A small vaginal opening was identified. His genitalia was still strange to look at as the large labia still resembled a poorly formed scrotal sac and the enlarged clitoris could be mistaken for an infantile penis. However, Tanko was not a baby anymore, and at puberty, the organs, especially in boys, are supposed to well formed.
The same advice was given to Tanko and his mother to think about it and discuss it.
Medically, it is easier to assume the identity of a female. Environments will be changed and gradually, hopefully, he could grow up as a woman. But Tanko and his mother were adamant- he would remain a boy. His father insisted otherwise- that Tanko stay in Kano and live with his friend, while assuming the name ‘Aisha’. The family fought bitterly in the hospital and all attempts to mediate between the couple failed. Tanko’s father divorced his mother and sent her back to Sokoto. She cried and lamented, but the father was adamant. Tanko, who was at the time fifteen years old had not yet attained the age of consent. Our hands were tied. And just like that, Tanko became Aisha and was enrolled in secondary school.
The next time I heard of Aisha was a year later when she was rushed to the emergency after an attempted suicide. She had taken the popular ‘ota pia pia’ and was clutching her abdomen in pain. When her file was dug up, the history emerged. Psychiatric evaluation showed a severely depressed teenager who was deeply troubled about her identity. Aisha desperately wanted to go back to her old life where she was a boy. She had been reading a lot about her condition and wanted to go ahead with gender reassignment surgery. Once again, her parents were summoned.
Aisha’s story once again spread like wildfire across the hospital community. A boy trapped in a girl’s body. A real-life intersex, transgender individual. The parents again differed in their opinions, but this time the father caved. The sight of his child on a hospital bed, thin and troubled, broke him. Aisha eventually got better and insisted on returning back to Tanko. A request was sent to the hospital’s ethics committee and after several deliberations, months later, a decision was reached.
Aisha commenced psychiatric counselling which continued until she turned eighteen. After that, surgical removal of the breasts was done. I remember the curiosity that pinched me until I went to the ward to read up her case notes. Testosterone injections were then administered intermittently. Surgery to remove the ovaries and uterus was booked. But just as suddenly, Aisha stopped showing up. When the psychiatrist called her father, he received shocking news.
Aisha was suspected to have drowned in a river. Her body was discovered by fishermen weeks after she was declared missing on the outskirts of Kano city. Her family suspected suicide, but kept quiet. The official statement was that she drowned by accident. Another secret buried.
The reality is that there are people like these, who live among us. People who do not fit into the stereotype of the phenotypic male and female gender. And whether they are Bobrisky or James Brown, the truth remains that we do not know or understand the reason for their behaviour. This life still remains a mystery.
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