Aisha Jalloh takes one of the hard, smooth balls of clay and rolls it in her hand. It looks like a fossilized dinosaur egg.
"I know it is bad but I wanted to sustain the baby, so I eat it," she says, looking at her newborn daughter. While she was pregnant she would eat between 10 and 15 balls of clay each day. Sometimes she roasted them, sometimes she ate them plain. The old women in her community told her the clay would make her baby strong and remove "bad water" from her stomach.
"When I ate it, the vomiting stopped," she says. She understands the idea of gnawing on a rock-hard piece of clay may seem bizarre, but it's surprisingly common among her friends and family in rural Sierra Leone. Most mothers waiting with her at the maternity clinic admitted they also ate clay.
"It's cultural, it's traditional," said Ms. Jalloh's doctor, James Smith. "We have been telling them to stop taking these things."
The ingestion of earth or clay, known as geophagy, is a little-known but relatively widespread phenomenon in parts of Africa and Asia. It's usually consumed by pregnant or lactating women in order to reduce nausea and supplement a mineral-deficient diet. Some researchers suspect the clay coats the gastrointestinal tract and absorbs toxins, which is why a substance commonly found in the clay is used in some Western anti-diarrheal medicines. But it can also contain harmful parasites and cause lead poisoning, intestinal obstruction and colon rupture.
"It is not medicinal," said Osman Kamara, a local pharmacist who treats many women like Ms. Jalloh. "It leads to appendicitis and operations during delivery."
Dr. Smith said it may also affect the fetus by inhibiting the absorption of nutrients, especially if the clay is ingested in large quantities.
"During the first trimester it might contribute to congenital defects. Babies sometimes have defects, which at the end of the day parents attribute to witchcraft."
He and other area health practitioners have recently started trying to persuade their patients of the potential danger, but so far few women have been willing to listen.
"Illiteracy is very high among women ... about 75 per cent," Dr. Smith said. "We have been telling them to stop, but these people are poor and do not have an alternative."
Many women like Ms. Jalloh say they eat clay because they often can't afford food.
"Sometimes when I'm hungry, I will eat this because of poverty," Ms. Jalloh said. "It helps sustain my life."
Which is why some experts are now switching the focus of their campaign from the customers to the clay miners.
Not far from the hospital, an entire community labours in the midday sun, knee-deep in mud. The men dig the pits and sieve the clay. The children haul off the buckets, and add salt and herbs. The women break the clay into pieces and roll them into balls. The balls are then sold in bags of 12 at markets across the country. One bag sells for 100 leones, the equivalent of three cents.
"We are not happy doing it," said John Kamara as he wades back into the pit and pours out a bucketful of clay. In a good month he will earn about $60. "I hope after my children are educated they will take me out of this filth," he said.
Some community groups are hoping to curb clay-eating by giving the miners a way out.
"If they're going to stop, they need a substitute," said Ramatu Fornah of the Women's Action for Human Dignity, a community-based organization in the heart of Sierra Leone's clay-mining district. "We've targeted about 30 of them and are teaching them agriculture."
With Western fundraising focused on deadly diseases like HIV and malaria, there is very little money available to tackle a problem as obscure as clay-eating. But experts say it's not an issue facing just rural Africa. Clay-eating was spread by West African slaves to states in the American South like North Carolina, where the practice has endured, albeit underground. And due to the arrival of thousands of African immigrants to England, edible clay is even sold in a few London markets.
Dr. Smith said he's not aware of any medical studies about the effects of geophagy on pregnant women and insists more research is desperately needed.
"I don't even know the ingredients of this clay, so we need to do further studies."
But Ms. Jalloh said no study will convince her to stop eating it during her next pregnancy.
"I nearly died because of starvation but [the clay]has helped sustain my baby."