I stand before the mirror naked, and I suck in my tummy. The top part of my belly, just below my ribs, sinks in while the bottom part bulges out, hard and round; sometimes the bulge shifts when I lie down. Some neighbours cast knowing looks at my tummy; others come right out and ask, but it is awkward saying, ‘I am not pregnant oh; it is just my tummy growing big.’ I imagine splitting open my tummy and ripping out whatever it is inside. I pray and hope that by morning the bulge will disappear.
I google hard movable lump in tummy and get results like hernia, hematoma, lipoma and tumour. I also read that surgery may be required if there are other symptoms. I close my eyes and press the top of my tummy with the tips of my fingers; then I move my fingers to the side, then below, gently at first, then firmly. I don’t feel any pain, and I don’t feel any discomfort, so I decide I don’t need to see a doctor. A voice in my head whispers, what if… I squash it before it gets too loud. The truth is, I cannot afford surgery; neither can I afford treatment.
Perhaps I am delusional in thinking ignorance would let it go away or let me live longer. The silent killers like hypertension and diabetes deceive us with the illusion of health, but those are rich people’s diseases—or at least they used to be. But what is the use of knowing if I cannot afford the drugs to treat the sickness? Death after all is inevitable, and if I should die today, my body will not be left to rot in the sun.
October is breast cancer awareness month. I should care because I am a woman; I am above thirty-five, and my mother had breast cancer. There are videos on YouTube and articles on Google, teaching how to feel for lumps in the breast and the best time to do so, but I have never examined my breasts—not at home and not in a health facility.
The early morning sun filters through the closed curtains, leaving my parents’ bedroom in a shadow; my mother is sitting at the foot of the bed, in front of the mirror, a comb in one hand, and tuft of hair in another. It is the day after her first chemotherapy. She runs the comb through her hair again, slowly, the fine teeth pulling out more tufts. She raises her head and sees me standing there in the doorway, watching her, and in her eyes I see questions I cannot answer.
She did not go back to the hospital.
For my mother, it was not about money—my sister in America had sent some for her treatment—it was about fear. Fear because the doctor hadn’t told her she would lose her hair this soon, and fear because she didn’t know what else to expect. That was about seventeen years ago, before the internet became a common part of our daily lives.
She was relentless in her battle against cancer; she fought with bottles of herbal concoctions, added ground moringa leaves to every meal, and drank dandelion tea like water; any herb, any food that my mother heard or read about that was claimed to have the potential to fight cancer, she sought it and bought it…it was probably too much because when she died, her liver was ruined.
It is easy to judge. It is easy to ask people why. Why had they stayed home for so long? Why had they not come earlier? When they come to the hospital so late that nothing can be done to save them, it is easy to judge, when you have never gone to bed on an empty stomach. In a country where the average worker earns less than five hundred US dollars a month, even money for transportation to the hospital can be a problem.
When I was pregnant with my first child, I debated between going to the Tema General Hospital or the Tema Polyclinic. The Tema General Hospital brings memories of November/ December 2009. My father was admitted there with a stroke in November. My mother, Efo Victor, Sister Enyo, Uncle Paa Nii and myself were always among the first to arrive at the hospital. Thick antiseptic smells tickled our noses when we entered the ward to see patients lying on the cold, hard terrazzo floor; they had fallen off their beds in the night, and there was no one to put them back. My father was never one of them. We used to help them, and I remember once, this very sick-looking middle-aged man eagerly raising his hands and his legs for us to help him as we approached his bed. That day, I finally understood this saying that we have in Ghana, literally translated, if your enemy will get you, it is through illness.
I don’t remember the name of the ward, but in my mind, it was the Death Ward. It seemed someone died there every day. There was a bed shielded with curtains, isolated from the others in a small corridor where we could all see. That was the place for the dead and the dying. The mortuary man would come rattling into the ward in the mornings with a rectangular tin with a dome cover on a gurney. He was so focused, so professional in dealing with the dead. He would rattle straight to the corpse, heave and haul it into his tin, snap the cover shut and rattle out again; this time, the sound muted with the weight it carried. We tried not to stare, but we could not help it.
After a week my father was much better, but his legs were still weak. We live at the Segico flats, Community Four, on the third floor. There is no elevator. We knew that once my father got back home, there was no way he was going to have physio. Who was going to carry him up and down those stairs? So we pleaded for him to be allowed stay and start the physiotherapy so that we could take him home when his legs got stronger.
The next day, my father’s bed was empty; he had been transferred to a mattress on the floor of a smaller room. This, according to the nurses, was to prevent him from falling from his bed.
The day my father was transferred from the bed to the floor was the day that broke him. He would pull at his bed sheet, listless, and stare at the wall all day. He started to fade until he was barely there, and the only words he would speak were, ‘ayi aphame’, I want to go home.
On December 8 2009, two days after we took him home, my father died. When we took him back to the hospital, his folder could not be found at the OPD, so we went to the ward where he had been on admission. An assistant was reclining in her chair when we came in; after she heard our request, she said, ‘When we are tired and we want to rest, you people will be bothering us.’
On December 23 2009, we rushed my mother, unconscious, to the same hospital because we didn’t really have a choice. In her state, no private hospital would take her in; even if they had, they would still have referred her to the Tema General Hospital. My cousin, Emmanuel, parked his car at the entrance of the OPD. People were sitting close to the entrance, watching us as we struggled to get my unconscious mother out of the backseat and into a wheelchair because that was what we could find. Some made suggestions, but no one offered to help. My mother was a thick woman and unconscious; we could barely lift her. Finally, we managed to get her on the wheelchair and wheeled her, her head lolling to the side, to where the nurses were, before she was placed on a gurney to await a doctor. The doctor, a young man, came in his white overcoat, with his stethoscope around his neck. He must have seen it all, because after checking for her pulse and heartbeat, he threw at us ‘But she is dead’ as if we should have known better than to have bothered bringing her there in the first place.
Since she was declared dead on arrival, the hospital could not keep her body. The gurney was pushed outside the doors of the OPD, where everybody, leaving or entering, could see my mother lying there, her eyes closed with the wind blowing at her dress. I could almost swear I could see her chest rise and fall.
The Tema Polyclinic won even though at that time they had no caesarean. At the polyclinic, the midwives were like personal friends even though most of the pregnant women were from the poor communities in and around Tema. There were no teenagers and no adults, no paupers and no rich, no insults and no criticism; every pregnant woman was treated with the same care and consideration. If a woman’s haemoglobin level was low, she was advised to eat well; if she was too weak, the midwives would even get food for her just to make sure that she and her baby were fine.
In those days, the National Health Insurance Scheme (NHIS) was a blessing, at least for pregnant women. Lab tests were free; scanning, when it was available at the hospital, was free, and the drugs they gave to us were free. I remember going home with my full monthly requirement of red, gold and green (multivitamin, folic acid and iron tablets); they were cheap drugs, but they worked.
Finally, when the day came for me to give birth, I did not spend a pesewa, not on drugs and not for the bed.
With my second child, three and half years later, things were a little different. Now there was a theatre for caesarean, which was a relief, but we were in the dumsor (power rationing) era.
During each visit, we were each required to pay three cedis for the running of the hospital’s generator. These three cedis were our little contribution to ensure that when any of us got into labour, there would be fuel to power the generator. This time there were no free drugs, and for every night spent on admission, we would have to pay thirty cedis; all other things were still covered by the NHIS.
I must have been in my sixth month when the midwife failed to hear my baby’s heartbeat. She told me to wait, went out of the examining room and called in some other midwives. They placed the Pinard horn at different positions on my tummy, and took turns listening. None of them could hear anything. At that time, doctors were on strike.
I was told to go for a scan, and I remember wondering what I would do if my baby was dead. If I could not afford a normal birth in a private hospital, how could I afford the cost of a caesarean which cost roughly three times as much? I remember praying as the physician smeared the gel on my tummy and started moving the wand. When I saw the tiny heart of my baby beating, my heart smiled. The midwives shared my joy.
In May 2022, the Daily Graphic reported an increase in maternal mortality in the country, from 776 in 2020 to 875 in 2021. This is an increase of 12.8%. In January, it was in the news: a woman died after a caesarean section at a hospital in Takoradi; she had developed complications and was to be transferred to the Korle-Bu Teaching Hospital in Accra—a four-hour journey. There was much delay because her husband was required to pay for fuel for the ambulance before his wife could be transported to Accra.
Neem trees grow abundantly in my area. The neem tree is said to have the ability to cure many diseases. At the height of the Covid-19 pandemic, we would boil and drink the leaves of the tree once a week. When the children found it too bitter to drink, we made them inhale the fumes. We could not afford to get sick.
Most of us cannot afford and do not trust the healthcare delivery in our country. Drugs and herbs are sold everywhere: on buses, trotros and on the streets; there are placards and posters showing their efficacy and potency. Some are even advertised on TV. They are cheap, and there are claims that some really do work. While our leaders are travelling abroad to check their blood pressures, we are also here, doing what we can to survive.
One day I may become a cautionary tale of, ‘if she had come earlier, she might have been saved.’ But a diagnosis is just the first step, a step that most people cannot get beyond. Our only options are really God, religion and faith. So just like how we handled the Covid, we drink our herbs. And we bury our sicknesses in our hearts and pray.
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