Monday, July 17, 2006

Diagnosis of a foreign frame of heart…

Have you ever seen people waiting in a hospital waiting room? They are exhausted (at least in Canada, where “hallway medicine” is the plague of the socialized health care system) from spending hours in the most unencouraging environment possible – but let’s be serious, even if it was painted bright colours and had patient, thoughtful counsellors on hand, it would still be a hospital. You would still be wondering whether your friend/relative is going to make it. They have the smallest of hopes that keeps collapsing like an ancient vehicle revived with duct tape and shorn bolts; the babies are crying and crying and no amount of cheering up can make the noise go away; the 5 year olds are bawling away, and their fathers are pacing up and down, up and down, to quieten them. Harried looking doctors, nurses, therapists, emergency paramedics, are running in and out, and the whole business resembles some sort of sick twilight zone.

I won’t say that I hate hospitals – I don’t, and to be honest there are few places I’m thoroughly uncomfortable in and hospitals aren’t one of those few. But I hate the feeling of helplessness. I hate that everyone is wholly alone in their silent but intense worries, I hate not knowing the answers.

I still remember, when I was 8 or 9, in the emergency room waiting for my mom (who was very sick at the time), seeing a doctor sitting on a bench, rip his green cap off, and just cry. I almost threw up. I had unending, almost mythical-power imbued confidence in the medical system. It was just a question of getting there in time, and voila - ! Illnesses would be gone. (Don’t be quick to blame television – I was not an E.R watching child). That was why I always wanted to be a doctor, so I could make people feeling powerless and hopeless feel better. Magically. So here, here was that hero that I so admired, that smart, thoughtful, caring, and all-knowing doctor, of the same variety that should be curing my mother, broken down?! My world was shattered.

I am no longer 8 years old, no longer full of naïve optimism regarding those questions of illness and wellness, or sickness and health. I know how quickly people can go from the laughing, joking, sanguine and ebullient individuals we know and love, to a loose assembly of decaying collagen and broken systems, lying in a box in a hushed room. Mortality is viewed with uncompromised realism on this continent; I’m told constantly (in regards to many things: why haven’t you married? Why don’t you have children? Why are you away from your family?), “you can die tomorrow”. And indeed, you can. And when you do, life will go on, as it has enduringly, for eons on the flat timeless grasslands of the sub-saharan Sahel.

So armed with these thoughts, and of course curiousity (admittedly, I’m still wanting to be a doctor; with some back-of-the-mind thoughts regarding using my profession to build people’s capacity and help them escape poverty..) of seeing a Ghanaian hospital, I hopped on my bicycle this morning and made the 5 K trek to Salaga Hospital.

[What was I doing there? During the last Tamale training, I slipped and fell in a gutter. I had a bunch of small cuts and bruises on my leg, and thought nothing of it. A week and a half later, small cuts have turned into festering sores and boils. My leg is infected and the infection is spreading around my ankle and up towards my knee. The whole apparatus of leg, ankle, foot, knee – they’re not happy and its clear. I would have just let it take its course, but recalling stories of previous EWB volunteers suffering the severe repercussions of this kind of negligence, I’ve decided to give the Cuban doctor in the hospital a go..]

So I arrive. Ghanaian hospitals, I find, don’t have clear signs on what to do and where to go – I wander through the X-ray clinic, the reproductive health centre, one or two sick wards, and finally I see a family friend, Mme. Maria. She directs me to the nursing station to ask them some questions. Already I have a growing fear that while striding past rows of people seated on grass mats, holding babies, that I’m bypassing the regular line, in the worst way. But the nurses see me and call to me.. Soon I’m asking them how to get a card to see the doctor, and instead they’re examining my wound. ‘Do I want to see the doctor or do I want a card’ I’m asked… Well, I want to see the doctor, but I thought the card was how…? Before I can speak, I’m taken through rows and rows of people, by hand (the nurses are all men, and tremendously “impressed” that I managed to bike to the hospital in my “condition”. I’m starting to get worried. I don’t have a serious condition. I could have waited even a day or two to get there…) right to the doctor.

Hold the boat. There are rows and rows of people, collapsed on wooden benches (no fan), outside the doctor’s office. Shivering with malaria, screaming babies, and red-eyed mothers, hacking coughing and laboured breathing – the most acute of cases have been brought to the Cuban doctor – and all too sick to even greet one another (tantamount in Gonja culture). As I walk up with the nurse; their eyes follow me asking, who is she? Is she a new Cuban doctor? Is she a nurse? Meanwhile, I’m all but thrust past the curtain to the doctor – WHILE she is seeing another patient. I’m about to cry. No, no, no! I don’t want to see the doctor now, I’m not dying, I don’t have malaria, liver pain, or fever – I just have a stupid sore that’s infected. I could probably hold off another few days with neem poultices and salt water baths! Please!

But no, they insist. They ask me, will it be quick? Well…yes. I know my foot is infected, there is little question about that (its happened before – summer of 2005, I stepped on a pencil and wore my dirty folk fest sandals. Bam! Tendon infection..couldn’t walk.). I know I need antibiotics, either ointment or pills. I just need her to write the prescription. I can wait.

But my fuss making is even wasting time. What do I do? I give in. I explain rapid fire, my situation. There are no Apoorva jokes, there are no greetings, there are no questions. Foot infected, need antibiotic. That was the totality of my explanation. Dr. Lien Lopez gives me my prescription and I bolt out of there, past the rows of watching and waiting eyes, too embarrassed, ashamed for them to see me. I don’t ever want to be back there again, robbing the people who have waited patiently for their health care, for hours, of their chance to see the doctor. I don’t ever want to feel that sickening nausea of privilege, I don’t want to remember the $100 box of doxycycline malarial prophylaxis in my cupboard at home… four months salary for a East Gonja farmer. The nurse chases me down; “Madame! Madame! Do you know where to buy the medicine? You left so quickly!”. No, I don’t. I was too guilt-stricken to think logically. So they send some boys on bikes with me to show me the dispensary.

About 25 minutes later, I’m biking home, uphill, exhausted, upset, and my leg is now killing me. All I can think of is getting home and not riding this bicycle. I have promised the nurse at the hospital that I will come and volunteer there a lot whenever I have time.
I’m still working out what I think – do I pity the people who are waiting? No, I don’t pity them. Pity is a disgusting emotion, it’s an ‘us’ and ‘them’ idea, wholly connected to money-throwing solutions. I’m disgusted more that the people who have become my friends, my family, the hairdressers who I greet each morning biking into town, the ladies who make soap with Mme. Janet; Sister Rebecca and Sister Helena and Auntie Maisie, they who graciously treat me as their friend and take care of me, if they were sick they would have to wait hours. And I have just bypassed them all in line. I didn’t even get a card.

Would we do that in a Canadian hospital? “Oh, you are German! British! Brazilian! Ghanaian! Fijian! You don’t have to wait to see the doctor! We don’t need your insurance or your medical card! Just go on ahead!” Yeah, right.

So now, I’m sitting in my room, upset that I can’t go out to the villages today with my friend Mr. Al-Haji Skipio Osman, because my foot is too swollen to wear shoes. I’m surrounded by the tons of antibiotics I was prescribed and the waiting, the patient, hopeless waiting, of the people in the benches – it just won’t leave me. There was nothing different here that you wouldn’t see in a Canadian hospital (okay, the Malaria..but still), the people were no more pathetic, no less dignified or worried. It was how quickly they were bypassed, their lives and waiting and patience was devalued by my arrival.

I’m at a loss for words; what do you do, in the afternoon, when everything seems the same, but your life has suddenly been given immense weight? When the final and ultimate privilege of health has been extended to you, and you didn’t even ask? I have fought with privilege for many years, but now I’m admitting its existence – what do I with it? When everything you’ve ever done comes under that sharp scrutiny of that perfect Galilean lens; when you miss everyone and everything familiar and you speak to your pillow (because Teddy is miles away, at home..), and ask – what am I to do with this imperfect offering that I’m supposed to call my life?

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