Breathing Desp(air)

The past two days have been the hardest for me so far here at Komfo Anokye Teaching Hospital. Since I arrived, I have heard the nurses, midwives and doctors say that many of the women die here because they lack insurance or money to pay for simple life-saving procedures. Some days I come to work and see a woman in the “dark room” (where the pre-eclampsia and eclampsia women are) and see a woman with her eyes rolled back, gasping for breath. And the next morning she would be gone, having passed away. I have also arrived on the ward to watch as the mortuary workers have come and collected these same women. But it has always remained impersonal – abstract and hollow. The imposing smell of death, despair and despondency engulfs me, sneaks up amid the silence where crying and grieving ought to fill the air. It’s as if, at the end of the day I leave the hospital feeling exhausted and empty without really knowing why exactly, despite what I see.

This detached state of being was shattered on Tuesday for me. It was my day to interview, and I was interviewing a woman my same age that had come here with severe ante-partum haemorrhaging. She described how she began bleeding heavily at midnight. She immediately set off walking for the nearest maternity home/midwife about 2 miles away while her husband frantically went around the rural village trying to secure a car. She had to stop on the way more times than she can recall to catch her breath, and each time she did, she would bleed profusely on the road. Her husband caught up with her on foot when she was almost at the maternity home- I took a full hour of walking, resting and bleeding before she arrived. Once there, the midwife referred her here, and drove her here immediately. But she arrived at 2:30 am, and had to wait another 6 hours to get a caesarean section, at which point two still born twins were delivered. The story was heartbreaking and made me so angry at all of the delay- to have to walk an hour!

While she was telling her story, a woman walked by who I’d been introduced to three days previously – she had just lost her baby and was wandering aimlessly through the hospital.

Throughout this entire interview, we were constantly interrupted by a woman in a bed across from us (there is no way to get the privacy we should have for these interviews in this hospital when women sleep two-to-a-bed). She was sitting cross-legged in her bed, moaning, screaming, gagging and coughing. She seemed incoherent, one minute talking to herself or singing, the next minute screaming out for the doctor or nurse- all of whom just stared at her and ignored her. It was so disturbing for me, especially amidst the despair of the story I was collecting.

I asked about this patient, and found out that she had renal failure. She had come to deliver, and had a stillbirth. She was discharged, but our hospital has a policy that if you have no insurance and are unable to pay the bill, the hospital essentially holds you hostage until your family pays it (so for instance there is a woman with her now month-old son who has been here since she delivered, waiting for her husband to come up with the necessary money). And during this time, her kidneys began to fail. The doctors weren’t going to put her on dialysis because she hadn’t even paid for her delivery. But a med student begged and was able to get them to front four dialysis sessions for her, after which she had greatly improved (although was still not totally cleared of the toxins in her blood).

Meanwhile, the government’s “social welfare” officers had gone to her home and assessed somehow that her family should be able to pay for ¼ of the bill. However, her family couldn’t even come up with that. So by the time I saw her on Tuesday, her kidneys had degenerated so badly that she was severely edematous – her whole body swollen from all the fluid in her tissues – and more disturbing was that the poisonous toxins building in her blood due to the kidney failure was making her delirious as the blood poisoned her brain.

Thus the current situation in which I saw her. She kept yelling out to the nurses, who were laughing and told me that she wanted to drink bleach…she wanted to die. Their laughter was both incredulous and pained, as they stood helplessly as they watched her fade. Meanwhile the women in beds around her tried to tune out her screams….

I felt so claustrophobic then – as if I was in an asylum where women were sent to die – and suddenly the full weight of the stale air dropped on me and I wanted to run out as fast as I could, my heart in my throat. Unfortunately, I had to finish my interviews and data entry.

On Wednesday I prepared myself to hear her or see her when I returned in the morning. But her bed was empty. She has died around midnight.

I was not ready for her to pass so quickly – for the full force of injustice to pass so swiftly – and to witness the ward continue as if nothing had happened. I could sense her soul in the air, and it was then I think I decided that the stale, heavy, opaque-tasting air may well be made up of all the grieving souls who have died in this ward without any of their family by their side – without ANYONE by their side. And maybe this is the cause of the indescribable weight I feel in these halls.

While I am confident that the research I am doing will have some sort of impact on the state of maternal mortality in Ghana, it is painful to watch helplessly as so many women die who might have been saved if born in a different country.