I sit on the steps of the Mannah Mission Hospital, which, according to the bronze plaque prominently displayed right here on the entrance steps, is supported in part by the generous contributions of the Wills Family of Nashville, Tennessee in their mission to provide an effective blend of compassionate medical care and spread the Gospel of Jesus Christ. On this last count the establishment is top notch- services in the hospital lobby have begun, in English and Ga, to the morning congregation exactly at 8 AM, as promised by the numerous signs tacked to the wall. Not so for the first, as the doctor who was promised to arrive at 7 AM is nowhere to be found and Asia, a friend of Lara and Nicole’s from Colorado who has by coincidence been visiting Ghana right when we are, now lies in a sweltering air conditioning-less ward in back with an I.V. in her arm and vague assurances that the doctor will be in soon, this morning, don’t worry.
Despite this, it’s a step up from last night, Asia languishing with a fever in a second story room while Napoleon’s mother cooks up a traditional herbal remedy and Nicole and Maya set aside natural herbal supplements, none of which do much to change the fact that Asia looks for all the world like the illustration next to the dictionary definition of malaria. Later she was taken to a clinic, where a doctor prescribed pills for malaria treatment, which she promptly vomited after leaving. Arriving back to our house she looked as drained, flushed and out of it as ever, and I finally decided enough was enough and hustled her into a cab with Bongo bound for the nearest hospital. Jarvis, the eye-rolling, eternally drunk attendant at the house, tags along in the cab at the last minute- for what we’re not sure since comic relief at this point seems a little beside the point. We bounce down tiny dirt alleyways to one clinic- it’s closed- and then to another, the Mannah Mission Hospital, which seems as hidden away and hard to find as a CIA outpost. The matronly nurse on duty refuses to treat Asia, claiming that they cannot treat malaria without a test to determine whether it is in fact malaria, which cannot be done until morning she says, so go home and put her to bed because she looks fine anyway.
This last point is, in fact, partly true- Asia does look relatively OK, but I know that this is more due to her graduating with honors from the School of Looking Better Than You Feel than to any improvement in her condition. When I protest that Asia has been vomiting and hasn’t eaten in three days, the nurse loudly berates me for failing to look after this girl who was in my care. She’s right, and strikes a nerve in me that knows we should have swept Asia up and into the arms of Western Medicine at the first sign of trouble, instead of leaving her behind while we all went to Labadi Beach and tested race relations on stage in between puffs of African marijuana and swigs of African beer, and then in the care of Napo’s mom, Nicole, Lara, and Maya, all of whom were convinced that herbs could cure anything. “How dare you let her no eat for days? This woman who is supposed to be in your care! For shame!” she yells at me.
“Is there a remedy?” asks Jarvis, his eyes rolling and his croaking voice sounding like it’s his first utterance in days.
The nurse, unsure whether Jarvis is referring to Asia’s condition or to my supposed carelessness, looks at him quizzically. Bongo and I, unsure whether Jarvis knows he is in a hospital right now, ignore him.
The nurse, apparently deciding right then that Asia was entitled to have a say in this discussion of her health, asks Asia how many times she has vomited, and as Asia answers her I walk away into the lobby, figuring that my presence and hot-headedness will only inhibit the conversation between Asia and the matronly nurse, which at that moment was surely leading the nurse to conclude that Asia was, in fact, sick with malaria and would prescribe her the necessary shot which would enable all of us to jump in the same cab that took us here and return home with Asia, healthy and triumphant.
At that moment Bongo beckons me back to the room, where I learn that the nurse has in fact relented but now says Asia must stay overnight and have an I.V. drip in her arm so that she can get her strength back and be treated by the doctor at 7 AM tomorrow. Asia, no doubt weary and sick not just of her condition but also of so much discussion of it, readily agrees that this sounds like the best plan, and before Bongo, Jarvis, the cab driver and I leave I promise to return and keep her company in the morning.
On the cab ride home Bongo tells me I did the right thing, that it was right to bring Asia to the hospital, that every September he gets sick and that even the Ghanaians get sick from malaria and have to be careful. I tell him I am worried that Lara and Maya refuse to take any malaria medication- just like Asia- because it isn’t natural.
The next morning I wake at sunrise and catch a cab to the hospital on my own. When I get there the matronly nurse demands to know why I did not bring Asia any food- food apparently being an added extra as far as hospitals here are concerned. I head out onto the streets in search of anything that looks like breakfast. Asia has requested bananas and, being new in Africa, I bring back plantains, and then eventually take a cab to a market and find bananas and coco milk with dough balls, all of which takes over an hour and during which time Asia lies hungry and unattended by any doctor in the ward back at the hospital. When I finally get back with the food it is an hour past the time when the doctor was supposed to come and look at Asia, but now that it is 8 AM and time for the services in the lobby all other activity in the hospital grinds to a halt as every single employee and a few of the patients line the makeshift pews and sing hymns and listen to the service.
Which is how I got here, sitting on the concrete steps of the hospital in the growing African heat, passing my time by writing in my journal and ruminating on the link between American bible belt evangelicals and African health care, when Big Nurse appears in front of me, evidently concerned about something for the first time since we met last night.
“Why you no take the service? You no like?” she demands.
In a split second I decide not to tell her I’m Jewish, not to tell her I’m not religious, not to tell her I’m uninterested in Christianity or any kind of religious worship at the moment, and not to ask yet again if the doctor will see my friend soon (since it’s obvious right now where the doctor is).
“It’s all right, I’m OK.” I reply.
“You OK?” she says, sounding perplexed at the thought that I could be OK without sitting in one of the pews in the lobby following the service along with everyone else.
“Yeah, I’m OK.” I say, sounding as confident as possible. Maybe, I think, my refusal of religion will speed the process of the doctor visiting Asia so we can get out of here and get on with being in Africa, since surely Big Nurse doesn’t want any heathens hanging around the hospital. Although maybe, I counter myself, this will only make things worse, maybe I have angered her and maybe I should just bite the bullet and sit in one of the benches for the service. I start to worry as Big Nurse stands before me, considering in her mind my refusal of religious salvation.
“OK” she says lightly, shrugging as she walks back up the steps and into the service.
The service lasts an hour, and then there is another hour of waiting in the heat for anyone to look at Asia, who alternately comes outside to hang out and says she feels fine and wants to go and then gets sick and lies down in her bed in the ward. As the minutes turn to hours, we are told she must get the test to determine whether she has malaria before the doctor can see her, and are given a prescription list of medicine that we must buy before she gets the test. Apparently treatment is conditioned on diagnosis but payment is not.
This leads to me asking at the pharmacy (a window and teller right down the hall from the ward) what all these drugs we are supposed to pay for are, and being told to just pay for them at the cashier desk (prominently positioned in the middle of the hospital lobby) and then come back to the pharmacy to sort it out. Somehow Asia talks her way into being tested in the laboratory (a room down the hall from the pharmacy) without paying for the drugs, which leads us to another round of sitting around in the ward and out on the steps, waiting for a doctor to come and tell her what the test results are, all the while fending off demands for us to go to the cashier and pay for the drugs we don’t know yet if she needs. All the while everything here, except the repeated instructions to head to the cashier desk, happens at the same leisurely pace we have come to expect when ordering food or waiting for a tro tro to start moving. Which means I shuffle back and forth between sitting on Asia’s bed and keeping her company when she feels like keeping her eyes open and sitting on the hospital steps in the precious shade of the increasing midday heat when she doesn’t.
Through it all I talk myself into believing that all of us should see this, touch this, experience and taste this visit to a third world hospital, if only to have the disorganization and chaos make us run straight to the airport or pop every pill and chemical we have as a defense against ever having to set foot somewhere like this again. And this, I am sure, is one of the better hospitals, Africa-wise. There are concrete walls, for example, and a pharmacy here that stocks the medication Asia needs, even though getting them to just prescribe it so we can be on our way has been about as easy as flying through Accra in rush hour, the notorious “Go Slow” period when every road becomes a parking lot and an afternoon trip to buy cell phone units or find a bank gets you home well past dinnertime. God forbid you should get sick in the Sudan, or Sierra Leone. I have to keep reminding myself that Ghana is well off for Africa, and that Accra, a relatively modern city, is well off for Ghana. This is easy to forget when your taxi is navigating a sandbank in the middle of a boulevard, water for your shower and toilet won’t be turned on until next Tuesday and the open sewers that line every avenue and alleyway here smell exactly as you’d think they would.
Indeed, Ghana’s economy being well off enough to attract migrants from neighboring countries like Nigeria and Ivory Coast apparently doesn’t mean it has the infrastructure to support and stock critical services like hospitals in the way we think of that in the West. Asia eventually does see the doctor- late in the afternoon, when she has treated everyone else in the hospital, as she is the only doctor in the entire building. Our annoyance at the repeated nagging by the hospital staff to pay up at the cashier desk was understandable- but so too, when you think about it, is their focus on our paying for the medicine and service they are supposedly providing. I’m quite sure the Mannah Mission receives little if any financial support from the Ghanaian government, hence the adherence to priorities laid out by wealthy Nashville evangelical Christians. At one point the matronly nurse yelled at me for asking, yet again, when the doctor would see Asia. “This is not United States! We don’t have the things you have here in Africa! The doctor will see her so just wait!” I replied that yes, I knew that was true but was only trying to get my sick friend some attention, but the stark differences she so indelicately pointed out only became clearer as the day wore on.
Asia’s test results come back negative for malaria, but the doctor says she does have malaria anyway since she has all the symptoms. This leads to her finally getting the shot she needs and her heading home in the car driven by the family she is staying with on the other side of Accra after dropping me off at the tro tro line, but not, of course, before a final round of wrangling with the cashier at the hospital over exactly what medicine she needs and exactly what medicine she has already taken.
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Over a month later, back home in San Francisco, I sit and joke around in a sixth-floor Berkeley hospital room with David, who has emerged from a coma a couple days earlier brought on by cerebral malaria. Feeling sick and feverish a full two weeks after we had left Africa, he checked himself into an immunization clinic, which told him the malaria test was negative and to go home. A few days later, he wisely disregarded that advice and headed straight for the hospital, ending up unconscious in intensive care, his family and girlfriend rushing to airports in Vermont and Kansas, all of us waiting for three days with baited breath and wondering at the seeming randomness of it all until he woke up. As Tracy and I show him pictures from our trip on my laptop and joke about the wires attached to his skin, this sterile, million-dollar room with million-dollar equipment somehow reminds me of the Mannah Mission, its gleaming electronic heart monitors echoing the battered file cabinets in the Mission’s lobby, the wall-mounted TV silently projecting PBS in the corner bringing to mind the ceiling fans in Asia’s ward that spun in the endless losing war with the tropical heat.
David gets better and is eventually home, leading everyone to breathe
a silent relief that this didn’t happen in Binaba, or on the road in Togo or, God forbid, Nigeria, where a search for a decent hospital would have turned into a truly life-threatening odyssey. But on the other hand, I can’t help but wonder- David was sent home from a clinic here in the USA which told him his malaria test was negative and he had the flu. Asia was told her test was negative too, but that the malaria parasites sometimes migrate from the blood to the liver and are thus undetectable. She was prescribed a shot, left the hospital, and that night arrived at our show in the Accra Art Center looking bright and healthy. David went home and languished in his own room for another day before taking things into his own hands and checking himself into a bright, modern and enormously expensive Western Hospital. African health care is unfortunately still a poor cousin, stripped of resources and starved of manpower. But at least its foot soldiers know what malaria is and what to do about it.