Appendix Over and Out
BYOB in Ghana means something different—bring your own bandages.
“’Loh Ma, howryoo?” I chewed noisily into the phone.
“What are you eating?” my mother demanded.
I swallowed. “A chocolate bar.”
“Are you sure you should be eating chocolate right now? Did they say that was O.K.?”
“Mom, they just gave me a fish head for dinner. It still had the eyeballs in it.”
“Oh my God.” There was a pause, and then, “Nadia, they made her eat a fish head!”
I heard Nadia reply at a volume of one desk away, “Oh my gawd, a fish head?” I imagined them both shaking their heads at my latest disgusting misfortune. My mother’s voice returned to the phone.
“Well, I guess you’re O.K. with the chocolate, then.”
Actually I wasn’t, because it was one of those crappy Malaysian bars—a waxy brown sheen over a wafer that might have been made from compressed newspaper. But as my only alternative to this was fish head, I could hardly afford to be choosy. I looked down at my half-eaten dinner. An eyeball, complete but cooked, gazed blindly back.
I was, at that moment, convalescing from emergency surgery in Korle-Bu Teaching Hospital in Accra. Three days before, I had been traveling to Kumasi, the city in Ghana’s Ashanti region where I kept an apartment during fieldwork, when a frightening illness struck.
Having finished up some research in the chocolate factories along the coast, I bought a bus ticket to return to Kumasi from Accra. With a little time to spare before boarding, I wolfed down a burrito and chocolate milkshake at Champs Sports Bar, the only place where I could get Mexican food in Ghana. So when the nausea first hit, somewhere on the outskirts of the capital, I assumed I was simply paying the price for my hasty, mismatched dinner.
But by the time we got to the rest stop halfway to Kumasi, I could no longer stand fully upright, and the other passengers were shooting me worried looks as I tried to walk around, bent over double. It felt as if a thick, immovable lump of lead had dropped into the pit of my stomach. When at last I climbed into my bed, well after midnight, the inexplicable, heavy pain kept me up through the night, as my resident gecko peered down from the wall above, nervous and twitchy. When morning dawned, I knew I needed to find a doctor.
I dragged myself outside to mime a request to my landlady’s niece, who spoke only Twi, to fetch a taxi. She ran off down the dirt road and arrived back fifteen minutes later with a dilapidated cab. A complicated transaction then ensued, during which I gave the driver, who also spoke no English, vague, second-hand directions to a clinic I had heard of, but never visited, and negotiated a price. We drove for half an hour over pitted, potholed roads, through the choking exhaust of Kumasi morning traffic, searching for the clinic.
By the time I paid the up-front admission fee and settled into an examining room, the leaden ball had migrated from the center of my stomach to the lower right side. Pressing gently on my abdomen, a stately Ghanaian doctor declared that the problem might well be with my appendix, but that it would take at least four hours for a surgeon to arrive from Kumasi’s public hospital, Komfo Anokye, and confirm his diagnosis. Upon receiving this news, I threw as much of a tantrum as the pain would allow, which had the happy result of halving the time it took for the surgeon to arrive, but the unfortunate one of terminating my good relations with the first doctor forever.
“I’m not waiting four hours for the surgeon to get here!” I half gasped, half shouted. “If it is my appendix, it could burst before then!”
“Are you a qualified medical doctor?” he demanded.
“No, but I don’t need to be a doctor to know my appendix could burst,” I insisted. “Everybody knows that.” The doctor turned without a word and stalked out of the room. He refused to communicate with me from then on except through the nurses, who deposited me into a wheelchair and wheeled me to another wing, where I was ordered to lay in bed and not move.
A small but formidable nurse army formed at the foot of my bed, commanding me to swallow an array of pills, from antibiotics to Valium. I refused. We engaged in a battle of wills over the IV drip, which I eventually lost; I lay there, eyeing the thin spoke of metal poking into my vein, hoping it had been sterilized.
With no choice but to wait for the surgeon to arrive, I grasped at the positives. By Kumasi standards, at least, the clinic wasn’t the worst. It seemed reasonably clean, and had some supplies. I had already seen a vision of hell in Ghana’s public health system, when I took my friend Kirti to Komfo Anokye one night when he had trouble breathing. As Kirti was treated with oxygen and a battery of drugs, I stood outside his room, aghast at the sight of the hospital’s apocalyptic corridors, lined with inert bodies on stretchers.
And Kirti was one of the lucky ones—he actually made it into a hospital, and could afford to pay for treatment once he got there. From my fieldwork in the cocoa-growing regions, I knew that access to health care was extremely limited for many Ghanaians, with most rural areas unserved by even a clinic. One heavily pregnant cocoa farmer had told me that when she went into labor, she would have to walk or be carried to the next village to find a midwife. This was not at all unusual.
The inaccessibility of reputable care meant that a shadow market flourished for dubious longevity aids. I’d seen salesmen board tro-tro vans as they slowly filled with passengers and give half-hour long, live infomercials about the amazing effects of the medication they were peddling, usually on behalf of a Western drug firm. Unencumbered by labeling laws, companies promoted pharmaceuticals that claimed to improve memory, delay old age, enhance eyesight, or boost mental capacity. Of course, they did nothing of the kind.
Ghana was also littered with drugs that were outright dangerous, nothing more than a random mix of chemicals in a bottle. I met another farmer who distributed reliable, over-the-counter medicines to her village. As we sat around her kerosene lantern one evening, she explained why she had taken up this side business. It made her money, to be sure, but it was also because she had lost too many friends and relatives to quack treatments. She told me about her brother-in-law, who had purchased a tonic at the local market to treat a stomach ailment. On the third day after buying it, he died. It wasn’t the stomach ailment that killed him, but the tonic.
In comparison, I was fortunate to be in a clinic, with true medical professionals at hand. Nevertheless, the surly treatment I’d received from doctor and nurses alike had made me uncomfortable, and there did not seem to be any official operating theatre. If it came to it, I did not think that the clinic was an ideal place to undergo the first surgery of my life.
After two hours with such morbid thoughts for my only company, the surgeon arrived from Komfo Anokye. He ordered an ultrasound, which, to my despair, confirmed that my appendix was grossly inflamed and needed to be removed at once. He would have to operate immediately.
True panic set in. Until that moment, though I knew that I was likely having an appendicitis attack, I had been able to keep the idea of surgery at bay, within the hazy realm of possibility. When that haze solidified into cold fact—that this man was going to sedate me and cut open my abdomen, and that not one friend or family member in the whole world even knew I was ill—I finally crumpled, and wept. My mind rebelled against the thought of permitting the doctor to perform the surgery in that questionable clinic, while inside my body, my appendix was on the brink of spilling forth poison. Not trusting myself to make any rational decision, I dried my eyes, and did the thing I had been dreading: I called my mother.
Upon hearing that her daughter was facing emergency “roadside surgery” (as she called it) in the middle of Africa, my mother calmly took control of the situation from New York. She conferenced me in with a firm that exists to aid Americans in distress overseas, and I spoke to one of their doctors. After reviewing her information on Ghana, this woman said, “Do not under any circumstances have this operation in Kumasi. Get yourself to Accra immediately.”
And so the decision was made. Armed with only a painkiller and repeated silent entreaties to my appendix not to burst, I paid my bill, rushed home in another dilapidated taxi, packed a bag, and sped to the airport to catch the day’s last flight to Accra. I steeled myself for the journey, wondering if the plane might do me in before my appendix even got the chance.
Although friends in Ghana regularly took the short flight, I had believed that nothing could ever induce me to board that rickety propeller plane and take off from that airport, where the “cafeteria” consisted of an ample woman stirring a cauldron of beans in a dirt yard, and rusting planes littered the sides of the runway. But I could not risk another eight-hour bus ride. I staggered into the terminal and was greeted by the pilot, a jovial Korean man. He looked at me, bent over double and sporting a large backpack, and asked why I was traveling to the capital.
“Oh, I’m having an emergency appendectomy,” I replied, trying to sound casual and not stricken. The baggage screener paused mid-X-ray as the pilot whisked my pack off the belt and carried it onto the plane himself. I boarded as the propellers spluttered to life, and we rose shakily off the runway, the tiny plane lurching sickeningly from side to side. I stared fixedly out the window as we flew high above Kumasi, making odd, detached observations to the guy sitting next to me. Part of me registered how delusional I sounded, but I could not stop myself from trying to make conversation, struggling towards normalcy.
“How green it is in Ghana,” I blurted out, as we teetered southward over the rainforest. The man ignored me.
“Oh, look, there’s the lake where the souls of dead Ashanti people go!” He stared at his briefcase.
I swam in and out of panic, praying continually that my appendix would remain intact for just a short while longer. Forty-five nerve-wracking minutes later, we landed in Accra, the city I had left less than twenty-four hours before. An ambulance was waiting for me on the tarmac. The other passengers gawked as I was whisked away, sirens wailing, to Korle-Bu.
Once there, I was carted off immediately to the operating theatre, where I greeted the friendly surgeon and anesthesiologist as if they were the only people I had ever loved. They chatted breezily about all the things that would happen during the surgery—“And then we’ll paralyze you and shove a tube down your throat to breathe artificially!”—and were soon ready to administer the anesthesia. As they did, I blurted out a desire to see my appendix after they took it out, as if this was some kind of desperate, dying wish.
I awoke to a view of a ceiling. “Where am I?” I slurred. The operating staff laughed, and one of them explained gently why I was there. She brought my appendix over for me to see, in accordance with my maniacal, last-breath entreaty. I glanced at the offending vestige, lying in a green Tupperware container. Then I fell asleep.
I soon settled into my new, appendix-less life. On the first day after my surgery, I enjoyed a steady stream of visitors, none of whom I had ever met before and only few of who displayed any meaningful medical credentials. One guy walked into my room, greeted me, flushed my empty toilet, said goodbye, and walked out. A second man came in and silently mopped half the floor, followed by a third who mopped the other half. Towards afternoon, two brand new people turned up and asked if they could pray with me. Sure, why not? I thought, and invited them in.
The man and woman took up positions at either end of my bed. They didn’t ask why I was in hospital, only if I had accepted Jesus into my heart. I replied vaguely that I had been raised Catholic and they nodded, seemingly satisfied with my relationship with Jesus. They assured me that whatever had brought me into Korle-Bu was part of God’s larger mystery. The man then said some energetic prayers for his own personal well being, while the woman belched repeatedly and impressively at the foot of my bed. Then they left.
The traveling prayer pair was followed by a whole bunch of people who opened the door just to ask where I was from and if I was married. I began to have the feeling they didn’t receive too many foreign patients at Korle-Bu.
At first, nurses maintained a pretense that Korle-Bu was equipped to satisfy all my peculiarly American, post-operative needs. A woman appeared in my doorway on the first evening that I was allowed to eat.
“Madam Kristy,” she began politely, “What would you like for dinner?”
“Thank you, I would love a glass of juice.”
“There is no juice,” she said, shaking her head.
“No juice?” I replied, incredulous.
“No, madam, I am sorry.”
No juice? How could a hospital not have juice? What were they planning to serve me, if not juice? Schnapps? I giggled at the thought. That’s what people always gave me on important occasions in the bush. As the nurse stood there expectantly, however, it occurred to me that she might actually try to give me schnapps. I decided to abandon the drinks portion altogether.
“All right, forget the juice. Have you got any vegetable broth?” The nurse went away, returning almost instantly.
“No, I am sorry, madam. There is no soup. They can’t get it for you.”
I gave up. “Well, just bring me whatever you have, then.” Moments later, my dinner of fish head arrived, on a bed of rice. Feeling starved after days of being fed through a glucose drip, I actually picked at the fish head. It was extremely spicy.
During the day I lurched around, marveling at what appeared to be a pre-colonial paint job and gargantuan cockroaches scurrying along the floor. There were no supplies. And not just luxuries like juice—I’m talking basic supplies. There was no drinkable water, or toilet paper. One day, my bathroom ran out of toilet paper and they had to send someone out to buy a single roll. For water, I had to stagger outside to the pharmacy and purchase bottles of it myself.
My surgeon had insisted on leaving my incision uncovered, explaining that this allowed the wound to breathe and dry and heal. Several days later, my uncovered wound became infected in the peeling, grimy corridors. I visited the nurses’ station to ask for a bandage. “Sorry,” the head nurse replied, “we gave out the last bandage yesterday.” I carried on outside to the pharmacy.
“Hello. Do you have any bandages?” I inquired of the pharmacist.
“No, I am sorry. Did you ask at the nurses’ station?”
“Yes, I did. They’re out.”
“I am sorry.”
“Do you have any plasters?”
“No, we don’t.”
No plasters. No bandages. Back in Kumasi, I had dragged out my first aid kit, which was so extensive I could probably have performed the appendectomy on myself in my own home, trying to decide if I should take anything from it with me to Korle-Bu. I had stopped, in my drugged haze, to remind myself that I was on my way to a hospital. They will have these things there, I thought. Funny, though, because they didn’t.
Days passed, and it became clear that my uncovered wound really did need attention. I returned to the nurses’ station, where a formidable woman scraped off the scab that was trying to form through the pus, and then walked out. She returned with the attending physician, who declared it was necessary to remove the stitches immediately. Chatting animatedly, the nurse cut out the stitches and swabbed my incision, then took out a precious bandage.
At that instant, an enormous cockroach—one of the African flying variety, and the size of my cell phone—scuttled across the white counter, heading straight for the sterilized instruments. I opened my mouth to sound the alarm, but the nurse had already spotted the wretched thing. She moved towards the counter, and raised her hand—the hand holding my bandage.
Impossible. I looked on in mute horror, unable to utter a syllable of protest.
As I watched, the nurse swiftly brought her hand down onto the countertop—BANG!—killing the cockroach in a well-practiced motion. Hard wings crunched into the thick body, flattened across the countertop. Briskly, the nurse swept the remains into a trashcan, and then calmly finished unwrapping the bandage. She reached down and firmly taped the bandage into place on my abdomen, covering my infected wound.
Perfectly unconcerned by this series of events, the nurse met the wild look in my eyes.
“Those cockroaches,” she remarked, “they are so troublesome.”
Kristy Leissle is a writer, professor, sailor, and long-time global voyager. She is happiest when writing about her adventures while having them, pen bent toward battered notebook while life’s extraordinary moments unfold.