This week I’m bringing to the forefront some of the issues that make it hard for women, particularly those of African descent, immigrants, to fully enjoy all their sexual and reproductive health rights. As community health ambassadors, we hear many stories; being too embarrassed to speak up, fear of retaliation and the shame attached to “outing” yourself as a victim of assault, even being too self conscious to speak up because of accents.
One woman in particular told me that she felt she was violated by her doctor and when she tried to report the incident, she kept getting the run round. Eventually she let it go and now she simply will not go to the doctor.
I then decided to create a fictitious person from Nigeria and also created her story ,to try to get you the reader to understand what some women have gone through and /or currently go through.
I cannot emphasize enough this point : THESE ARE FICTITIOUS PEOPLE and the stories are my creative way of bringing to the fore front real issues that women particularly of African descent, experience here in Canada. Any similarities to a real person, is coincidence. (very weird coincidence)
With that said, I introduce you to Ayo from Nigeria
SOMETHING DIDN’T FEEL RIGHT!
AYOLUWA “AYO” FROM NIGERIA
41 YEARS OLD
“Ayolu, Ayouluwa, am I saying your name right?” The young cheerful nurse called out to her from behind the glass window. She got up, walked closer to the front desk, and lowered herself slightly so she could speak directly into the opening of the window.
She had become a master at offering a fake, rehearsed but polished polite smile complete with head nod that served both to pacify and congratulate people for attempting to pronounce her name, even though most times, it was far from being correct. It seemed people in this county felt so good about themselves when they believed they had correctly pronounced a “foreign” or was it “different” name. Who was she to quail their happiness?
“You are so close; I’m really impressed, most people struggle. It’s Ayoluwa but you can call me Ayo”. There! She had provided an extra layer of acknowledgment, elevated this nice young nurses’ attempt at her name to being better than most, if it were class she would be a getting a gold star. She hoped the rapport building mini exercise would translate into the nurse rushing her paperwork and she would finally see the Doctor.
“So, Ayo, there’s a bit more paperwork that you need to complete. You are over 40 so the doctor will have to do a breast exam as well okay? Just sit back down and it shouldn’t be too long now. I’m sorry for the wait. It’s just so hectic today. But it won’t be much longer okay? Thank you.”
Ayoluwa took her papers, started for her seat, grateful that no one had gone to sit in her chair, quickly making a scan of the table to see if the pen was still there. “Ayo, Ayo”, she turned and saw the cheery nurse motioning to her again. Now her chair was surely not going to be there. She plastered her signature smile again as she approached the glass window. “You know what, on second thought just tick the box on the bottom of page 3 and I can take your file back to the Doctor okay?”
So, it seemed the smile exercise had not been in vain.
This had been a long morning and she was ready for it to be done. The humid Toronto summer didn’t help neither. She had been sitting there for close to an hour and a half and the longer she sat the more she realized how hungry she really was. The ladies in the Shelter had told her that before the immigration medical exam, she was not supposed to eat anything from midnight the previous night. After an eleven minute walk in the hot and sticky humid air, 2 buses and a ride in a subway car that had very little air conditioning, she arrived at the immigration doctor’s office.
Apparently, there were specific doctors one had to use for these types of exams and for some reason this doctor was on the opposite side of town. The appointment said to arrive 30 minutes before her appointment and she had arrived 45 minutes before for good measure.
As she climbed the stairs to the third-floor office of Dr. S, she had a brief flash back of home. Elevators not working was something common back there, but seeing an Out of Service sign in Canada struck her as odd. She only hoped that at least the waiting room and subsequent examination office would be air conditioned. She reached in her bag for her cloth and wiped her face as she got to the landing of the third floor. A stream of sweat made its way down her back and all she wanted in that moment was to lie in Anambra River and cool off.
Dr S’s office was a hive of activity and the waiting room was full. There is a belief back home that a doctor with many patients is a good doctor as it reflected his or her work and as she surveyed this waiting room, a part of her anxiety dissipated, albeit momentarily.
Forty one years on planet earth and she had never been to see a doctor. Her grandfather was a sought-after herbalist in their part of the state back in Nigeria and they had a large room in their homestead dedicated to his healing practice.
On any given day, there were many people who came to seek help and many swore by the amazing strength and healing of the concoctions he had in his healing room.
Rows and rows of bottles and jars that had different colored roots and tree barks in water and various other liquids. Dishes of dried then powdered herbs that were given to the “patients” wrapped in old pieces of newspapers. If you wanted to make their grandfather happy, just bring him old newspapers.
For some reason, none of his children or grandchildren had ever needed his healing. Many in their village believed the urban legend which said the water spirits of their fore fathers that had settled on her grandfather and guided him to the “secret valley” where they revealed which trees and roots and herbs had healing powers, watched over the family. The theory had never been tested.
All feminine related ailments fell under the tutelage of great aunt Abebi. Her scope was everything from menstrual hygiene as she understood it, to lessons on the art of how to behave as a woman in the bedroom but only after you were married of-course and everything else culturally appropriate in between.
Her roommate at the shelter had said she would be required to wear a hospital gown for the X-ray but even that made her very nervous. She had never been naked or semi-naked all her life in front of a man except perhaps her late husband. Even then with Uzo, the pitch-black backdrop of their bedroom at night had always been a welcome and constant companion.
Her performance when it came to conjugal relations was executed in the way that great aunt Abebi had so carefully instructed. She dutifully disrobed under the veil of darkness, quick to get under the covers and quickly pull them back up to cover herself. Even in pleasing her husband, she was not to lose her dignity and be “jezebel-like”. It was important to stay a respectable woman such that even with the illumination of the horizon by the early morning rays of the African sun, he could still respect you as his wife and mother of his children.
When she first sat down in the waiting room, forms completed and awaiting her turn with the doctor, she had been grateful for the air conditioning and the chair. As the waiting got longer, anxiety replaced gratitude. Why was this necessary? What if she didn’t go through with it? That flight of fancy she knew, would lead her nowhere. They had given her 30 days from when she entered Canada to get these tests done.
She had so many questions but even the social workers at the Shelter had not adequately answered any of them. The lady on duty last weekend had asked her to “bank” her questions till Monday as another social worker from Africa would be on duty. What did it mean to “bank” a question? The worker apologized and told her that her accent was unfortunately too thick and perhaps speaking to a fellow African would help. She added, for good measure and political correctness, she wanted to make sure that all her concerns were heard. The lady turned out to be from Eritrea, with her own accent. Who would translate for who?
Ayoluwa was so wrapped up in her thoughts she didn’t hear the chirpy nurse call out to her. It took a nudge from the lady next to her to get back to reality. “Ayo, come through and go into door # 5 please”. Finally, she could get this over and done with.
She located door number 5, walked in and didn’t know what she was expected to do. She stared at the thin raised bed, lined with a long sheet of paper and the medical instruments carefully arranged on the shelves. There was a small sink in the corner with little cups shaped like the funnels they used to put fuel in cars back home. The room had a peculiar smell that she could not place. It smelled like medicine, or rather sickness or a something in between.
Just that minute, a different nurse walked in, one arm laden with files and in the other hand a blue robe. “Okay ma’am, I won’t even attempt your name. Please change out of your clothes, put on this robe with the opening at the front. You can leave your underwear on and sit on the bed. Amanda will come do your blood work and the doctor will be in shortly after to speak to you and do the rest of the exam.” As fast as she came in, she left.
She looked around the room again, replayed the instructions from the nurse and slowly placed her bag on the stool next to the bed. Her hands were clammy, heart beating louder now as she realized what was expected of her. Slowly she took off her dress, all the while glaringly aware of how bright the lights were in that small room. She neatly folded her dress and placed it in her bag. She heard a knock, perhaps on door # 3 or was it # 4 and the voice of a man saying “I’m Dr. S”.
Soon she knew the knock would be at her door. She resolved to quicken her pace and be suitably covered up by the time that happened. Bra off and standing in the robe, she wondered whether she would be required to also remove her head wrap. Surely the physical would not include her head!
What was it with the way these medical people spaced the time between one thing and the next? Amanda had since done her part, leaving the room with vials of blood and again, Ayoluwa waited. Mostly naked except for this tissue paper like excuse of a robe and her underwear, she wondered when all this would end. Never in her life had she felt so exposed and the coup de gras was she was to have a breast exam. Cheery nurse at the front had indicated that because she was over 40 this was part of her exam. How was this relevant to her immigration? She had so many questions but after the “my accent is finer than yours” fiasco of last Monday, a part of her wished she spoke with a good accent that was nice and clear.
She heard 2 knocks on the door and in came Dr. S. He was a short stout man, unimpressive features, salt and pepper hair with thick rimmed glasses. He looked at her over his glasses and asked how she said her name. “Ayoluwa, but you can call me Ayo” she quickly offered. He looked back at his notes, wrote something on the paper and as he approached the stool with her bag, Amanda came back in. A small feeling of relief swept over Ayo, welcoming the presence of another female in the room and she begrudgingly made peace with what was happening.
Dr. S kept his gaze affixed to his papers then looked up suddenly. He rattled off some instructions for the nurse, peppered with medical jargon and finished by saying, “I think I’m okay here, follow up on that case for me”. Amanda quickly left and again it was just Dr S, Ayo and the quite drone of the air conditioning.
Finally, he asked her to remove her bag from the stool so he could have somewhere to sit. He went through her forms, asking her all the questions that she had already answered and made markings in his notes. He then asked her to lay back on the bed.
He asked her if she had ever had any operations and she answered no. She offered to him at that point that she had never been to a doctor. He looked at her blankly, but held the gaze as he asked her to affirm her statement. “You have never been to a doctor before?” “No, Sir, never”.
He turned towards the shelf with the medical gadgets and rubbed some type of oil or antiseptic on his hands. He told her to lift her right arm and lay it over her head so he could perform her breast exam. He felt around her breast and said he was looking for lumps. Had she ever heard of breast cancer? Yes she had heard of it but had never known anyone close to her to suffer from it.
He continued to gently press on her breast and he stopped and made a note on his papers. Resuming his exam on the same breast, he started with a kneading type of motion. She would later liken it to how they made bread in the village. He ran his finger around her areola and continued that motion for what seemed to be like a minute. Again, he abruptly stopped made a note in his pad, before resuming his exam. Next, Dr. S ran his index finger on her nipple and she tensed, avoiding his gaze by staring at a small chipped corner of a painting that hung in the room.
Something didn’t feel right! But what did she know? He was the doctor. He asked her to change arms and he repeated the same exam on her other breast. This time he lingered longer on the nipple and asked her if it hurt when he pinched it slightly. This didn’t feel right but all the while he did this he kept taking notes. Surely one does not do anything untoward and proceed to take notes.
Her stomach growled, unable to keep up with the otherwise silence of the room. She had not eaten since last night. He turned back to the shelf of medical equipment, and she couldn’t make out what he was doing. As he turned back at her she affixed her gaze again to the chipped corner of the painting that now provided a distraction from what was happening.
He pressed on her stomach in circular motions and slowly made his was down to the base of her stomach. He asked if she had ever been pregnant and she replied no. He asked her to put her legs in the stirrups. Something didn’t feel right! Dr. S looked at her stomach, gazed at her thighs then asked her to lower her underwear just for a second so he could verify gender. What did that mean? Verify gender!
“Okay so you are a woman”, Dr. S dryly offered and resumed simultaneously rubbing and pressing her belly. He slowly made his way back to her breasts again and rubbed her left breast, then pinched her nipple again. She winced and he asked, “What number would you rate the pain, from 1-5? 5 being very painful.”
Many thoughts were rushing in her mind now, lead among them that something didn’t feel right. Yet, he asked for a pain threshold. Maybe he had “caught” something? “3 doctor. Or maybe even a 4”, she offered. Dr. S, returned to his notes, jotted some stuff down. “Okay, please put on your clothes and I will be back in a few minutes”. He turned, opened the door and walked out, taking his notes with him.
The knock came again at the door and Dr. S walked in, looked at her from above his glasses again and said, “We will send your results to the address on the Immigration papers you gave us. Have a good day”. With those words, he disappeared into the hall and moments later she heard him introduce himself to the next patient.
Ayoluwa was not sure how she felt, how was she supposed to feel? Something about this whole thing had not felt right but Dr. S took notes the entire time. Her mind was now in overdrive. He must have found breast cancer in her. Why had he taken so many notes? What of that feeling that she couldn’t place when he was examining her? Was that how all women felt? What did the pain in her nipples mean when he pinched them? Was he even supposed to pinch her nipples?
Who could she talk to about this day?
Perhaps when she got back to the shelter she could speak to the social worker. What day was it again? It was Wednesday and the one who could not understand her was on duty. The volunteer who understood her accent would be in week after next. She only came in once every two weeks.
Her questions would have to wait till then.