A Conspiracy of Silence

Sometimes we come across stories that are stranger than fiction, tales that sound positively fallacious and yet, are owned by persons living these incredulous truths. Over the years, I have trained my mind and most importantly, my face, to master the art of appearing indifferent whenever I hear a shocking narration. People come to the […]

Sometimes we come across stories that are stranger than fiction, tales that sound positively fallacious and yet, are owned by persons living these incredulous truths. Over the years, I have trained my mind and most importantly, my face, to master the art of appearing indifferent whenever I hear a shocking narration.

People come to the hospital to find answers, for treatment, for healing and to find comfort and succour. No one comes to be judged by the doctor, hence, in my opinion, a listening ear is the most important quality a doctor should imbibe in their career.

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It was during a routine ante-natal clinic that I first met Aisha*. She was a thirty-nine-year-old woman and this was her sixth pregnancy. The previous five children belonged to her first husband who had died two years ago. Aisha remarried six months ago and was now pregnant for her current husband. She had normal pregnancy symptoms and everything seemed standard. I gave her the routine tests to do and booked her next appointment for six weeks. Routine ANC stuff, that is, until she returned for her next visit.

This time around her eyes were blood shot and it seemed like she had lost weight. She stared gloomily at the wall as I perused her test results. I soon saw the reason for her red eyes- her HIV serology was reactive, meaning she was positive for the virus. Aisha had already been given the routine post-test counselling so she had an idea of the journey that lay ahead. When I asked her how she contracted the disease, she bowed her head and burst into tears.

‘It is my husband.’

‘I am sorry.’ I replied. ‘Your present husband? Or your first husband?’

Aisha married her first husband immediately after secondary school at age of seventeen. He was a business man who sold wrappers in the market. It was a typical northern polygamous set-up, with the husband marrying more and more wives as his riches grew. By the time he died, he had four wives, 2 ex-wives and nineteen children. The women were well taken care of and Aisha was engaged in a small-scale business of her own, selling women’s shoes and bags she imported from Malaysia. Ten years into the marriage, her husband became ill with fever and diarrhoea. The illness persisted for months until he was diagnosed with ‘Diabetes’ and given medication that he would take for life. Aisha found it strange that, for a man diagnosed with diabetes, her husband did not reduce his sugar intake. Instead he continued to drink his tea and kunu with lots of sugar and consuming his normal diet which comprised of Rice and Tuwo. Her own father was diabetic, so she kept urging her husband to change his diet, but he just shrugged her off. Another thing she noticed was that his ‘diabetes’ medication was always kept in the glove compartment of his car, never at home. He insisted that it was because he needed to be with his drugs at all times. When his symptoms subsided, he continued taking his medication and went about his normal business while marrying more wives.

A few years ago, his symptoms returned. The diarrhoea worsened and became bloody. He began to lose weight and his fever persisted. In all his hospital visits, he was accompanied by his cousin who was also his best friend and business associate. Only when he was admitted, were the wives allowed to stay with him in the hospital. And even then, they believed he suffered from diabetes. He was in the hospital for three months during which he deteriorated at an alarming rate. He became gaunt and weak. So weak, that he needed help using the toilet and had to resort to adult diapers. Aisha and her co-wives took turns nursing him until he passed away three months later. 

It was at this point in her story that Aisha’s emotions transformed from sadness to anger. Why did her husband not tell her? How could he be so callous that he would withhold such vital information that would affect her and her children? How could he not tell in all the years he knew? Why did his cousin not tell her? Why did all the doctors and nurses, some of which she had become quite close to, during all their stay in the ward, not tell her? Why? 

Instead, everyone around her kept quiet. Her husband’s confidant had since stopped visiting them during his stay in the hospital and even after his death. Her in-laws wanted nothing to do with them. The house and business her husband owned were liquidated and shared according to Islamic law. She used her inheritance and that of her children to buy a small house in a rural part of Kano. Her business suffered in the financial meltdown and she now sold cold drinks for a living. Six months ago, a police officer in her new neighbourhood started courting her. He was married with two wives and promised to take care of her and her children. True to his word, he provided of what he could afford: food and clothing. Aisha became pregnant shortly after the wedding. No pre-marital screening was done.

‘Have you told your present husband about your condition?’ I asked.

‘Why should I?’ she retorted angrily. ‘Who told me?’

She narrated how, when she was told of her diagnosis in the lab, she fainted. The health workers in charge of the Voluntary Counselling and Testing (VCT) resuscitated her and spent many hours soothing and counselling her. Her sister was called to take her home. After a few days, Aisha stormed the house of her first husband’s cousin, demanding answers. He was sorry, he claimed, but he could do nothing. His friend had sworn him to secrecy, he lamented. Why did you not tell us after he died? Aisha asked. How could you keep quiet when you heard that I was getting married again? Why did you not call me aside and tell me? Why did you not tell my other co-wives? Why did you stand aside and watch as one by one, we all remarried? One of her co-wives had died last year from prolonged vomitting that was attributed to ‘ulcer’. Why did he not speak up then? Were they not human? Did their lives and that of their children not matter? 

After leaving his house, a still seething Aisha called the nurse of the hospital where her first husband had been admitted and whom she had become friendly with, asking the same questions. So livid was she that she did not want to understand her friend’s reason of confidentiality in the medical profession. She felt betrayed and angry. Aisha’s argument that her husband’s cousin and her nurse friend should have told her after his death was one I could not find fault in. Truth be told, they had betrayed her.

I tried to reason with her. I told her that their betrayal should not make her bitter. That she should not allow her present husband whom she praised for helping her, suffer the sins of her past husband. I pleaded with her to not betray him, in the manner that she had been betrayed. He deserved to know, just as she did. I appealed to her for the sake of her unborn child. Did she want to live a life of secrecy just like her late husband? Hiding her drugs? What about her present co-wives? What did they do to deserve this? 

Ethically, the decision to divulge this information lies with the patient alone, and yet, as I lay on my bed that night I wondered if I had done the right thing. Should I stand back and watch her if she decided not to tell? To watch as another family is destroyed? Why could I do? What was my business anyway?

I did not sleep much that night. Till date, I do not know what decision she took. Aisha stopped coming for ante-natal visits and I am sure went to register elsewhere. Her story still haunts me. 

May we never be betrayed by our loved ones, ameen.