A beginning

By Dr Subarna Chakravorty

As the stern voice of the air stewardess boomed over the Tannoy, asking passengers to keep their seatbelt fastened ‘until the aircraft came to a complete standstill and the seatbelt signs were switched off’, Lilian could barely contain her excitement to have finally made it to the country of her dreams. Ever since she was a schoolgirl, she had read of summer picnics, ice creams and bicycles, cucumber sandwiches and jam scones and she imagined herself as one of the Famous Five, having adventures by the seaside. Life in Abuja had not been a cake walk, but she knew deep down how fortunate she was to have a large and loving family, food on the table, good grades at secondary school and then an opportunity to study at the UoA, Nigeria’s most prestigious university, with its sprawling campuses right by her doorstep. She had seen how her schoolteacher father had spent his life at the service of his community, how her seamstress mother busied herself every waking hour, hoping to give her 4 children the life she had been denied. Her mother and aunties had knitted, sewn, pickled and baked everything in her bulging Noclac that had tipped the scales at the check-in desk to over 24kgs, but the kindly clerk had chosen to ignore. It was everything she could do to stop her mother from packing an entire ghanamusgo bag with yet more ‘essentials’ that she was sure she could get from any decent African shop in London.

For it was to London she was headed, the city of her dreams, the place of promises and possibilities. Many of her friends could kill for what she had landed for herself- an offer letter of work as a healthcare assistant in a care agency at the Capital, a 2- year ‘health and care’ work permit, and her ticket to freedom. She had not really believed her luck when opportunities like this started springing up at a time the world was on its knees with the pandemic. Her parents had been worried about her catching that dreadful killer virus that earlier had been ravaging through the West. Throughout those terrible lockdown weeks in Abuja, they had all seen the footage of elderly white men panting into their ventilators. But three years had passed since those dreadful pandemic days, the world had opened up, and no one was wearing masks anymore.

For years Lilian had spent hundreds of hours tracking every possible opportunity of living and working in the UK. She was aware that the UK had needed healthcare workers to look after its ageing population, and it was no coincidence that her chosen course had been at the Allied Health Sciences Faculty at the UoA. She inwardly heaped thousands of praises to the entrepreneurial Nigerians who had, almost overnight during the pandemic, created opportunities for fellow Nigerians to apply as healthcare assistants in the UK via the Shortage Occupation list when the pandemic hit.

Lilian did not want to dwell on the weeks and months leading up to this moment. She had needed an astronomical amount of money in her bank account to satisfy the High Commission enough to issue her a healthcare worker visa, not to mention the fees that she had to conjure up to get sponsorship from the agency in the UK. And then there was the money for the flight itself, the TB check at the clinic, the NHS surcharge, and that ridiculously expensive English qualification test she had to take online. Even a 6^th grader could pass that test with their eyes closed! But needs must.

And then there was Uzor. The dreamer who had imagined a future with her by his side. She did not want to recall the shock on his face when she finally mustered the courage to tell him about her job in the UK. Uzor, the quiet, thoughtful, shy student she had met at college, the one who was so unlike the macho Abuja boys with their muscles and conquests. Uzor had known about her deep longing to see the world, but had somehow hoped that she would choose him over an uncertain life abroad if the opportunity ever arose. How wrong he was. At times it even infuriated her that he had not understood her need to follow her dreams, he had never felt tempted to look beyond what he had grown up knowing. She had thought about daily WhatsApp messages, successful long-distance relationships, but even before the words escaped her mouth, she had known that it was not meant to be. He had said nothing- just turned his face away for a moment and then pulled himself up from the chair at the café, paid for their drinks and headed out. For a second she had the urge to follow him out, beckon him back, but knew she had to face this on her own.

The hurrying passengers tugging at overhead bins snapped her out of her reverie. The seatbelt signs were off, and people were jostling to leave the aircraft as though it reminded them of a painful past that they wanted to abandon as soon as possible. She had read about scary immigration experiences at the UK Border, people being deported on the spot due to some shortfall in the mountain of legal documents. But she had her UK visa, a shiny new Nigerian passport and a strong conviction that nothing could come between her and her right to be in the UK. She had joined the sea of travellers queuing to gain entry and was astounded to see the diversity of faces around her and even more astounded to see stout Nigerian women with cleaning tunics going about their business with effortless efficiency. Everything was just so shiny!

A serious Asian woman in a hijab inspected her papers as she kept fishing them out of the document wallet, all the while remembering to not lose her handbag, her phone and her extra layers of clothing she had been told she would be needing as soon as she stepped out of the airport. It was December, and she had known to expect it to be cold and wet. The woman asked endless questions about her reasons for coming to the UK, where would she be working, where would she be staying, how would she be sustaining herself until her first pay cheque? And what would she be doing when her work permit ended? After what seemed like a lifetime, she was finally allowed to enter the UK, with not so much as a ‘have a nice stay’. Well, she had not cared. She was in, and that was all that mattered.

She was going to be staying with an auntie in a place call Penge in South London until she could find a place of her own. The lady had visited her parents’ church in Abuja a few times when she had visited home, and her mother had written to her asking for help. Lilian was not sure that help had come easily- the pastor had to write a supportive letter, and it was only then that a confirmation email had arrived with an address for her to produce during her visa application. Auntie Grace had two grown up sons and one of them had just moved out with his girlfriend, leaving an empty room for Lilian to use. Only temporarily, she had hoped, confident in the belief that she too would find somewhere to live independently. There was expectation of rent, and also of household help while Lilian was at auntie Grace’s house. Nothing she cannot manage, she hoped.

Lilian had carefully planned her journey from Heathrow to auntie Grace’s house. It was not like anyone will be waiting at the airport gates for her.  She had left nothing to chance. She even had a £20 note set aside to buy a single ticket to a station called Penge East. How was the name pronounced; she wondered. Peng? Penj? Lilian tried not to feel overwhelmed by the huge array of conveyer belts spitting out hundreds of bags and suitcases. It was another hour before she finally managed to find her own and haul it to the airport exit.

The enormous airport crowd disappeared off into cars and buses and trains and she was suddenly all by herself at the airport station. It struck her how cold it was and how quiet. It was sort of a wet, dripping cold that seeped all the way into her bones. The thick overcoat that had seemed fiery hot in Abuja had been remarkably inadequate amidst the wind that crept into it and chilled her very bones. The sky was overcast, and although it was barely 4pm on her watch, daylight was all but gone.

Lilian felt a pang of nausea as she got off the train at her station and stopped to figure out the way to auntie Grace’s house, which she knew was only a short walk away. She wondered if it was the plane food that made her feel that way. She prayed this would not become something serious, because she needed to report to her agency in less than 24 hours. The house was exactly what she had imagined from the Google Earth images she had studied back in Abuja, although up close it looked a little frayed at the edges. It was, she realised, half of a full house, with both houses stuck together in the middle. Some scrawny perennials divided the shared front space. The people next door had lined their half of the garden with fat little gnomes, faded of their original colours. With a little trepidation she sounded the knocker, and a Nigerian woman in her 30’s opened the door. Lilian spoke to her in English, explaining that she had come to stay with Grace for a bit until her accommodation was sorted out. The lady introduced herself as Omowunmi (‘but most people here call me Mo’) and motioned her to leave her suitcase by the door and follow her into a kitchen at the end of the hallway. Grace, she said, had gone to visit a friend at the hospital and should be back soon.

She smelled the kitchen before she saw it. The usual Nigerian kitchen smells were there of course, but it was layered with unacquainted smells that she had occasionally whiffed when foreign suitcases were opened back in Abuja. The smell she had always associated with glossy shops, clean pavements and blue skies. Except the shops she had noticed on her way in had not exactly been glossy, and the deserted winter pavements were not just a little bit littered.

Grace Akinlabe was a stern, god-fearing woman in her late 60’s. Her husband had worked for the Southeastern Railways as a ticket collector for over 40 years. Grace never quite understood why a hard-working religious man who never had a bad word to say about anyone, sent money back home for his mother and so many relatives over the years, never gambled or drank or took other women had to die with so much suffering at the end. He had wanted to live, but the Lord had other plans. She still shuddered to remember the time he fell ill during those early days of the pandemic when so little was known about the deadly virus. Still, she was not bitter. Her hope of a quiet, godly retirement with the only man she had loved was taken away by the Lord, but her faith had held strong through those tumultuous weeks. Isaiah’s pension had paid off what was left of the mortgage, and she had found solace in service to the Church.

Grace had seen countless young hopeful men and women pass through her door to find a better life for themselves in the UK. Some fulfilled their dreams, others- not so much. She had little time for people who unable to take care of themselves, especially women who were too impatient, got drawn to promise of love and found themselves at the mercy of handouts when the inevitable pregnancy came along. Without any fanfare, she would tell these women that she did not want anything to do with them anymore. She eyed Lilian’s tall and upright stance with an inward nod of approval. The girl would look after herself, she thought.

Lilian had an appointment at the agency the following morning. The agency itself was a long way from Penge, and she needed to leave very early. Several train and bus rides later, there she was, and not a minute late. Lilian had been sent training material in advance and the agency needed her to be at an unpaid training session for a week before she was allowed anything on her own. She had waited most of her life for this opportunity, and yet this morning, she felt an enormous lethargy, and it took every ounce of her determination to make it to work. The people at the agency were nice enough, and the lady who was meant to train her for a week was a kind, older lady from Zimbabwe, Miriam, who had been a carer for decades. Lilian forced herself to be cautious. She had heard terrible stories of foreign carers being given significantly less hours of work than what was promised at the outset. And given that their visas were linked to the agency, the workers were in thrall of these people who could easily exploit. She had made her own enquiries about the agency, and everyone she had spoken or shared WhatsApp messages with,  were generally positive about them as an employer. The last thing she needed was to be trapped in an illegal low paid job that effectively tied her to her employer due to the visa restrictions.

Lilian’s tiredness was now coupled with heartburn and nausea. She was certain that the unaccustomed food and stress of a new job in a new country was what was causing this. The week of training went well, and she was told she would be placed at a residential care home in Surrey and her job would be to care for elderly people with dementia. She would be given a room to stay at the care home and would get days off during the week.

Lilian felt invincible.  She spoke to her mother about her new job, carefully avoiding telling her about her health issues. They will pass as soon as she settles in, she was sure. The first couple of weeks went by in a flash. She worked through Christmas and felt good to be providing care and comfort to the elderly. The care home sparkled with tinsel and baubles- the festivities were infectious. Christmas songs played on the radio, and staff came in to work daily with the most outrageous Christmas accessories that their uniform code would permit. Lilian allowed herself to be drawn into the charm of her first Christmas in the UK. She missed her family terribly, of Christmases spent at home with song and food and friends and family calling in at all hours. This was so different, and yet so alike.

Lilian grew fond of the men and women in the care home. Her particular favourite was Lorna, a devout Irish Catholic woman with a great sense of humour, who had moments of clarity amidst her endless fog of dementia. She had even been a nun in her youth, but realised she loved a local boy more than she loved the Lord. Sixty years of marriage and a life of adventures later, there she was, trying to hang on to memories she held dear. Not that everyone was as kind as Lorna. Some of the older inmates complained about ‘too many Africans’ in the care home to nodding relatives. Lilian knew that she could not let that get to her. She had known the world to be unfair and also believed that not everyone thought that way. Lilian felt something was not quite right with her health. Her periods were usually like clockwork, she could almost set her watch to it. And when the expected pain and bleeding had not arrived, she had shuddered inwardly. She and Uzor had been very careful during their time together, that was one thing she was grateful to him about. Yet, she had known that no protection was absolute. What if she was pregnant?

Lilian decided to return to auntie Grace’s house when some leave came up in early February. She would need to buy a pregnancy test kit at the first possible opportunity. She forced herself to not think of the consequences of a positive result. Yet, thoughts of despair and helplessness kept seeping into her mind.  She knew she could not go back to Abuja without at least earning enough money so that she can return what she had borrowed. What would her parents think? Should Uzor be told? How will she continue to work after the baby was born? She had never imagined having an abortion. If it came to it, will she be able to see it through?

Lilian walked into a pharmacy in London Bridge station and asked for a kit. It was so expensive, but she had no choice. She found the nearest public toilet at the station. It took her ages to get her trembling fingers steady enough to break open the package and then ages to read the instruction leaflet. And with a pounding heart, took the test. As the minutes passed by, her eyes riveted to the small white window of the test kit and her heart sank as she saw the second red line appear and gradually get darker and wider.

Lilian suppressed a cry that was forcing to escape from within the depth of her gut. What could she possibly do? Her pang of fear soon gave way to a sliver of joy at the thought that she and Uzor had made a real human together. Soon after that came the despair. All her pragmatism came flooding in, she knew the pregnancy would cost all that she had worked for so far. It was everything that her mother had warned her against, everything that she herself had told herself to avoid over the years. She sat on a bench in a shelter on the platform for ages, praying that she finds the strength to face her predicament.

Lilian walked into the GP surgery she had registered when she had first arrived in the UK, without first stopping at auntie Grace’s, grateful to have somewhere to go for medical advice. Walk-in appointments were not allowed, said the lady at the desk, but she somehow managed to get a nurse appointment later that week. She was not sure she had ever felt this lonely in her life. She resolved not to feel sorry for herself though, this was her cross and she would bear it as best as she could. Grace Akinlabe need not know about this; Lilian did not think that the matriarch would take kindly to this situation. Mo, the younger woman she had met earlier had her own problems to deal with – her student visa had run out and she could be deported any day. She spoke to her parents on the phone about mundane things at work, hoping that her uncannily perceptive mother would not detect anything unusual. It reminded her of how she used to do silly little acts of rebellion as a teenager, almost with a wager with herself to not get caught by her mother. Well, if only life was that simple now.

The nurse at the GP surgery talked her through next steps of the pregnancy. She asked about her family origin, took her blood pressure, repeated her pregnancy test, all the while completing multiple forms. The nurse asked her about the father of the baby, to which Lilian could just lower her eyes and shake her head. She heard that all pregnant women had to be booked into an antenatal clinic at the surgery, and a sickle cell test would also be taken. Lilian found solace in the practised efficiency of the nurse. She liked to plan ahead, and the nurse had given her a template.

The rest of the week flashed by in a wink. Lilian spent most of it in her room at Grace’s house (she now had to share it with Mo, given that she was only there intermittently) thinking long and hard about next steps. To her amazement, she found herself wanting to keep the baby, despite every rational fibre of her body telling her what a bad idea it was. Uzor and her parents need not know yet; she needed time to make up her own mind. She guessed she was about 9 weeks pregnant, given how timely her cycles came. She did not need to make any decision for some weeks yet.

A text message buzzed in her uniform pocket some days later while she was in the middle of changing bed linen back at work. She had been almost meditative the last few weeks, weighing her options. She often looked through the photos of her and Uzor together and thought of the love they shared. She had burnt her bridges with him, she told herself. If she went running back to him now, it would ruin everything they had shared together. Yet, the thought of a child, born out of love, who would perhaps share Uzor’s wisdom, his twinkling eye, maybe the child’s face would also light up the room with its smile, maybe it would be her purpose in the cold and lonely country of her choice. Yes, she would keep the baby, she resolved. She would work until the very end, save every penny to fund her maternity leave, and return to work as soon as she could. Perhaps her mother could come and look after the baby for her for 6 months, on a visitor visa. She was sure she would understand. But telling her parents would have to wait, she thought. She needed to wait until the first trimester was through.

It took her a few reads to understand the text message. It said that she had tested positive for the sickle cell carrier test, and she needed to contact the community midwife as soon as possible. She remembered the midwife’s question about the history of sickle in the family. All babies born in the UK was tested for sickle she had learnt, amazed by the efficiency of it all. She had of course read about sickle cell in school and then in her university course. She clearly remembered the sickly cousins with swollen bellies and short lives back in their ancestral village in Benue State, where they had occasionally visited when her grandmother was alive. She had known that they had been ‘sicklers’ and as a child wondered whether being sick had earned them the moniker. Sicklers die early, she had heard being told as a child and could even be a curse befalling the family for past sins, her grandmother had said. She remembered how children at school with yellow eyes stayed off school for weeks and then stopped coming altogether. Hadn’t she lost her own best friend from the second grade to this killer disease? How gentle she was, Lola, who loved dolls and chats, her nose always in a book, until one day she just disappeared from her life. Lilian later learned that Lola fell suddenly sick with a high fever and had died in her sleep. Lilian’s heart sank. What if Uzor was a carrier too? Had they ever discussed sickle cell during their countless hours of chats? She hoped he was not a carrier, having recalled that both parents needed to be so for the baby to be affected.

The London midwife called her at an agreed time the following Monday. Could she please bring her partner over for testing, she had asked. When it was clear that no partner would be available for testing, the midwife offered to see her in clinic to book her for prenatal diagnosis. Time was of the essence; she was already 11 weeks pregnant, and it was best if the prenatal test could be arranged within the next week or two. Lilian was sent a link to an NHS information website about sickle cell and another about the prenatal test. Lilian looked up about sickle cell on the internet. There were countless accounts of people affected by the condition who often called themselves ‘warriors’, talking about the challenges they face daily. She read how most children die of it in Nigeria and other sub-Saharan African countries. She also read how good healthcare in rich Western countries has resulted in affected people living longer and there were curative treatments now. She came across harrowing stories of isolation, pain, suffering and death. She could not inflict that upon her child, she shuddered as she thought. She would need to find out if her baby had it.

Within a matter of days Lilian found herself in front of a huge modern building with frescoes, sculptures and large glass doors for her prenatal testing. She forced herself to not think too much about what she was about to go through. She would have a needle inserted into her womb so that some fetal cells can be extracted and tested for sickle cell. The whole setup was efficient and business-like. The procedure itself was swift- she went into an operating room where masked and gowned men and women scurried about with purpose. Someone held her hand through the procedure, but she could not recall her name. She had bright eyes with thick lashes that blinked all the time.

Not knowing what to do until the results came, Lilian plunged body and soul into her work. Miriam, her Zimbabwean colleague said that the manager had been pleased with Lilian’s work and ‘she should enrol into nursing college’ when she finds her feet a bit more. Lilian smiled inwardly. No one had known about her pregnancy, and she had taken to wearing oversized scrubs at work. Nurse training would have to wait.

Lilian’s tall frame had kept the pregnancy hidden from others. Her nausea and heartburn had disappeared, and her skin glowed. She had spent a lot of time watching videos about sickle cell. About the pain and suffering, about the stigma of it in Africa and in Europe. She kept going back to videos where little children had to be rushed to hospital with pain so severe that they gave morphine and ketamine to ease the pain. She saw men and women filming themselves having a pain crisis, barely able to sit up, depending wholly on friends and family for living their lives. Then she saw happy videos of children getting stem cell treatments, finally freed from the shackles of this terrible disease. How could she inflict this life of pain and suffering to her child? How will she look into its eye and not blame herself for letting it happen?

The call finally came about 2 weeks later. The baby had tested positive for sickle cell, the midwife had said over the phone, gently breaking to her the options of carrying on with the pregnancy or booking in for a termination. The choice was hers. Lilian felt the world crumbling around her all over again. She knew that there was a chance the baby would test positive, but had not thought what she would do if it did. She needed to call Uzor, or her mum, or both. How does one break such news on a long-distance call? One look at his face on the phone made Lilian crumble. All these weeks of uncertainty, of being strong, wanting to manage everything by herself just melted away at his sight. She wanted to be held; she wanted to be told that whatever decision she makes would be the right one for them. As always, Uzor listened. She told him everything- her time in London, her lucky placement at the care home, her positive pregnancy test, the prenatal testing in London, the option of termination, everything. Yet, something was not quite right, thought Lilian. Uzor had listened but had very little to say. There was a tentativeness in his voice, and she noticed him looking behind his back, as though someone would enter his room any minute. And she did. A tall woman with an upright posture walked into his room with a practised walk. Lilian could see her flinging her handbag on his bed, asking who he was on the phone to. And then her face appeared on the screen. Hello Lilian, she said this is Umu. Uzor has told me all about you- how’s London- you are so lucky you know, things are as bad as ever here. At least Uzor has me now, she said- flashing her left ring finger- and my dad got him a job in his printing press- you know how much he likes books- hopefully he will get his own books printed in the future! She saw Uzor’s longing expression now directed at this striking woman, and wished the earth would part so she could disappear into it. Uzor ended the call, and moments later a message came through – sorry you had to go through this all by yourself- I hope the termination is not too traumatic.

Lilian had another call to make, this time to her mum. Have you got 30 minutes, she asked. And can you make sure you get your passport made asap?

Dr Subarna Chakravorty is a Paediatric Haematologist with a special interest in non-malignant haematology and stem cell transplant for haemoglobinopathy and non-malignant diseases. She is a trustee of the British Society for Haematology and the UK Forum on Haemoglobin Disorders. She is interested in clinical and molecular research in sickle cell disease and is involved in a number of projects at King’s College London.

Photo by Jonas Leupe on Unsplash