At Risk, at Home and Abroad

As Joy Notoma grapples with uterine fibroids, harmful biases in the medical establishment, and a move from Brooklyn to West Africa she wonders where, as a black woman, she can find safety.

Joy Notoma | Longreads | January 2019 | 12 minutes (3,079 words)

 

Akosua* was in my care when she was assaulted. A man entered the bedroom where she was sleeping and tried to undress her.

She called out, waking us around 3 a.m. Moments later, she appeared in our bedroom doorway hugging herself, a distraught expression on her 15-year-old face. Akosua was sleeping in the bedroom next to where my husband and I slept, in the house we were renting in Benin, a small country on the southern coast of West Africa.

“There was a man!” she stuttered through tears. “He came into my room. He tried to undress me,” she said.

I wanted it be a nightmare, but Akosua was an unlikely person to confuse reality so dramatically, and we would have taken her word for it anyway. She was the type of teenager who contemplated big issues about the world, who could hold her own in conversations about race and politics, who expressed emotions easily while still managing to be grounded. She was selfless in the way American parents sometimes wish their own kids were.

There was an exit door in the bedroom where she slept that I had carelessly neglected to lock, which made me culpable. I was overwhelmed by guilt.

The man who did it was the groundskeeper for the house we were renting, hired by the owner. People called him the security guard, but I never could. It made me feel like the house was a prison. What could he have actually protected us from anyway? His only valuable task which I could discern was yard work, so I called him the groundskeeper. And then it was he — the supposed security guard — who assaulted Akosua.

***

Homes in certain neighborhoods of Benin are surrounded by concrete walls. Sometimes the walls are topped with jagged broken glass, designed to slice the skin of anyone who dares to climb. Sometimes they have long spirals of barbed wire. Most people with modern homes hire security guards, whose main daily job is to open the driveway gate when people of the house arrive. It is the same in neighboring Nigeria. When I was growing up in South Carolina, my mother told tales of how unsafe Nigeria was when we lived there. She, an American from South Carolina, lived there with my Nigerian father for six years. We moved back to the states when I was a year old. From my mother’s memories and the memories of my older siblings, I slowly began to piece together details of their life there. When I went back to Nigeria as an adult, my favorite aunt told me about the armed robberies that she, my uncle, and cousins had survived. Both she and my uncle worried about kidnapping when I traveled by road from Benin to visit them. Last year at a cousin’s wedding in Nigeria, my 7-year-old nephew was playing with a smartphone when an uninvited stranger who had wandered into the building approached and asked to use to the phone to photograph my nephew. The stranger promptly stole the phone, locked my nephew in a bathroom stall, and fled. A short while later, I went around the venue searching for my nephew. I moved through the crowds of dancing people toward the bathroom where I last saw him. In the quiet of the corridor of the hallway, I heard screaming. I followed the sound, threw open the door of the men’s bathroom, and busted into the stall where his voice was coming from. He was standing there in tears, shaking with terror.

***

For weeks after the incident with Akosua, I pictured the groundskeeper’s face hovering over her body and the fear his presence had inflicted. He lived in a freestanding room just about 100 feet from the house. It had bare cement floors with a mattress pushed against the wall, and an orange painted gas burner where he cooked his meals. He was fired the very next day and a police report was filed. Before the incident, we saw him everyday and listened to his off-key singing as he cleared the yard of dead leaves.

***

No one knows how or why fibroids grow. I discovered mine like a small potato bulging from the left side of my belly button after a cold shower one night. The showers are always cold in the house we rent in Benin.The house is a short walk away from the land we have purchased to build a home. We had been there for almost six months, but even after countless cold showers and becoming beguiled by the sight of spiders and lizards everyday, which I never thought possible, I still wondered how two people who’d spent 10 years in New York City decided to move to a small town in Sub-Saharan West Africa.

When I was growing up in South Carolina, my mother told tales of how unsafe Nigeria was when we lived there. She, an American from South Carolina, lived there with my Nigerian father for six years.

After the cold shower that night, I lay on my back and pushed down on my abdomen, snooping for unusual activity and there it was — a lump about the size of a small potato.

“What is that?” I said aloud and straight away grabbed my husband’s hand to press and feel for himself.

Like an estimated 80% of African American women in their childbearing years, my uterus had been beset by bulbous benign growths known as uterine fibroids. Black women are three times more likely than white women to develop uterine fibroids. Their sizes are compared to fruits and vegetables — peas, cantaloupes, grapefruits. I learned later that the one that made a home on the left side of my womb was the size of a grapefruit. It grew on a stalk from the top surface and bulged from the side of my navel, protruding through the flesh.

I emailed a friend about the incident that happened with Akosua.

“How could you want to live in a place where women and girls are so unsafe?” he responded.

It is true that girls in Benin are sexually assaulted so frequently that parents anecdotally fear sending them to school because of sexual attention from male teachers. It is true that the week after Akosua was assaulted, another friend of ours in Benin was also sexually assaulted. It is true that a few years prior a Peace Corps volunteer was violently murdered after reporting sexual abuse at the school where she volunteered in the north of the country.

But I bristled at my friend’s comment, nevertheless.

“You can’t tell me that you think women and girls are safe in the U.S.!” I wrote back.

I pointed to all the newly uncovered Me Too movement stories and the thousands of others that will never surface because the women victimized don’t enjoy the privilege of movie stars. I pointed to the girls and boys who aren’t safe in American schools because of gun violence, a problem completely unheard of in Benin. I pointed to the abuse of enslaved black women that was so common in America that there are white and black sides of families who trace their origins to the same white male ancestor. I pointed to the ongoing sanctioned terrorizing of black people, central to American history.


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He got the message: No place is perfect and I won’t tolerate Western normative ideas that make the rest of the world seem unsafe while America gets to be lily white and full of picket fences.

What would people in Benin think if they knew that stores in my home country sell alcohol from behind bulletproof glass? How do I answer potential subletters of my apartment in New York who ask me how “safe” my Brooklyn neighborhood feels? Would they ask the same question if they hadn’t seen only black and brown people on the street on the way to the apartment? There is a man in my building who warns me about doing laundry in the basement. I want to tell him to stop driving his car and taking flights, which are significantly more dangerous and at least as inconvenient.

***

After the night that I found the potato by my belly button, the Googling began. Convinced that it was an inflamed organ, I searched for anatomic images of the female body. I looked up rare disease symptoms. Or could it be constipation? I spent far too many hours reading stories online of women who didn’t know they were pregnant because of false negative pregnancy tests. And sometimes the bulge in my stomach seemed to flutter and twinge. I knew it was far too early for a fetus to have a definite shape, but maybe this was a weird unknown early pregnancy symptom.

Back in the states after a six-month stretch in Benin, I told my gynecologist about the lump. He did the same push down motion all over my stomach I had begun doing every night. “That’s a fibroid,” he said with the professional assurance which doctors master.

When I see him, we are in New York for our final stint. The past fews years have been spent shuttling back and forth between two countries. But this time we are moving out, getting rid of our things, and packing up the New York apartment that has been ours for the past eight years.

For our honeymoon, we traveled for six months across Africa. That’s how we found Benin, a country neither of us had given any thought to before.

When the trip was over, we went back to New York, to the same apartment in Brooklyn that we’d sublet out for the long trip, and the truth was looking at us around every corner, every block, every street we walked down: Our decade-long drama in the city where we had become adults was in its final scene. Nothing was keeping us there. Our jobs didn’t tether us to it and we knew how much farther our money could go elsewhere. We tried to decide on a city in the U.S. or in Europe where we wanted to move, but Benin had become a fascination. We went back to try to shake ourselves out of any possible romanticization of the place because we really thought it was perfect. Little by little, over four separate trips, we stripped ourselves of the illusion. We knew that it would be difficult, that no place was without flaw, and that there was no sense in comparing it to New York. And then we decided to move and build a house.

Now, in the midst of an unwieldy move, there was this new mystery growing to the left of my navel — not poop, not a baby, just a grapefruit-sized fibroid that needed to be surgically removed.

I went in for an ultrasound and then an MRI in preparation for surgery. It turned out there were five of them, of which the grapefruit was the largest. I started eating flaxseeds and walnuts and swallowing a vitex pill everyday to try to naturally balance my hormones. I read that fibroids can be a sign of repressed creativity so I started writing feverishly, the way I’d always imagined my favorite writers wrote. If my fibroids were repressed creativity, I’d let it all out and watch them drain from me like jelly and fluid like a friend told me had happened to hers.

“Sometimes they have teeth and hair and bone fragments like babies. Look closely at photos. Sometimes it’s like they have faces. Little angry faces,” my friend had said with the certainty of a self ordained healer, but I declined to buy the $50 fibroid removal tea she recommended. I have sufficient belief in natural healing remedies, but when it comes to serious health concerns, I prefer to go a bit natural (thus the flaxseeds and walnuts) and a bit Western (thus the surgical removal).

Despite my ethnic heritage — Nigerian dad, black American mom — by my estimation, I was an unlikely candidate for fibroids. I was in impeccable health. The previous months in Benin, I had eaten a nearly sugar-free diet. I usually ate garri — cassava flakes, commonly served in different forms all over of West Africa — for breakfast; freshly roasted cashews and peanuts for snacks; and beans, fish, and vegetable-based stews for lunch or dinner. I did yoga and meditated. I wasn’t overweight and I thought my stress levels were fairly low. But stress levels are hard to gauge when you’re making a move as drastic as the one I was. Amid the daily fluctuations between excitement over the prospect of adventure and utter sadness over leaving behind a life you love, stress is nothing more than an arbitrary factor slipping imperceptibly in and out of sight, relative to all the others.

I missed my friends and deeply connecting with people in Benin sometimes felt hampered by language and culture, and then there was what happened with Akosua.

***

Nightmares of the surgery followed. Thoughts of how unsafe the medical industry is for black women haunted me. I remembered studies that show medical professionals overestimate black people’s pain thresholds and are more likely to ignore black women in pain than they are to ignore white women. I thought of Henrietta Lacks, the way the medical industry had profited off of her body without her or her family’s knowledge or consent.

“Why do black women get these things?” I asked my friend who had insisted that the fibroids were unreleased creative demons.

“We’re sad from living in a society that doesn’t recognize our beauty, from not feeling safe, and from living without black men. So we eat breads, sugars, and soul food to comfort ourselves,” she responded.

Like an estimated 80% of African American women in their childbearing years, my uterus had been beset by bulbous benign growths known as uterine fibroids. Black women are three times more likely than white women to develop uterine fibroids.

My friend described it as a pathological sadness eating its way into our wombs. I rolled the information around my brain. Obesity, high blood pressure, and diabetes are well documented health concerns among African Americans, but I wasn’t so ready to sign onto her theory about diet, depression, and repressed creativity leading to uterine fibroids in black women. I found it plausible, but still doubtful, especially with all the information about hormones, like estrogen, and fibroids, available. In America, approximately 12 million women experience depression every year. Rates of mental illness among black people are similar to those among the rest of the population, but the lack of access to quality, culturally competent care makes depression particularly dangerous for African Americans. Women already experience mental illness at higher rates than men, so none of this bodes well for black women. Still, why would black women’s depression manifest itself in this particular way? But the lack of safety she mentioned spelled out a harrowing scrawl behind my eyes like a dispiriting headline I’d have preferred to deny. No matter where I turned, the uncomfortable truth of it rang in my ears, rattled my brain. I had uprooted myself and moved to an entirely new country. It didn’t matter how many times we had visited Benin before; renting a house, buying land to build our own home, and moving all of our possessions across an ocean was different. I was game for the challenges of our new life, but unfamiliar surroundings, even the most serene, can signal a lack of safety. In the science of stress and disease, researchers now place more emphasis on a perceived lack of safety rather than actual threats in the environment. A mere lack of information about safety is sufficient to activate a stress response. It didn’t matter that Benin is a politically stable country where private citizens don’t own guns; according to new research, just being regularly exposed to the unknown can trigger the type of stress response that, left unchecked, could lead to disease. It would be impossible to define what constitutes the unknown in the life of each black woman, or if and why such lack of perceived safety leads to uterine fibroids in some and not others. These are not hard facts. All I know is that four months after moving to a new country, my womb formed a growth large enough to bulge from the surface of my flesh.

During the previous six months in Benin we had searched for land to purchase; been swindled by a supposed friend who stole our money and threatened our lives; and taken care of a teenager who had a brush with sexual assault while she was in our care, for which I was partly to blame. There were months of not knowing what was growing in my belly, missing friends and home, trying to hold on to one community while creating another…and it made sense.

Three weeks after the fibroid removal surgery, I was given clearance to travel. Two weeks later, we were on a plane to Benin with ten suitcases carrying all of the belongings we could transport. We moved back into the rental house we’d been in at the beginning of the year, where I had discovered the lump, in a town 20 minutes outside of Cotonou.

As you can imagine of a person willing to move to a completely new country, I have a certain amount of courage. Even so, safety, especially for black women, is more than just an idea to ruminate on in essays. Safety is finding your feet on sure ground in a world that says women who look like me can’t create their own lives, that only allows us a measure of freedom if we have the right hair, the right size, the right degree, the right job, the right relationship status, the right bank account amount… that says our bodies are at the disposal of whoever can dominate them. What other free spirit wouldn’t feel some distress over the systemic overlooking of its beauty, the willful trampling of its inherent right to be free? Perhaps it has fallen upon the womb and she has created these growths to call out, to be noticed and cared for. Perhaps I have felt this sadness, even through the exuberance and utter privilege of my new adventure. Some days I call it grief. Grief seems to encapsulate the varying waves of joy and wistfulness that occasionally hit me when I think of my move, but grief should not overshadow joy. There is joy in the uncertainty, adventure in curiosity, adrenaline in the readying of oneself for war. I know, like my body knows, that wherever I move in the world, the wrestling with patriarchy will never end. It will be there as certain as my womb, fighting for its dear life.

*Name has been changed.

* * *

Joy Notoma is an essayist and journalist. Her work has appeared in CNN, Al Jazeera, the Huffington Post, and other publications. The Moving Chronicles is her biweekly missive about her adventures in moving to Benin.

Editor: Sari Botton