The hospital is a clean, modern cement building with bare scrubbed hallways, rooms with beds, a waiting room with a few patients. It's nothing like the hospital in Accra, the capital, with its outdoor courtyard crowded with patients from morning till night.

A nurse sits at the reception desk. She discusses our situation with Minessi in Fanti for a while, then writes "cough" on the sheet of paper in front of her.

"His breathing, too, listen to it, it's not just the cough," I chime in. Minessi glances at me uneasily. The nurse adds a few notes to her paper, then tells me I should come in with Minessi and Yao to explain the situation to the doctor. I add that it was already going on when I left a month ago. The nurse looks at Minessi in surprise.

"Bohsom?" she says sharply, which means month. Minessi nods slightly, looking caught out.

We enter the doctor's office. I'm amazed by the low fees: only 200 cedis so far, less than 40 cents. The doctor is a young Ghanaian man in a white button-down shirt and wire-rimmed glasses. He wears a silver cross around his neck. Probably a recent university graduate doing his mandatory public service. He sits behind a broad desk, wearing a stethoscope. He speaks curtly to Minessi, and she replies respectfully, her eyes dropped.

"Bohsom eko," she murmurs softly in Fanti. One month.

The doctor brings his hands down on the desk in an impatient gesture, barking a response. I'm dismayed to see the Minessi cowering now, her elegant posture literally shrinking under this man's rebuke. She unwraps Yao and sets him, naked, on the desk.

"She feeds the baby mashed kenke. No milk," the doctor tells me in English. "Do you know what is kenke?"

Kenke, made from fermented corn meal, is one of the region's staple foods. I nod stiffly. Minessi avoids my eyes.

How can he speak like this in front of her? I think. Does he think she doesn't understand? If she's feeding him kenke it must be all she can afford. But isn't she also breastfeeding? I realize I don't know, and now I can't remember if I've ever watched her feed him. For a heart-stopping moment, I wonder if she's guilty of negligence. My mind flits to her other children: Why aren't they with her? I quickly push away the disloyal thought. She's wonderful with Yao, so gentle and patient. If she's stopped breastfeeding there has to be a reason, doesn't there? And cow's milk, which can only be found in tins, is certainly out of her range.

The doctor orders Minessi to remove a small pouch that hangs on a frayed red ribbon around Yao's neck.

"I too have my superstition." He winks at me. "I won't touch the baby while this is on."

Placing the stethoscope against Yao's tiny chest, the doctor looks up and shakes his head at me again.

"They feed the babies mashed kenke and then wonder why they grow pale and have no energy," his voice rings with disgust. "I tell them and tell them but they won't listen."

I hate him making Minessi a "them." Even more, I hate being a part of his implicit "us." He smiles at me ingratiatingly. I keep my expression coolly neutral, refusing to forge an alliance. In my periphery I see Minessi adjusting her orange cloth, looking sideways at the bare walls of the room. When the doctor turns his attention back to Yao, I try to catch her eye.

After the examination, the doctor again speaks sharply to Minessi in Fanti. She nods, expressionless, head down.

He turns to me. "The baby has pneumonia. It is lucky that he is alive. He will have to sleep two to three days here in hospital," he continues in a comradely tone. "One-hundred cedis a day to stay here. Not so much, eh? But she is afraid to bring him. Instead she will visit the witch doctor. Then she will sit in her house until the baby dies. They can never find money for the hospital, but they will always find money for the funeral."

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