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COVID-19: Tales of Recoveries, Deaths (1)

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By Tobore OVUORIE


Nigeria is one of the countries that have been hit by a second wave of the COVID-19. Currently, the country struggles to curb the spread of the virus as figures of infection rates soar each day.

TOBORE OVUORIE who visited  Delta, Lagos, Ogun, Anambra,  Sokoto states and the Federal Capital Territory, Abuja reports about  COVID-19 survivors’  tales of recoveries and deaths. She discovered that while many Nigerians still believe COVID-19 is a myth,  others think the infection no longer exists in the country. She also observed that stigmatisation and discrimination against persons who have contracted the virus are rife.

Nine survivors, all from diverse backgrounds, spoke with her. 

Here are their stories.

Of falsehood and misinformation

December 14th, 2020

Ughelli North, Delta State.

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5.47AM

“Oga, there is no more coronavirus in Nigeria,” I heard a rather very high-pitched voice from someone nearby. I was shocked by the outright falsehood and misinformation being served with  confidence where I was sitting just two meters away from the front desk; scene of a fresh unfolding drama. It had been quite a scene since 5 am when I arrived at Agofure Motors park  at Ughelli North, in Delta state. Other dramas did not consist in  life-threatening gross misinformation. I stood up, turned around and behold, it was Omoh, a ticketer at the Agofure park.

Some passengers at the Agofure Motors Park, Ughelli North, Delta State, December 14th, 2020. Photo: Tobore Ovuorie

I do not know her surname but everyone at Agofure park in Ughelli, call her Omoh. She also confirmed that to be her name. The strongly-built, not so dark in complexion, young lady, with athletic legs revealed by her knee-length dress, is within the age range of 20 to 30 years and five feet and four inches in height. The recipient of the false news was a  dark  man of average height, in his sixties. Omoh was not done with misinforming the elderly man about the presence of the COVID-19 in Nigeria.

“Oga, we dey carry full load here for Agofure. Passengers for we bus dey complete because coronavirus no dey Delta state and Nigeria.”

The elderly man argued that there is coronavirus in Nigeria and Agofure is a standard  motor park, so shouldn’t be breaching NCDC Covid protocol of carrying  full-load in a 14-passenger seater. The old man who all the while had his facemask fastened on, stood some distance away from Omoh.

Later, a middle-aged man – possibly a driver with Agofure park, as he wore a green uniform like others –  came to listen to his complaint.

Some passengers at the Agofure Motors Park, Ughelli North, Delta State, December 14th, 2020. Photo: Tobore Ovuorie

The middle-aged man joined Omoh in spreading the gospel of no coronavirus in Delta state and Nigeria. The elderly man then said he wouldn’t board a bus with complete passengers.

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“Oga, then make you go Effurun go enter motor. But na charter you go charter o because no park for this Delta wey no dey carry full loading!” she retorted.

The elderly man stared at Omoh and her colleague in sheer disbelief, turned away with hurried steps. I caught up with him to engage him in an interview but he was either in a hurry, angry or too shocked over what had just happened. He ignored me, boarded a motorcycle and left.

Some passengers at the Agofure Motors Park, Ughelli North, Delta State, December 14th, 2020. Photo: Tobore Ovuorie

I was tempted to go tell Omoh and her colleague that the coronavirus is not only present in Nigeria but on the increase. I felt like telling her I actually came to Delta state to speak with some survivors of COVID-19 in the state. I doubted she would believe me except I played my audio recordings of Itiveh Ekpokpobe, Andrew Usen and Onoriode Onosode. All survivors of the COVID-19 in Delta state, South-South, Nigeria.

ONORIODE ONOSODE

“Customers Laugh At Me For Contracting COVID-19”  

Onoriode Onosode, 32,  work-from-home entrepreneur went down with fever and body weakness first week of July this year, then within four days, her very sensitive nostrils which perceives anything easily, suddenly failed her when she cooked. No more could she taste salt in the food she prepared. The mother of three ran a domestic test by chewing unwashed bitter-leaf, yet tasted nothing. Onos, as she is fondly called by everyone around her, then suspected she had contracted the coronavirus.

Already tensed, she shared her fears with Daniel; her husband, who is a medical doctor with one of the renowned private hospitals at Ughelli North, in Delta state. He requested she got tested for the virus. Four days after being tested, her fears were confirmed. Positive.

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Onos was very scared for her kids and herself. She was still breastfeeding at the time, so her fears and worries knew no bounds.

“I was not taken to the isolation centre. I was asked to go home and isolate because one of the doctors said it wasn’t that serious though I was coughing and breathless,” Onos narrated.

Although placed on medications, she took ginger, garlic and other hot spices concoctions alongside. Her medications included vitamin C 1000mg, several ‘strong’ antibiotics among others I cannot mention in this story due to health reporting ethics.

Her treatment regimen was quite long until the symptoms were over. She was down for about three weeks and some days, while recovering was slow and uneasy. Onos still wonders why no contract tracing was done in her case. She wasn’t asked for names of persons she had been with before testing positive to the virus. Only her husband’s elder brother visited her and showered her with care. Other persons disappeared.

 

“Now that I have survived it, my family and friends are back and free with me. The only person that makes fun of it is my first son.” Giggling while talking, dark-but-shinny-skinned Onos continued “whenever I sneeze or cough, he will say “mummy shift, coronavirus.” My little baby does that. Every other person is okay. Very okay with me.” The little baby is a five year old boy, while Onos says nothing has changed in her body since her recovery.

Though she defeated the coronavirus, Onoriode is still very worried. She says because it is believed out there that the COVID-19 is a government and global propaganda. She also never believed it existed in Nigeria until she contracted it. Ever since her recovery, she now “preaches about the coronavirus” every time she goes to the market.

“I talk about it to my customers but they laugh at me. I preach about it but they tell me to leave it that there is no COVID-19. I told a customer I contracted the virus but she laughed at me that na you dey fear am.”

Her customers in the market make jest of her that she contracted the virus because she is afraid of it. Onos’ customers and many of her friends still believe that COVID-19 is not real but shift away from her when she tells them she contracted it.

“Even as at yesterday (December 8th, 2020) I was sitting in a bus and they (the passengers) were talking about it. I kept quiet and after a while, I said I had contracted it before. The persons sitting by my right and left-shifted away from me.”

Onoriode is now more deliberate about keeping the virus away from her home and space.

ANDREW USEN

I could barely hear him well during the interview. I wondered if he was this very soft-spoken or it was the sore throat, he said he was battling with again, or maybe because I sat quite far away from him in his large living-room. Listening to the audio recording of the interview with him later on proved my first take was correct, possibly the first two because I positioned my recorder quite close to him.

He and his wife were about to have a baby second week of May this year when Andrew Usen, 37, a nurse at a major private hospital in Warri, Delta state, took ill. He had malaria symptoms and was used to ignoring such. But many of his colleagues tested positive for  COVID , so he decided to get tested as well. Two days later, his result returned positive and he quickly dashed off to request for his wife’s result which surprisingly was negative.

He was concerned for his wife because of the nature of his job, and moved her out of their home when he had to self-isolate during treatment because there was no available bed space at the isolation centre in Delta state.

A Covid patient receiving treatment

Andrew’s family and friends were initially very scared. “A friend of mine asked ‘Hope you are not going to die?’” . But after the initial fear, they all started to encourage him that he would pull through.

He was treated with several medications but refuses to tell me their names. “It’s unethical for me to tell you,” he explained.

On the eighth day, he was taken for a repeat test which came back negative the next day. And he has moved on with his life though now very cautious of observing all COVID precautionary measures, with patients at the hospital in particular, to ensure he doesn’t contract it a second time.

Itiveh Ekpokpobe

Itiveh Ekpokpobe, six feet and three inches tall, a journalist and management consultant who lives in Delta state was in Lagos February this year when the news hit the country that Nigeria had recorded the first case of COVID-19. Coincidentally, it happened in Lagos where he was meeting with six persons who had just returned to the country; two from the United States, while four from the United Kingdom.

Within four days of his return to Delta state, Itiveh became very ill. He had severe cold and was terribly feverish. He took an overdose of malaria medications – two packets – yet, remained sickly. He consumed over a pack of immune boosters but there was no improvement whatsoever. Then, he resorted to more self-medications: a combination of spicy teas and was relieved eight days later.

A week after he felt better, he learned that two of the persons who were at the meeting experienced exactly what he battled with. Itiveh then went online to study the symptoms of COVID-19 and discovered he exhibited all of them. These include cough, fever, shivering chills, body pain, headache, shortness of breath, diarrhea, abdominal pain, runny nose, catarrh, fatigue or tiredness.

Itiveh has lost no fewer than three friends who were politicians in Delta to the virus. But after recovering, he never bothered to go for a proper test at a government approved centre. He says he didn’t get tested for the virus because at the time he contracted it, there was no test centre in Delta state, while the first two known COVID cases in the state were poorly handled. Itiveh says an investigative story about the Delta state government he worked on for some time was published that period. It had heated up the polity, so feared for his life if he still tested positive and being quarantined at the then makeshift isolation space was recommended.

 

He says the first two known cases in Delta state were abandoned in the hospital and treated with disdain as if they were lepers. Hence, he didn’t want to expose himself to such ill treatment. A part of his self-treatment included consumption of very hot liquids, ++ fresh foods and fruits to boost his immune system and was always in very warm environment. He never contacted the NCDC for contact tracing because he did not want to expose himself for security reasons. But his girlfriend whose house he went to from Lagos joined him in taking the medicines and home treatments because she exhibited mild symptoms.

Though Itiveh’s father is a medical doctor, he never informed him of his contracting the virus because the dad is 85 years old, while his mother is managing high blood pressure. But when he recovered, he informed only his father but requested his mother must never be told.

Itiveh alleges the Delta state government poorly handled COVID-19 cases in the state during the lockdown, while the isolation centre in the state was completed just when the COVID complete lockdown was lifted July this year.

If my story had been published when Omoh was peddling wrong and quite untrue information about COVID-19 in Nigeria, I would have also shared the survivor stories of Lucy Okechukwu, and Sele Hussein with her.

Lucy Okechukwu

It all started sometime in the middle of May this year. Her husband still had complaints of extreme tiredness and fever after taking all antimalaria medicines he was given at the hospital. This was two weeks before Lucy Okechukwu, 35, and a journalist who lives in Anambra state, South East, Nigeria, took ill and had to go to the same hospital where her husband had been treated for malaria. Hers was consistent pounding headache, slight sore throat, fever, loss of appetite, and extreme body weakness. The hospital conducted a Widal and malaria test which returned positive. Then she was given a dose of injection and antimalaria medications.

But three days into taking the medications, every food Lucy ate were tasteless while her environment too was odorless. She was not getting any better. Just about same period, every food eaten by the husband had no taste while the usual perfumes he had always used were suddenly scentless.

He phoned the medical doctor who attended to his wife at the hospital to complain and was told they should return to the hospital for re-examination. But the doctor phoned her husband back that morning to recommend they undertake test for COVID-19, instead. Lucy sought a second opinion over the phone from Prof. Sunday Omilabu, a virologist at the Lagos University Teaching Hospital, LUTH. After explaining all that had happened, he also advised they test for the COVID-19.

Getting tested was tedious as Lucy’s husband had to call the state’s emergency health lines countless times before his call was answered. And, after a series of questions about their state of health, they were asked to come to their office for the test.

“Inserting that cotton stick into my nose and throat was very irritating. After the test, they asked us to quarantine ourselves while we await the results,” Lucy narrated.

By Saturday night, the couple concluded they were COVID-free after not hearing anything from the hospital since Thursday the test was carried out on them. This changed the following morning.

A certain Dr. Chijioke phoned Lucy’s husband to announce their test results came back positive. Then instructed them to pack their bags because the center will be coming to pick them from their home to the isolation center. They were scheduled to be on treatment for the next 10 to 14 days.

If a needle had dropped on the ground in the Okechukwu’s home, it would have made a deafening noise. The couple didn’t talk to each other. A potpourri of emotions enveloped them. They became angry, quiet, afraid, sad and depressed. Lucy was struck with fear of death. The fever and headache she was battling with became worse. “Really, I became afraid to die,” the health journalist disclosed.

“I did not travel to anywhere and honestly; I still cannot specifically say this is how I got infected. I was working from home most of the time.”

Lucy guesses she possibly contracted the virus from the market as she sometimes didn’t wear the facemask because it made her nauseous. She also thinks possibly her husband may have contracted it because as a civil servant, he went to work regularly and interacted with many people.

The couple phoned the doctor back that Sunday morning to tell him they would meet up with the ambulance at the junction of their street. This was to prevent calling the attention of their neighbours due to rife stigmatization of persons who have contracted the virus.

Quiet but not a lonely ride   

When the couple boarded the ambulance, they met two other patients. It was a quiet drive to Onitsha where the Protective Care Centre – as it is called in Anambra state – is located. Four other patients who had arrived earlier were in the 12-bed ward. Two doctors wearing Personal Protective Equipment (PPE) addressed and encouraged them. They kept repeating “COVID-19 is not a death sentence.” It was only then reality hit Lucy that she and her husband indeed had COVID-19. She had been in denial all the while.

 

‘Compulsory’ while lies   

Their siblings, when informed, did not believe them until they made video calls and saw where the couple were. No one else aside their immediate family members were told. They deliberately did not tell their friends and neighbours. Lucy says they kept lying to them that they had traveled to spend some time with her grandma whenever they phoned. Other patients too kept lying on phone  about their whereabouts. Lucy’s husband called in sick at his workplace. He said he needed to go take care of himself. Lucy was with her gadgets and did more of telephone calls, zoom and webinars.

Treatment regimen

Every morning and night, medications were passed to the patients through a window by a medical doctor. The treatment pack contained zinc, vitamins D and C respectively and other medications I cannot mention in this story due to health reportorial ethics. The meds were to boost their immune system to fight the virus.

Patients with underlying health issues such as diabetes and hypertension were given more medications to manage their health condition.

After their medications, a doctor came in every morning to check the patients’ vitals and health status, then would leave them all alone for the rest of the day. Everyone in the ward bonded by sharing life experiences and watched television as there was constant power supply. This possibly explains why patients in isolation centres shown on TV looked very healthy, while the public expected to see frail-looking sickly people.

“People need to understand that there are different categories of patients – the asymptomatic, fully symptomatic or  patients with severe condition,” Lucy who specializes in health reporting, explained.

“The very severe cases were isolated in the Intensive Care Unit (ICU). We heard some were on drip or either intubated. We could see some of their family members far off the building waiting to see a doctor whom they could ask about the health status of the sick loved ones,” she added.

Lucy’s case was not severe because most of them in her ward were asymptomatic patients. She was actually ill but after three days of treatment and checks, the headache, fever, sore throat and body weakness were all gone. But her loss of senses of smell and taste lingered. Other patients  were also responding to treatment.

A cousin to a patient in Lucy’s ward contracted the virus, too. The young man refused to come in for treatment when he tested positive and insulted the health worker who informed him of his test result, as well as the Anambra state commissioner for health who also phoned him and pleaded that he agrees to be picked up for treatment. The young man was later wheeled into the centre when his case had become severe. While being treated for COVID, it was discovered he was diabetic but he never knew all the while. He died three days later.

“Believe it or not, COVID-19 is real! This disease is spreading daily because some people who tested positive refused to present themselves for treatment and some refused to go for test. It is unfortunate that such people are helping to spread the disease and some people they might infect might not have strong immunity to survive the disease,” she lamented.

Five days after being at the protective care centre, Lucy and her husband were re-tested. Their results were negative. They were admitted on June 7th, 2020. A second confirmatory test though was not conducted before they  were discharged on the 15th of June

Sele Hussein

Sometime in June 2020, Mr. Sele Hussein, a lawyer-turned -businessman started having headache. He was later in and out of Omotayo hospital, situated in the capital of Lagos state, regularly, treating malaria but never got better.

One day, during what would become his last visit to the hospital, his doctor asked if he had been tested for the COVID-19. Omotayo hospital didn’t have the facility to run a COVID test so gave him a phone number to call. It turned out to be the NCDC centre at Agege, a suburb in Lagos. No one at the centre answered his call.

Sele as he is popularly known amongst his friends, neighbours and colleagues, later saw NCDC Abuja’s phone number on TV that night. He called. It was answered, while the person at the other end of the phone promised to escalate his complaints to the Agege centre. But when Sele woke up the following morning, his sense of smell had vanished.

“I sprayed my perfume but couldn’t perceive its scent. I sprayed insecticide in my room and couldn’t perceive the smell, too.” Six hours later that day, his sense of taste has also disappeared. He put some salt in his mouth but it was tasteless, same  with sugar. At that point, he knew he had contracted the virus, and went on self-isolation; never to leave his house anymore until he received proper treatment.

Sele was called Tuesday the following week to be tested at the NCDC Agege  centre. Four days later, the test result confirmed his fears.

“I was afraid at that point. It was not funny because I didn’t know how I contracted it. I was using my facemask and living alone, then,” he said.

Sele whose wife and kids live in Abuja had big bottles of hand sanitizers in his office, car and home respectively and used them regularly. Thus, he is still wondering even till this moment about how he contracted the virus.

“It happened at the peak when people were dying, not now that they are not serious about it. I was really afraid that I was going to die,” he added.

But with the counselling from doctors at the centre, he became somewhat hopeful; reason he was able to drive by himself and alone to the isolation centre in Yaba, a commercial part of Lagos state.

During contact tracing the NCDC tested his colleagues at the office but their results were negative. Sele’s home and office were then fumigated.

Sele was given so many medications which he doesn’t know their names because it never dawned on him that a patient can demand to be told what is being administered on him or her from a doctor. He only recognized vitamin C 1000mg.

The father of three girls had his mind fixated on leaving the isolation centre alive. He was scared and traumatized by the fact that he contracted the much talked about coronavirus. But he encouraged himself with the positive news of patients being discharged at the centre. “If these people survived and left here alive, I will,” he kept repeating to himself.  The death-rate was lower compared to the survival rate at the Yaba centre.

“I wasn’t particular about the environment. I just wanted to get well and move on,” he replied when I asked about the environment and patients’ comfort at the Yaba isolation centre.

Betrayal and strained relationship

Sele’s immediate family members were supportive and praying for him all through the ordeal. He says his father phoned him 10 times a day while his siblings kept his phone very busy with prayers via phone calls, text and WhatsApp messages. These gave him more hope that he would defeat the virus and leave the centre alive.

However, one of his very close friends bluntly told Sele he would not visit him at the centre, even just to sit at the reception like visitors did, nor at his home after he was discharged. The friend now treats Sele like a leper and told him he can’t be around Sele anymore because he contracted the coronavirus. Tender-hearted and soft-spoken Sele is still deeply hurt by the unkind words and treatments from his close friend whom he believed so much in. Their relationship since then has hit the rocks.

“I cannot do that to him if I were to be in his position. There is no way I would have abandoned him,” he kept repeating with so much emotions.

 

After 14 days of being managed for COVID-19 at the isolation centre, he was tested again but the result returned positive. A week later, another test was carried out and it was negative.

Since after recovering, Sele noticed he has yellow spots all over his brownish skin but isn’t bothered about them because the doctors told him it is a harmless aftereffect of contracting the virus.

Sele’s family members are still very free with him. Their love, care and treating him kindly keeps him going, while four of his friends who used to say COVID-19 is a government propaganda are now very deliberate about their hand hygiene and using facemasks after he shared his COVID experiences with them.

Covid reality

Nigeria, West Africa’s most populous nation, like countries across the globe, is battling to curb the spread of COVID-19. Daily statistics of confirmed cases by the Nigeria Centre for Disease Control (NCDC) indicate the country is yet to cross to the safe path as many Nigerians are contracting and spreading the coronavirus. Unfortunately, testing remains extremely limited.

Dr. Osagie Ehanire, Nigeria’s Health Minister, had announced to journalists earlier this year that: “We (Nigeria) have passed that era when people used to think that COVID-19 was something for big men and big women who came from abroad.”

The country, he explained, is now in the community transmission phase of the deadly virus.

First detected in Wuhan China, the viral infection has rapidly spread globally, hence declared a pandemic by the World Health Organization (WHO). The medical online publication called Statista, indicates in a research titled ‘Cumulative cases of COVID-19 worldwide from January 22 to December 2020, by day’ and authored by Mr. John Elflein, that over 73 million persons have contracted the virus globally. The disease, the publication reveals has impacted almost every country and territories globally, with the United States confirming no fewer than one-fifth of the global cases.

The Nigeria Centre for Disease Control (NCDC) reveals that Nigeria, as at 10.17am, December 20th, 2020 had tested 874,617 Nigerians, while 77,933 persons tested positive. The agency further indicates on its website that as at this stated date, there were 8,931 active cases in the country while 67,784 of the confirmed cases have been discharged and 1,218 deaths recorded.

 

 

The novel coronavirus also called COVID-19, mostly affects the respiratory systems with catastrophic consequences in various body organs. It is however more severe in the elderly and people with underlining health conditions. Many aspects of the novel virus remain unclear; while vaccines critical to preventing infections in humans are not yet readily available.

The Nigerian government, like other global governments and agencies recommend physical distancing of humans being observed because it is an effective measure in reducing transmission of viral diseases, such as the COVID-19.

But investigations so far reveal the physical distancing guidelines are not being observed in many parts of Nigeria.

Life after Covid

Since leaving the COVID treatment centre, Lucy and her husband have been extra cautious. “I’m so married to my face mask and sanitizer,” she revealed.

Lucy has become an advocate by speaking with Nigerians who are living in denial and doubting the presence of COVID-19 in the country. She wants more lives to be saved.

“The truth is, this disease is really killing people every day but our people have a way of covering up the cause of death. My advice is, people should stay safe by adhering to the safety precautions, go for test when you feel the symptoms and present early for treatment,” she concluded.

Itiveh is now more deliberate about not exposing himself to the coronavirus. He advises Nigerians should not joke with their health. “You don’t hear that there is a bomb somewhere and you say because it hasn’t exploded you want to go close to it. What will it cost you to follow the regulations?” he asked.

Andrew Usen ensured a social distance between us when I went to speak with him at his home for this story. “The COVID-19 protocol is meant for our safety; so, it is ideal we practice them to reduce the chances of contracting the coronavirus,” he kept telling me. “Please, pass the message to Nigerians when you write your story,” he requested when I was leaving his home.

Sele Hussein has moved on with life but worries that many Nigerians are asymptomatic but do not know because they are yet to submit themselves to be tested for the virus. He advises that Nigerians should walk into centres to get tested.

“It is better for Nigerians to get tested and get treated if their results turn out positive. The virus is real. It is not a government propaganda. I went through it, survived it and I am out. Anybody that wants to propagate that COVID-19 is not real lives in another planet”.

He advises COVID survivors not to let their guards down by believing they are now immune to the virus. “It is good we adhere to the COVID precautionary measures,” he said.

“My advice to people out there is that COVID-19 is real. I didn’t believe it till I had it. There is no need to panic; you just need to act fast. When it hits you, you may not be financially buoyant to take care of yourself.” These are Onos’ message to Nigerians.

Onos says she spent over N60,000 on medications, alone. These meds and their costs are different from those bought for her kids to prevent them from contracting the virus.

“Imagine someone who doesn’t have the means like those in the villages? That is death.”

Dr. Daniel Onosode – Onos’ husband – a public health practitioner says people with underlining health conditions such as high blood pressure, respiratory issues like asthma, amongst others, are not only more prone to contracting the virus but are at greater risk when they do and don’t recover on time.

He used his wife as an example. According to him, she coughs right from childhood especially during dry season; such as from October of every year, reason her recovery was uneasy.

Dr. Onosode says elderly people contract it easily due to low immunity as a result of old age. “Everybody should keep safe by using their facemasks, wash their hands and use sanitizers regularly. These are cheaper, safer and with no risk, compared to contracting the virus,” he said.

Covid-hiked fares, yet no Covid protocol observed

Agofure Motors, a major transportation company with its headquarters in Delta state had hiked transportation fares by 100 percent when the COVID-19 pandemic began in Nigeria. Employees of the organisation had explained that it is because only eight passengers would travel in each bus in accordance with the World Health Organisation’s social distancing COVID-19 precautionary measures. But when I traveled to and from Delta state through Ughelli December 8th and 14th, 2020 respectively, we were squeezed like loaves of bread in Agofure Motor’s 15-seater bus.

On my return trip to Lagos, sitting with half of my buttock and resting my head and side on sacks of garri which pinned me to so little space in the bus, I spent the over eight-hour road trip adjusting each buttocks on the chair and scrambling for a comfortable space to put my legs in the bus. I was the only passenger in the bus who used a facemask while traveling to Delta state, while only two of us had our facemasks on during the return trip to Lagos.

This report was facilitated by the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under its COVID-19 Reality Check Project.

 

If you or someone you know has a lead, tip or personal experience about this report, our WhatsApp line is open and confidential for a conversation

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