Musafiri was admitted at HEAL Africa six weeks ago for respiratory distress, fatigue and fevers. On physical exam he had multiple large lymph nodes and hepatosplenomegaly (big liver and spleen). His blood showed anemia and elevated white blood cells.
I suspected cancer, but he improved very quickly with antibiotics and fluids, so I discharged him home with close follow-up. Over the proceeding weeks, I saw him often. He had not become worse and seemed to have slight improvement. That was until two days ago.
As I was walking away from morning conference, I saw Musafiri’s father lumbering through the front gate of the hospital. I had a brief moment of confusion and then realized that Musafiri was on his back, with his legs wrapped around his waist and arms around his neck.
I quickly pulled them into the exam room. Musafiri was as pale as a ghost, his heart was pumping in overdrive and his spleen was encroaching on his pelvis. I immediately suspected his leukemia was coming back with a vengeance.
I ordered lab tests and, within twenty minutes, I discovered his hemoglobin was 2 g/dl (normal is 12-15 for his age) and he had abnormally low white blood cells.
The other doctors were extremely busy with rounding on the other patients, so Lisa and I brought the patient to the pediatric ward and gave him an emergency blood transfusion. The effects were remarkable. After four hours, he sat-up, smiled and said “thank you”.
I then had a short discussion with the father and said “Musafiri will die shortly without chemotherapy. If he is going to survive we must leave the country immediately and try to find a center that will care for him. It will be a long process, likely two to three years of treatment. What do you think?”
The father immediately said “Let’s go!” and scurried home to gather their belongings.
Thirty minutes later, Musafiri, his father, Lisa and I left the hospital and jumped in a cab. “To Kigali” we told the driver.
As we crossed over to Rwanda, I noticed that the patient and his father had very little in the way of luggage. When the customs officer asked to see their items, the father placed a small briefcase on the table. He then removed a t-shirt, toothbrush, three bananas and a small cup of porridge. That was everything they owned together as a family.
We then proceeded on the drive to Kigali. Despite his illness, Musafiri was amazed by the three-storied buildings and mesmerized by the lights of the city. At one point he mumbled “wow, this is what Europe must be like”.
At 8PM, we pulled up to the emergency room and Musafiri was immediately placed on a stretcher. I thought he looked relatively stable compared to earlier in the day, but the medical team there immediately jumped into action. He received another blood transfusion and intravenous antibiotics.
The following morning, I went to rounds and met the supervising pediatrician. After a brief discussion, he told me “We are not very comfortable here with pediatric oncology. We can do it. But, for example, we must send our bone marrow biopsy to Uganda and it takes 2-3 weeks to get back.”
Ouch, that is not good. I did not continue the discussion and simply said “Thank you for your care. Can you please have him ready for discharge early tomorrow morning and we will head to Uganda?”
At this point, I felt I was over my head. I had never been to Uganda, Musafiri and his father had no passport, we were running out of money and our patient was very sick. Despite the obstacles, both Lisa and I had committed to helping him and we felt obligated to keep trying.
For the remainder of the day, our friends Miguel and Karolina drove Lisa and me all around town. First to the Ugandan embassy. They said we must first get a passport for the patient and then they would issue a visa. Then to the Congolese embassy. They said they do not issue passports “but under these circumstances…… we will make an exception.”
We all slapped “hi-five”, rushed back to the hospital to grab the father and then returned to the Congolese embassy. Within 90 minutes we had two, crisp new passports.
As the day was winding down, we finalized plans and purchased bus tickets to Kampala. We dropped the father off at the hospital and rested for the night.
At 6:30AM the next morning, we were off. Everything at the hospital was prepared for our departure and we left uneventfully. At 8:30AM, we boarded a large, rickety bus and began our next adventure through the rolling hills and jungles of northern Rwanda and southern Uganda.
As we drove, Musafiri took oral medicines and I administered IV antibiotics. He had fits of nausea and slept part of the way, but at other times he was excitedly looking out the window.
Ten very long hours later, under the cover of darkness, we arrived in Kampala. We quickly disembarked the bus, jumped in a taxi and drove to a local hotel.
Musafiri and his father seemed to be in a trance. The idea of a hotel was new to them and as we sat down for dinner, they admitted that they had no idea how or what to order .
At 10PM I gave Musafiri his medicines and then we prepared for bed.
I am excited that tomorrow we will arrive at the famous hospital and see the renowned cancer institute.