By Dr Ibrahim Musa
With her beaming smile, she seemed excited that the surgeons had finally removed a growth troubling her tommy that had proven difficult to diagnose. She stretched her arm to deliver a sealed envelope containing a histology report of the growth. As an Attending, I was the only one working that day because the resident doctors were on a strike. Charmed by her smiles, I quickly opened the envelope hoping to read good news that would match her spirit and her equally excited mother. My smile froze. What should I tell her? The pathologists had made a diagnosis of a diffuse large B lymphoma. It’s quite an aggressive tumor that could overwhelm a patient within a short time.
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“Doctor, what is the report saying?” “You have cancer”, I replied. The devastating news instantly changed her mood. Breaking such bad news is a job no doctor wants to engage in. I explained the treatment options and the fact that there is a targeted therapy called Rituximab that could potentially improve survival if added to her chemotherapy. A vial of the drug costs hundreds of thousands and she would need at least 6 cycles within ~5 months of 3 weekly treatment. “Doctor, we cannot afford it,” her mother interjected.
Three months later, when I came for the ward round she had deteriorated badly. The growth is already back and almost 10 times bigger- obstructing her intestine and protruding on the anterior abdominal wall from her pelvis. She could barely breathe while struggling to hold on to her mother. As I watched her writhe in pain, I felt hopeless and sad. I felt defeated but beyond that I felt like we have all failed her. I silently fought tears as I struggled not to betray emotions. If I cry I would break the hearts of the people around at the time they needed me to give them hope. “You must be strong”, I told myself. But at that moment I was so sure that death would be a relief for her. She died the next morning unable to do even an X ray due to poverty. I keep asking myself what we can do to mitigate these unfortunate scenarios? Over 40% of the Nigerians live on less than $1 per day. With this extreme poverty, how do we expect them to shoulder the cost of exorbitant care from the angle of catastrophic spending?
Dr Ibrahim Musa is a consultant at Aminu Kano Teaching Hospital
