John* was in his forties when I operated on him 7 years ago. He exuded courage when he spoke. A keen eye would tell he had lost weight though. He spoke of a past better health and confessed to sweating at night and feeling generally weak, besides the tummy discomfort. He had bowel cancer. I thought the operation went well. We removed all cancer. He would later get a transfer to Nairobi for chemotherapy.
When I ran into him 3 years later in Nairobi, he looked healthy. Just complained of some swollen neck gland. Scans had revealed nothing concerning in his bowel, same as the needle biopsy of the neck gland. He told me he was flying to India for PET scan (special scan that looks for cancer spread). I wished him well.
It was a chilly Thursday morning and I was caught up in the usual rush hour Nairobi traffic. The gear was in parking, hand brake up, foot off the pedal. Peponi road had turned into a parking lot. A foreign number was calling on WhatsApp. It was him, calling from India. I can’t remember anything conclusive from what he told me about the PET scan. I remember him saying he was going in for stem cell therapy. I was taken aback because this treatment is still at investigational stage and I have not read anything about stem cell therapy for his type of disease.
A few weeks later I got a missed call from his Kenyan number as I changed from my theatre apparel. When I called the next day, the number was switched off. I was perturbed to learn a few days later that he was dead.
It was not until a few weeks ago that I was reminded of this case when a colleague shared her experience. She had a relative who had kidney failure and needed transplant. The costs in a private hospital were tormenting. As fate would have it, they found themselves in the hands of Indian medical marketing executives. They got a good deal. The total costs would amount to less than needed in Kenya. After a rigorous screening, a perfect match was identified from among the relatives. Both the patient and the donor left for India.
They were back to the country right on schedule as promised. Everything had gone well. But the patient would not improve. They thought he was still recovering from surgery. But a day led to another, then a week turned into a fortnight. He was taken to hospital, going into coma. His kidney function was still the problem. Many questions went through my colleague’s mind at this point. He succumbed shortly after (may his soul rest in peace).
It was confusion all over. There were scars to show surgery had taken place.
Thanks to the mystery, the family decided to have a post mortem examination. Much to their collective angst and disappointment, there was no new kidney! The chain reaction extended to having a belly scan for the donor. There was no kidney! It had been removed for sure, where it lay remained the question.
On hearing the story everyone in the room was up in arms wondering how the relevant regulatory authorities could not tame the exodus of Kenyans to India where some of them land in the hands of conmen.
“We have so many patients who are hopeless. They find hope in Indian colleagues”, one of us observed as she hushed the group into calm. Someone protested that it’s not hope to lie to a dying patient with stage 4 cancer that you will cure them. The discussion was stopped.
I thought to myself, we must improve in empathy if indeed our communication to patients drives them this far.
The reality is, the patients’ social dynamics are varied. There are those who will decide to go to India just to have a special scan which is available in Nyeri. Those who will cross oceans and mountains to hear the same story, albeit from differently cultured doctor. I am ok with that.
My request is, please share your experiences widely when you come back. It will help us blacklist some of the unethical institutions you may encounter.
*Not his real name
Dr Aruyaru is a General Surgeon in Nyeri.Twitter: @arumwesta