Africanizing Oncology by Marissa Mika

Author:Marissa Mika [Mika, Marissa]
Language: eng
Format: epub
ISBN: 9780821424650
Google: cR1UzgEACAAJ
Publisher: Ohio University Press
Published: 2021-01-15T05:28:12+00:00

Epilogue

In Memoriam

MOST EVERY Tuesday, somewhere around 1 or 2 p.m., after staff consumed a fast lunch of local food, fish, and groundnut sauce, we piled into the examination and intake room of the Lymphoma Treatment Center (LTC). A wooden table surrounded by hardback chairs dominated the room. A filing cabinet stood in a corner. The social worker, counselor, and I usually assembled on the slightly ragged examination bench with legs dangling. An old sterilizer sat in the corner, donated sometime in the early 1990s by a Christian NGO. Occasionally one of the nursing staff would come in during ward rounds and fire it up, sterilizing piles of cotton gauze that would be used for cleaning up veins after blood draws.

Dr. Joyce Balagadde Kambugu, the head pediatric oncologist at the Uganda Cancer Institute (UCI), would usually rush into the room, apologizing for being late. She would sit down at the seat reserved for her in the middle of the table, surrounded by nursing and laboratory staff, and voluminous piles of pink, manila, blue, and green patient records. Some of the files were so thick they were nearly falling apart. Others were slender, containing only a face sheet and a referral note that had been filled out that very morning. Kambugu would slip a wad of Ugandan shillings to Sister N, the elderly Muganda nurse who had been working on the wards of the UCI since the 1970s. Sister N would come back several minutes later with black caverras (plastic bags) of sodas. Coke, Fanta, and Stoney ginger beer would be distributed along with straws to the fifteen or so in attendance, the ward round officially commencing to the sound of bottles being cracked open and the discussion of “very, very sick children.”

Quite soon upon returning from a year of training in South Africa, Kambugu, who was running a ward with twenty-four beds and thirty-four to forty more inpatients sleeping outside on the verandah at any given time, decided to initiate comprehensive “sit down” ward rounds in the privacy of the doctor’s examination room rather than “standing” ward rounds. Part of this was done to reduce the amount of time spent on one’s feet, shuffling from one bed to the next with an entourage in tight quarters. But there was also the question of privacy. “They listen to what you are saying about them,” Kambugu says. “They are watching, wondering if you are going to give up on them or if it’s game over.” “Game over” was the phrase Kambugu invoked time and again for residential cases at the UCI who were for all intents and purposes salvage chemotherapy patients. In a setting that was so public—twenty-four beds jammed on top of one another along with family members and additional kids and relatives coming in to say hello—creating a space for private and frank discussion changed the tenor of the ward round. Given the volume of patients and shortages of space, the long-term goal of admitting a patient—the Luganda phrase olmuwadde mu’wadde

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