I hadn’t seen Momba since before I went to Kinshasa at the end of August, last year. At that time the swelling in her face, caused by TB, had gone down considerably, and she’d gained weight. We left her with the instructions that sometime in September she should return to her village of Bokakata. While she stayed at our second centre, she’d followed a course of drugs to cure her. She’d got her appetite back – and amazingly, become a new person. Any further medication the hospital might give her she could carry with her to her village. Our work was done – we’d already saved her life.
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| Mama Momba with children the day before her hospital visit |
She came to see me, only a few days after my arrival in March. I noticed that, although most of it had gone, the swelling in her face was still there. She had always talked about “when the bone started to stick out!" and we always assumed she was describing the TB ganglions that made her face swell. This time she showed me inside her mouth. Her back teeth at the back seemed double. Along the length of her teeth on one side there was a ridge of toothlike growth, but just the thickness of a comb. “When I lie on this side, it hurts. At first, it was the other side – but now it’s this side,” she said.
Dr Eric was busy with a patient when we arrived at the Catholic hospital next door. She was able to be examined by one of the Medical Assistants (nurse practitioners), Jean-Paul. I’d done my own research and could have come to several conclusions – one of them, bone cancer. Jean Paul confirmed my suspicions. “It could well be bone cancer,” he said. “But it seems to be made from tooth enamel. That had already been in my research – bony spurs growing from the jaw and associated with TB. “She’d need specialist treatment in Kinshasa. It would be expensive and there’s no guarantee of success,” he added. “But you’ll need to see Dr Eric for confirmation."
Dr Eric was now free. He was certain it wasn’t cancer. The tooth enamel growth could just be removed – but it would need to be in the operating room. “Leave it with me and I’ll research it a little more at home. But meanwhile, I’ll book her in for the operation tomorrow morning. It’ll be under general anaesthetic.”
I went back to my house and told Judith what had been decided. Judith wasn’t happy.
“We’ve already treated her TB and paid her keep for 6 months, Francis,” she explained. “Her costs have been more than any one of the malnourished children we’ve treated. What if the operation goes wrong and she dies? Then we’ll have more problems!”
Judith was getting annoyed. Momba had reminded her of a recent patient whom we’d offered to help. The patient had suffered a crush injury, in Baringa, after the wall of a house had fallen on him. He’d been bed-ridden for almost 2 years and the family had finally agreed to amputate his leg. I’ve known his family for 30 years, and so was keen to help. Although the family had paid most of it already, Judith and I agreed to pay the remainder of his hospital bill for the amputation. In addition we would pay for any further medication and dressings.
What actually happened was this: six weeks after his operation, he died. The remaining bill for the operation was never paid, even though we’d given the family the money for it. As well as that, they’d done another operation on his hand where the skin had torn apart, without our consent. We ended up with a bill for $400 and the young man was dead. He died from poor bedsore management – his whole body had just deteriorated. Incidentally, the amputation was a great success and the wound was very clean and healing very well – but not so the rest of his body. It was for this reason that Judith had sworn we’d never get involved in someone else’s operation again.
I told her that we’d come so far with Mama Momba that it would be a shame to leave it all now. I insisted that she have the operation, and that it would just be like a visit to the dentist. Reluctantly, she agreed.
The next morning, Momba arrived with some family members. We made the short journey to the hospital and I found them somewhere to sit and wait. A porter came across and said that Dr Eric wanted to see me. I went across to his little office and entered. There, sitting on a chair behind the door, was Judith! She’d been for a chat and explained her worries! Judith left me to talk to the doctor.
“I did some more research,” Eric said. “I’m coming down more on the side of possible cancer, but we can’t be certain yet. Judith is right to be concerned – you could be starting a long line of procedures. Let’s see how it goes for a while.”
The truth is that diagnostic capacity is very low in Basankusu hospitals. Eventually, our resources have to be taken into consideration. We can’t save the whole world – and if we tried it would bankrupt us very quickly.
Dr Eric called Momba to his room and told her that he’d decided not to go ahead. She was happy, and told us how she’d had a dream in which she died and went to heaven, during the operation.
“So, it sounds like you’re very relieved,” laughed Dr Eric. “Do you remember telling me last time about falling and the ‘bone’ broke off?”
“Yes,” she replied, “that’s when it started on the other side.”
“Let’s wait and see if the same happens this time,” he said.
We got Momba back to the house. I kept in mind that her condition could possibly bring her back at a future date. We gave her some money and food to keep her going and told her the time of the next boat to Bokakata. And she thanked us and promised that she would go.
But she’s still in Basankusu – she never went!
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