Just in case you have forgotten, we were waiting for authorisation from NHIMA to go ahead and get a CT-Scan from Royal Diagnostics, a private lab within UTH. This was requested in order for the doctors to determine the actual spread of Mother’s endometrial cancer. In the early hours of February 6, mum started struggling to breathe and was put on oxygen.

At this point, Jennipher and I were fully indoctrinated in UTH culture. My brother Chatila had supplied some comfortable crocs, aka “Bikilonis” and we wore chitenges on the daily – we fit right in. We walked up and down those UTH hallways I lost almost 2kgs in two weeks (I’m not complaining, it gave me a head start in my weight loss journey)! For the first week, Jennipher was the solo night time bed sider while I commuted after pumping milk for my son every day. I actually lost about 40 per cent of my breast milk supply that month – stress.

At the start of the second week, my other elder sister Abigail arrived from Mansa. She, Jennipher and my other mum, Mummy Keresia would alternate night shifts. When I arrived to see her on February 6, , I found that her upper body had been elevated in order to relieve her lungs of some pressure. The fluid which had started building up in her abdomen had increased in volume and it was now compressing her lungs. By now, she was barely eating, she was vomiting everything she ate, including her beloved chocolate which she convinced me to smuggle once or twice.

Now, let me digress a little and talk about the importance of community. One final lesson Mother taught me was the power of good relationships. She was so good at making and keeping friends and this was so clear to see in her final days. Her humans, our people, would turn up during visiting hours. Her bedside always appeared like a congregation and what warmed my heart was that some of her friends would literally walk all the way from Garden Compound just to come and see her because they didn’t have transport money. That gesture can only be fuelled by love, I thought. I want that for me. I want that for you. It’s a lesson to be intentional about relationships. I wish could mention everyone who used to turn up to comfort us but that would be a whole book! I will just generally say we appreciate the support from family, friends, work mates and neighbours. Your presence kept us going.

On some days, I wondered if she was even aware of everyone who was coming. I would ask her whenever I noticed she was feeling better and she would name each and every person who came. Mother would even recall all the stories which people had! This cemented another lesson I had learnt – the importance of visiting the sick.

Anyway, February 6 was Mother’s eighth day in UTH admission but she still did not get any relief from the fluid build-up and constipation. They kept loading her up with pain killers which she would actually vomit most times so she was always in a lot of pain. We managed to get early NHIMA approval and waited anxiously for the next day, when doctors could tell us the way forward after reading the CT Scan report. The next two days, however, only junior doctors were available to see mum and they couldn’t make any decision. The junior doctors read the CT Scan report and gave us some hope, they said there were no obvious different abnormalities compared to the report which was issued in October. Surgery was still an option then, we hoped.

February 9 finally came; the day senior doctors would grace us with their presence and hopefully tell us the way forward. When the same senior doctor who had ordered for the CT-Scan came in, he looked at mum’s file and asked the junior doctors who among them had determined that the cancer was at stage two. One of them started explaining their thought process when the senior doctor received a phone call and went out to pick it. When he returned, he quite casually said “this has advanced so unfortunately, we cannot do anything.

The senior doctor then turned to his juniors and gave them some instructions to the effect that mum be moved to the Cancer Diseases Hospital (CDH). Thereafter, he looked at my sister and asked; “have you been counselled?”

“Counselled? For what?” Jennipher asked him but the doctor only repeated the line about the cancer being advanced and left. And once a senior doctor is out of that ward, good luck finding them for anything else!

Puzzled, Jennipher followed one of the junior doctors and asked him; “I am a layman but I believe there are better ways to handle such cases. Do you care about the patients? Mum can hear everything and he just goes and blurts out such information without any care? As a bedsider, you can call me aside and tell me what the situation is. Explain to me what is happening so that my family and I can decide how best to handle everything.”

Jennipher is the strongest of all of us. I don’t know what energy she was running on but while all of us, her younger siblings, often took turns walking out of the ward to break down outside, she kept her cool and remained positive. Even when there was no reason to hope, she had hope. But that day, when she came out to update us after that encounter, she was defeated. The senior doctor had mentioned that the cancer was advanced, but we did not understand how he came to that conclusion. We didn’t understand the way forward.

Later that day, I passed through my office to collect a fuel book. My boss, Joseph, wanted an update on Mother’s condition and I expressed sadness at the fact that she was in pain and she was neither getting any relief nor receiving concrete information on the way forward. Joseph suggested that we try contacting Ministry of Health permanent secretary Professor Luckson Kasonka, so that we ask for some advice on how we could get some private consultation. He went ahead and contacted Prof Kasonka who was courteous enough to pick the call despite it being after hours.

Prof Kasonka was shocked by the details of the story and he lamented that this was not how the public health system should function. He said despite the fact that there were a shortage of medical staff, doctors are advised to also keep a close eye on patients who are in delicate conditions. With that intervention, we saw a change of attitude. On February 10, a doctor who had actually been part of Mother’s team all along performed a manual faecal extraction and managed to drain a bit of the fluid in her abdomen in order to test it for malignancy. Mother was also given some IV fluids in order to hydrate her and some medication was prescribed to manage vomiting. A doctor from CDH also came in to see her and he wondered how the senior doctor had determined that the cancer was at stage four without testing the fluid first. He said he would wait for the fluid test results before deciding whether she would be transferred to CDH or be handled by UTH. That day, Mother opened her eyes for the first time in about a week. She was so relieved she even managed to chat with each and every person who came in to visit her, we had to remind her to stop wasting energy by talking too much!

I felt bad for others who “don’t know anyone” who can influence doctors and public health practitioners to do their job. I am not a medical practitioner but should it really take a PS to ask doctors to offer cancer patients some pain relief? To manage their symptoms? Or is there a policy that patients who have stage four cancer must just be left to suffer through such excruciating pain without any assistance because ‘they are gone anyway’? Is this the meaning of palliative care in Zambia? These are questions which have plagued my mind since then.

To be continued next week Wednesday.

For now, I repeat the lessons I’ve learnt, which I shared in Part 1 on the state of our public health care system.

1. Our public healthcare system is truly a mess. We need more doctors and specialised doctors, as well as other healthcare workers and they must be well motivated. We need more infrastructure and medical equipment which must be regularly serviced. We need more ambulances. Of course, the current government has taken a positive step by hiring almost 12,000 health workers, but how good are they without the equipment they need to diagnose patients? There’s need for massive investment in healthcare, period!

2. We need to do all we can individually to stay away from the hospital for as long as possible. You know how doctors like to encourage us to go for regular health check-ups? WE NEED TO LISTEN TO THEM. It is not just some fancy tagline they like to utter just for the heck of it. Sometimes, it could just be those check-ups which save your life. For any ailment, the earlier you treat it, the better. This is especially true for cancer, more so here in Zambia where there is only one hospital which specialises in treating cancer. If you are like me and you cannot afford to fly out to Dubai, India or South Africa for medical attention, #grabyourbestieandgoforcheckups

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