The Loneliest Journey

The women’s ward at KCMC is more or less overflowing with heartbreak. Each room in the ward contains six to twelve beds, but often twice as many patients. To accommodate the extraordinary need, cots have been erected wherever there is space available – both in the rooms and in the hallways – giving the ward the appearance of a MASH unit in a war zone instead of a hospital in a small tourist town.

 

This ward has weathered its share of storms over the last few decades as one health crises after another washed over the banks of this community like a series of tidal waves – malaria, complications of maternity, HIV/AIDS…

For decades mothers, daughters, sisters, experienced a quiet holocaust with each new malady. And then just as the community developed the tools to overcome the crisis, another appeared. Tragically, until only recently the great majority of the deaths occurred without even an attempt at treatment. The expense of seeking out health care was simply too much and husbands, fathers, and brothers, were left with the impossible choice between feeding their hungry children or providing health care for these women.

Asia came to the hospital after experiencing a set of symptoms that are frankly too horrific to describe. As her symptoms escalated over the years prior, her husband (who controlled the family finances) was unable or unwilling to take her to a clinic for an exam. When the pain eventually became too much to bear, she left the village alone, desperate and unsure of even where she was heading.

After finding her way to the hospital, she was admitted in the midst of a long line of women who all shared the same story.

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Cervical cancer is quickly becoming the leading cause of death in sub-Saharan Africa, a disturbing trend alone, but made particularly horrific by the fact that only women get it – meaning that it is more than twice as likely as the next leading cause of death. The great majority of these cases are caused by HPV and would be very simply prevented in the United States, and most certainly treated in the unlikely event that the virus went undiagnosed for long enough that cancer actually occurred. Although the treatment is inexpensive and relatively simple by medical standards, it’s simply not available in places like Tanzania.

When I met Asia, she was wrapped in a beautiful scarf and sitting quietly, staring out the third-floor window of the ward. She had just been told that she had cancer and that no treatment was available. Unable to provide any reassurance or comfort, I offered to take her home. She didn’t respond. She just sat quietly, staring out the thirdfloor window of the ward.

As I stood there unsure of what to do next, a nurse came up to me and explained, “She left the village. Now there is no home to go to.”

Weeks later I returned to the United States and was telling an older oncologist about our plans in Tanzania and my friend, Asia. He said, quickly and callously, “You know the best way to treat cervical cancer in Africa is to prevent it.”

If I had the courage I would have said, “Of course that’s true. Unless you’re one of the millions of women that already have it.”

Later as I reflected on how much credit we claim for overcoming sexism in the United States, I realized that when it comes to issue of women’s health, we really haven’t evolved very far beyond the village.