What We Talk About [When We Talk About Cancer]

I’ve shared several posts now about the challenges and frustrations I’ve encountered while caring for cancer patients in Botswana, but I also need to mention a couple funny and soul-nourishing moments which could only happen here.

One day on rounds, I was evaluating a patient with Dr. Musimar Zola (who came to Botswana due to the political instability of his home country, the Democratic Republic of Congo) as well as several nurses.  He gave me a short history of what brought the patient to the hospital, and mentioned that the patient believed he got prostate cancer because an enemy put a curse on him.  I looked at the patient, then looked curiously at Dr. Zola and the nurses, strangely feeling the need to state the obvious.  “But…you know that’s all superstition, right?  That’s not real.”  They looked curiously back at me, and it was one of those moments where the cultural divide felt like a huge yawning canyon between us.  One of the nurses simply said, “We are Africans, we believe in magic.”  Dr. Zola then proceeded to tell me about the different categories of magic, including white magic and black magic, and the manifestations he’s seen of each.  I had never had a conversation like this on rounds before!  I realized at that moment that many (though not all) African physicians have this unique ability to marry their scientific understanding of disease with their spiritual and cultural beliefs.  American physicians tend to strictly separate the two realms with no acknowledgment of an overlap.  It was fun to get an education from the African doctors and nurses about a topic that was definitely never mentioned in medical school!

While in the US we have very sophisticated technologies to diagnose and characterize all different forms of cancers, in Botswana we still have to rely on simple and limited tools.  One of the easiest cancers to diagnose clinically is chronic myelogenous leukemia (CML).  The internal medicine doctors alerted me about a man who had a big spleen and an extremely high number of white blood cells.  All I had to do was look at his blood under the microscope, and it looked like a textbook picture of the disease—a dense crowd of white blood cells at different stages of maturation, and an increased number of dark purple cells called basophils.  I sent his blood for further testing to confirm the typical switching of chromosome parts, and started him on treatment to reduce the number of white blood cells.  Luckily in Botswana we have the wonder drug which has completely changed the lives of people with CML—imatinib (Gleevec).  After starting him on Gleevec, he rapidly improved—his enormous spleen, previously jutting out above his hip, shrank to normal size, and his sweats and aches disappeared.  His white blood cell count went from several hundred to normal.  When he came back to see me in clinic, he grabbed my hands and thanked me for saving his life.  Good outcomes for cancer patients are so rare in Botswana, and each time they happen, I feel like I could burst from happiness.  There is truly no better feeling.