I could see that there was something wrong with the child’s eye as she peered over her mother’s shoulder. She was wrapped onto her mother’s back with a colourful piece of cloth. The story was pretty typical – hot body, headache, cough, abdominal pain. However, the rapid test for malaria was negative. I asked the mother to unhitch the child so I could examine her properly.
She was 18 months of age, with normal build. Apart from a problem with her left eye, I could not detect any signs of disease. I looked through her medical notes and saw that she had been treated on numerous occasions for eye infections until my predecessor, Dr Ted, referred her to the local district hospital for a second opinion. Now it was obvious that she was almost blind in the left eye.
“What’s wrong with her eye?” I asked. “Did they find anything at the hospital?”
Mother explained that they had been sent up the referral chain, from Kamoto Mission Hospital to Chipata Regional Hospital, and finally to University Teaching Hospital in the capital, Lusaka. There, the specialists informed her that the child had a retinoblastoma, one of the commoner cancers occurring in children.* The parents had initially declined any treatment for their daughter, so the specialists sent them away to reconsider their decision.
In UK, one would expect about 90% of children with this cancer to be treated successfully. I am not sure of the figures for Zambia, but the specialists clearly felt the child could be cured. I asked her mother why they had rejected the offer of treatment. “We are praying to God,” she replied. “The Lord will answer our prayers and the child will be cured.”
My heart sank. There is no law in Zambia which protects the child, making its interests paramount. I could not call upon social workers to get a court order and whisk the child off to have surgery with chemotherapy in the capital. I felt powerless, but I tried to persuade her.
“I know that you feel that God will intervene and cure your child, but it is important to do all you can to help her here on earth,” I said.
“God does not need our help or your help,” she replied. “If she survives, it is God’s will.”
I was lost for words. I couldn’t find an argument which would get her to change her mind. I said that I would be very happy to see her at any time in the future, whatever her decision was about specialist treatment. That was a month ago, and she hasn’t been back to the health centre since.
* Catherine Ahern, of “Mrs Merton” and “The Royle Family” fame, had retinoblastoma as a child. She has since developed related tumours in her bladder and lungs.