A half ticket to Heaven!

The in-flight newspaper on the Kenyan Airways flight from Mumbai to Nairobi announced that hundreds of people were dying of malaria in the rift valley. The rift valley is endemic for rift valley fever and malaria which kill hundreds of humans and animals annually.I never imagined that malaria took its toll in such a dramatic way until I saw a child die in his mother’s lap. I had just landed at the mission Hospital in Kilimongogo, where I was to spend the next one-month as a volunteer dentist. A little boy with cerebral malaria lay on the lap of his mother, his eyes rolled up to reveal only the whites. He was delirious, muttering words and making incomprehensible noises. The mother sat mute and helpless as the young doctor examined the boy and drew blood. “Cerebral malaria” the doctor informed me “do you see it in your country?” The doctor was himself a refugee from Rwanda- A Tutsi, who fled massacre in his own country. “ I am sure there are cases” I replied “ I haven’t seen one though.” Later that evening he informed me that the child died and they were keeping the boy till morning so that the mother could take him back home- somewhere in the rift valley, I assumed. There was no public transportation. The hospital had just one ambulance and several people were dying. I wondered how the mother was going to deal with it. She was gone in the morning, carrying her dead son !This incident brought back memories of something that happened many years before that incident, in my hometown of Salem in India. A little boy with an ulcerated growth on his palate was referred to me from a village.  As an Oral surgeon I often encountered these conditions. The father explained that he was an extremely poor sharecropper. They were unable to get any treatment at the government hospital and were referred to me by their village doctor. The growth was surgically removed under local anaesthesia and sent for a biopsy. The report was inconclusive. A couple of months later the same boy was brought to me again. The surgical site in his mouth had healed completely but he now had an ulcerated lesion on his leg, quite similar to the one he had in his mouth earlier. His leg was grossly swollen, as were his genitals. I had the boy admitted and asked for my friend Dr Ranjan David, a general surgeon, to see him. Despite Ranjan’s best efforts the boy died of septic shock a day later. We never found out what the problem was. The hospital was gracious enough to waive all the expenses except the drug bill. As the little boy was admitted in my care, I went over to complete the formalities. The boy’s father was extremely distraught. He was inconsolable and kept wondering how he was going to tell the boy’s mother in the village. I realized he did not have the money to pay the drug bills. We passed the hat around and collected some money to pay it off. I then asked him how he planned to take the dead boy home. His brother in law had enquired at the local taxi stand and was told that they charged a hefty sum to carry a dead body. Virtually no ambulances transported corpses those days, as there was a stigma on such vehicles. A couple of taxis parked around the general hospital did transport dead bodies, but they charged exorbitantly. He told me that he could not afford the transportation costs and that he would manage somehow. I watched helplessly as he thanked me and heaved the boy onto his shoulder and threw a cloth on to his head. He told me that he was going to take a one-hour bus ride to his village. When I asked him if the conductor would allow it, he answered simply “ I will say the boy is sleeping and take a half ticket for him.” The picture of a father carrying a dead child on his shoulder in a bus was imprinted indelibly in my mind and it comes up every time we consider the inequities in our health system.