“And miss my last chance ever to perform cancer surgery?” That was a slight exaggeration; a few cases would keep slipping through the HealthGuard net for years. Most of my usual work was trauma, though, which was going through changes of its own. Computerised safeguards had made traffic accidents rare, and I suspected that within a decade no one would get the chance to stick their hand in a conveyor belt again. If the steady stream of gunshot and knife wounds ever dried up, I’d have to retrain for nose jobs and reconstructing rugby players. “I should have gone into obstetrics, like you.”
Lisa shook her head. “In the next twenty years, they’ll crack all the molecular signals, within and between mother and foetus. There’ll be no premature births, no Caesareans, no complications. The HealthGuard will smooth my job away, too.” She added, deadpan, “Face it, Martin, we’re all doomed to obsolescence.”
“Maybe. But if we are…it’ll happen sooner in some places than others.”
“And when the time comes, you might just head off to some place where you’re still needed?”
She was mocking me, but I took the question seriously. “Ask me that when I get back. Three months without mod cons and I might be cured for life.”
My flight was called. We kissed goodbye. I suddenly realised that I had no idea why I was doing this. The health of distant strangers? Who was I kidding? Maybe I’d been trying to fool myself into believing that I really was that selfless — hoping all the while that Lisa would talk me out of it, offering some face-saving excuse for me to stay. I should have known she’d call my bluff instead.
I said plainly, “I’m going to miss you. Badly.”
“I should hope so.” She took my hand, scowling, finally accepting the decision. “You’re an idiot, you know. Be careful.”
“I will.” I kissed her again, then slipped away.
I was met at Entebbe airport by Magdalena Iganga, one of the oncologists on a small team that had been put together by Médecins Sans Frontières to help overburdened Ugandan doctors tackle the growing number of Yeyuka cases. Iganga was Tanzanian, but she’d worked throughout eastern Africa, and as she drove her battered ethanol-powered car the thirty kilometres into Kampala, she recounted some of her brushes with the World Health Organisation in Nairobi.
“I tried to persuade them to set up an epidemiological database for Yeyuka. Good idea, they said. Just put a detailed proposal to the cancer epidemiology expert committee. So I did. And the committee said, we like your proposal, but oh dear, Yeyuka is a contagious disease, so you’ll have to submit this to the contagious diseases expert committee instead. Whose latest annual sitting I’d just missed by a week.” Iganga sighed stoically. “Some colleagues and I ended up doing it ourselves, on an old 386 and a borrowed phone line.”
“Three eight what?”
She shook her head. “Palaeocomputing jargon, never mind.”
Though we were dead on the equator and it was almost noon, the temperature must have been 30 at most; Kampala was high above sea level. A humid breeze blew off Lake Victoria, and low clouds rolled by above us, gathering threateningly then dissipating, again and again. I’d been promised that I’d come for the dry season; at worst there’d be occasional thunderstorms.
On our left, between patches of marshland, small clusters of shacks began to appear. As we drew closer to the city, we passed through layers of shanty towns, the older and more organised verging on a kind of bedraggled suburbia, others looking more like out-and-out refugee camps. The tumours caused by the Yeyuka virus tended to spread fast but grow slowly, often partially disabling people for years before killing them, and when they could no longer manage heavy rural labour, they usually headed for the nearest city in the hope of finding work. Southern Uganda had barely recovered from HIV when Yeyuka cases began to appear, around 2013; in fact, some virologists believed that Yeyuka had arisen from a less virulent ancestor after gaining a foothold within the immune-suppressed population. And though Yeyuka wasn’t as contagious as cholera or tuberculosis, crowded conditions, poor sanitation and chronic mal-nourishment set up the shanty towns to bear the brunt of the epidemic.
As we drove north between two hills, the centre of Kampala appeared ahead of us, draped across a hill of its own. Compared to Nairobi, which I’d flown over a few hours before, Kampala looked uncluttered. The streets and low buildings were laid out in a widely spaced plan, neatly organised but lacking any rigid geometry of grid lines or concentric circles. There was plenty of traffic around us, both cycles and cars, but it flowed smoothly enough, and for all the honking and shouting going on the drivers seemed remarkably good humoured.
Iganga took a detour to the east, skirting the central hill. There were lushly green sports grounds and golf courses on our right, colonial-era public buildings and high-fenced foreign embassies on our left. There were no high-rise slums in sight, but there were makeshift shelters and even vegetable gardens on some stretches of parkland, traces of the shanty towns spreading inwards.
In my jet-lagged state, it was amazing to find that this abstract place that I’d been imagining for months had solid ground, actual buildings, real people. Most of my secondhand glimpses of Uganda had come from news clips set in war zones and disaster areas; from Sydney, it had been almost impossible to conceive of the country as anything more than a frantically edited video sequence full of soldiers, refugees, and fly-blown corpses. In fact, rebel activity was confined to a shrinking zone in the country’s far north, most of the last wave of Zairian refugees had gone home a year ago, and while Yeyuka was a serious problem, people weren’t exactly dropping dead in the streets.
Makerere University was in the north of the city; Iganga and I were both staying at the guest house there. A student showed me to my room, which was plain but spotlessly clean; I was almost afraid to sit on the bed and rumple the sheets. After washing and unpacking, I met up with Iganga again and we walked across the campus to Mulago Hospital, which was affiliated with the university medical school. There was a soccer team practising across the road as we went in, a reassuringly mundane sight.
Iganga introduced me to nurses and porters left and right; everyone was busy but friendly, and I struggled to memorise the barrage of names. The wards were all crowded, with patients spilling into the corridors, a few in beds but most on mattresses or blankets. The building itself was dilapidated, and some of the equipment must have been thirty years old, but there was nothing squalid about the conditions; all the linen was clean, and the floor looked and smelt like you could do surgery on it.
In the Yeyuka ward, Iganga showed me the six patients I’d be operating on the next day. The hospital did have a CAT scanner, but it had been broken for the past six months, waiting for money for replacement parts, so flat X-rays with cheap contrast agents like barium were the most I could hope for. For some tumours, the only guide to location and extent was plain old palpation. Iganga guided my hands, and kept me from applying too much pressure; she’d had a great deal more experience at this than I had, and an overzealous beginner could do a lot of damage. The world of three-dimensional images spinning on my workstation while the software advised on the choice of incision had receded into fantasy. Stubbornly, though, I did the job myself; gently mapping the tumours by touch, picturing them in my head, marking the X-rays or making sketches.
I explained to each patient where I’d be cutting, what I’d remove, and what the likely effects would be. Where necessary, Iganga translated for me — either into Swahili, or what she described as her “broken Luganda.” The news was always only half good, but most people seemed to take it with a kind of weary optimism. Surgery was rarely a cure for Yeyuka, usually just offering a few years’ respite, but it was currently the only option. Radiation and chemotherapy were useless, and the hospital’s sole HealthGuard machine couldn’t generate custom-made molecular cures for even a lucky few; seven years into the epidemic, Yeyuka wasn’t yet well enough understood for anyone to have written the necessary software.