“Yeah. If I’d seen the HealthGuard coming fifteen years ago, I might have been right at the heart of the changes. And I’d have never looked back. Let alone sideways.”
Iganga nodded sympathetically, quite unfazed by the notion that molecular technology might capture the attention so thoroughly that little things like Yeyuka epidemics would vanish from sight altogether. “I can imagine. Seven years ago, I was all set to make my fortune in one of the private clinics in Dar es Salaam. Rich businessmen with prostate cancer, that kind of thing. I was lucky in a way; before that market vanished completely, the Yeyuka fanatics were nagging me, bullying me, making little deals.” She laughed. “I’ve lost count of the number of times I was promised I’d be coauthor of a ground-breaking paper in Nature Oncology if I just helped out at some field clinic in the middle of nowhere. I was dragged into this, kicking and screaming, just when all my old dreams were going up in smoke.”
“But now Yeyuka feels like your true vocation?”
She rolled her eyes. “Spare me. My ambition now is to retire to a highly paid consulting position in Nairobi or Geneva.”
“I’m not sure I believe you.”
“You should.” She shrugged. “Sure, what I’m doing now is a hundred times more useful than any desk job, but that doesn’t make it any easier. You know as well as I do that the warm inner glow doesn’t last for a thousand patients; if you fought for everyone of them as if they were your own family or friends, you’d go insane…so they become a series of clinical problems, which just happen to be wrapped in human flesh. And it’s a struggle to keep working on the same problems, over and over, even if you’re convinced that it’s the most worthwhile job in the world.”
“So why are you in Kampala right now, instead of Nairobi or Geneva?”
Iganga smiled. “Don’t worry, I’m working on it. I don’t have a date on my ticket out of here, like you do, but when the chance comes, believe me, I’ll grab it just as fast as I can.”
It wasn’t until my sixth week, and my two-hundred-and-fourth operation, that I finally screwed up.
The patient was a teenaged girl with multiple infestations of colon cells in her liver. A substantial portion of the organ’s left lobe would have to be removed, but her prognosis seemed relatively good; the right lobe appeared to be completely clean, and it was not beyond hope that the liver, directly downstream from the colon, had filtered all the infected cells from the blood before they could reach any other part of the body.
Trying to clamp the left branch of the portal vein, I slipped, and the clamp closed tightly on a swollen cyst at the base of the liver, full of grey-white colon cells. It didn’t burst open, but it might have been better if it had; I couldn’t literally see where the contents was squirted, but I could imagine the route very clearly: back as far as the Y-junction of the vein, where the blood flow would carry cancerous cells into the previously unaffected right lobe.
I swore for ten seconds, enraged by my own helplessness. I had none of the emergency tools I was used to: there was no drug I could inject to kill off the spilt cells while they were still more vulnerable than an established tumour, no vaccine on hand to stimulate the immune system into attacking them.
Okwera said, “Tell the parents you found evidence of leakage, so she’ll need to have regular follow-up examinations.”
I glanced at Masika, but he was silent.
“I can’t do that.”
“You don’t want to cause trouble.”
“It was an accident!”
“Don’t tell her, and don’t tell her family.” Okwera regarded me sternly, as if I was contemplating something both dangerous and self-indulgent. “It won’t help anyone if you dive into the shit for this. Not her, not you. Not the hospital. Not the volunteer program.”
The girl’s mother spoke English. I told her there were signs that the cancer might have spread. She wept, and thanked me for my good work.
Masika didn’t say a word about the incident, but by the end of the day I could hardly bear to look at him. When Okwera departed, leaving the two of us alone in the locker room, I said, “In three or four years there’ll be a vaccine. Or even HealthGuard software. It won’t be like this forever.”
He shrugged, embarrassed. “Sure.”
“I’ll raise funds for the research when I get home. Champagne dinners with slides of photogenic patients, if that’s what it takes.” I knew I was making a fool of myself, but I couldn’t shut up. “This isn’t the nineteenth century. We’re not helpless anymore. Anything can be cured, once you understand it.”
Masika eyed me dubiously, as if he was trying to decide whether or not to tell me to save my platitudes for the champagne dinners. Then he said, “We do understand Yeyuka. We have HealthGuard software written for it, ready and waiting to go. But we can’t run it on the machine here. So we don’t need funds for research. What we need is another machine.”
I was speechless for several seconds, trying to make sense of this extraordinary claim. “The hospital’s machine is broken —?”
Masika shook his head. “The software is unlicensed. If we used it on the hospital’s machine, our agreement with HealthGuard would be void. We’d lose the use of the machine entirely.”
I could hardly believe that the necessary research had been completed without a single publication, but I couldn’t believe Masika would lie about it either. “How long can it take HealthGuard to approve the software? When was it submitted to them?”
Masika was beginning to look like he wished he’d kept his mouth shut, but there was no going back now. He admitted warily, “It hasn’t been submitted to them. It can’t be — that’s the whole problem. We need a bootleg machine, a decommissioned model with the satellite link disabled, so we can run the Yeyuka software without their knowledge.”
“Why? Why can’t they find out about it?”
He hesitated. “I don’t know if I can tell you that.”
“Is it illegal? Stolen?” But if it was stolen, why hadn’t the rightful owners licensed the damned thing, so people could use it?
Masika replied icily, “Stolen back. The only part you could call ‘stolen’ was stolen back.” He looked away for a moment, actually struggling for control. Then he said, “Are you sure you want to know the whole story?”
“Yes.”
“Then I’ll have to make a phone call.”
—
Masika took me to what looked like a boarding house, student accommodation in one of the suburbs close to the campus. He walked briskly, giving me no time to ask questions, or even orient myself in the darkness. I had a feeling he would have liked to have blindfolded me, but it would hardly have made a difference; by the time we arrived I couldn’t have said where we were to the nearest kilometre.
A young woman, maybe nineteen or twenty, opened the door. Masika didn’t introduce us, but I assumed she was the person he’d phoned from the hospital, since she was clearly expecting us. She led us to a ground floor room; someone was playing music upstairs, but there was no one else in sight.
In the room, there was a desk with an old-style keyboard and computer monitor, and an extraordinary device standing on the floor beside it: a rack of electronics the size of a chest of drawers, full of exposed circuit boards, all cooled by a fan half a metre wide.
“What is that?”
The woman grinned. “We modestly call it the Makerere supercomputer. Five hundred and twelve processors, working in parallel. Total cost, fifty thousand shillings.”
That was about fifty dollars. “How —?”
“Recycling. Twenty or thirty years ago, the computer industry ran an elaborate scam: software companies wrote deliberately inefficient programs, to make people buy newer, faster computers all the time — then they made sure that the faster computers needed brand new software to work at all. People threw out perfectly good machines every three or four years, and though some ended up as landfill, millions were saved. There’s been a worldwide market in discarded processors for years, and the slowest now cost about as much as buttons. But all it takes to get some real power out of them is a little ingenuity.”