A Story of Two Sisters

Every year, millions of Americans participate in walks, marathons, bar crawls and bike races to raise awareness about cancer. When surrounded by pink ribbons, sparkly new Nikes and yellow bracelets, cancer takes on a specific feature – it is treatable and in time, curable. In East Africa, cancer appears to us in an entirely different fashion. In this case, on the back of a motorcycle, thousands of feet in the mountain air of Kigutu, Burundi.

When two women from Tanzania arrived at the clinic, news of their arrival and unique circumstances spread quickly, "two women," the nurses told us, "they made it on the back of a motorcycle. Someone told them to come here. Someone in Tanzania told them they could be treated in Burundi, at Kigutu."

The two sisters wait patiently until called by Dr. Melino to enter the examine room one at a time.The first sister, only 27 years old, enters the exam room complaining of abdominal pain. Indeed, her stomach protrudes as if she is noticeably pregnant. She complains of a rock in her gut and great discomfort. She’s been seeking treatment for years with no relief. As instructed, she travelled several hours to the hospital in Tanzania each morning, only to wait all day to be sent away. Before setting out on her hours long walk home, she would be told to come back again the next day. The years of medical visits have drained her finances entirely despite never receiving treatment.

Dr. Melino, our Burundian Medical Director, asks her to lie back. She loosens her mustard colored paigne and Melino readies a portable ultrasound, one of our most powerful diagnostic tools.

The prognosis is not an easy one to deliver; the tumor is large and fibrous. Not only will she need surgery, she will likely need a full hysterectomy. As a young, childless woman in a country that values fertility, this will be hard to accept and painful to hear.

The second sister enters the room as her sister departs. She tells us that while nursing her child she discovered a lump in her breast that grew and grew until she started producing blood instead of milk. She visited a traditional healer who suspected she had a ghost in her breast. Though he prayed and cut to remove the spirit, she felt no better. Instead, the lump grew to 5 centimeters by 8 – about the size of a robin’s egg. When she lies on the table, the lump is visible.

The sisters will need to be sent to another hospital – we don’t yet have surgical facilities in Kigutu. Though VHW staff will accompany them, it’s still another long journey for these weary pair. We wish we could treat them here at our mountain paradise, but until new facilities are built, it’s simply not an option.

Dr. Melino decides to send the sisters to Bururi hospital; we have an excellent relationship with the doctors there. The first sister will have her tumor removed while thesecond will undergo a lumpectomy. Tissue samples will have to be sent to a lab in Rwanda; Burundi lacks the facilities to test biopsied tissue. Whether the cancers have spread or not, the only treatment that these sisters will receive is surgery. There is no chemotherapy or radiation in Burundi.

Despite the wonderful successes of walks, marathons, bar crawls and bike races in the USA, there remains a tremendous amount of work to be done to raise awareness of cancer globally. Malaria, TB and HIV are not the only health challenges we face in East Africa – any illness an American doctor may see, we see here too (with the exception, possibly, of Alzheimer’s). The difference is that we currently lack the infrastructure to treat many of these problems.

Village Health Works is therefore committed to building a center of excellence for teaching and healing that is already beginning to turn the tide form many of these health disparities in Burundi. Our next major clinical expansion — the Women’s Health Pavilion — will be an important step towards realizing this mission.