That Tuesday morning,
my otherwise faithful Volkswagen Beetle car had seemed exceptionally slow. And
the snail-paced procession in the early morning city traffic jam only made
things worse. I sat in the idling car, impatiently tapping on the steering
wheel as my mind raced. What could be killing all these people? I wondered,
rummaging through my briefcase for a medical file of a case that had the medical
and detective worlds baffled.
As of yesterday,
twenty-three people had been confirmed dead in a remote village, a hundred
miles away from the capital. More others had been referred to the city hospital,
and they all presented with similar symptoms of unexplained weight loss, a
persistent cough with blood-tinted phlegm, shortness of breath, pain in the
arm, chest, shoulder or back and either pneumonia or bronchitis.
Using their high
suspicion index, the doctors had been quick to diagnose these patients with the
HIV virus. But on running their tests, only seven of the patients tested
positive to the virus that causes AIDS. So
what about the rest; what was ailing these people?
I pulled up at the
hospital parking lot thirty minutes later. After leaving the secretary with
instructions to make a copy of the file, I convened a crisis meeting of all the
hospital’s lab technicians and pathologists at the hospital’s board room.
What was happening? I
had asked them and they equally looked puzzled at me. The hospital chief
pathologist—a short man with a red bulbous nose—tabled some gruesome
photographs and said he had noticed what was clearly advanced lung cancer when
performing an autopsy on some of the patients who had died at our institution. The
very mention of lung cancer made me shudder down to the marrow. Of all the
cancers, lung cancer is the deadliest with a five year survival rate of only
ten to fourteen percent. What was even worst, was that by the time any symptoms
popped up, the cancer was so advanced and metastasized that the only thing a
doctor could do was to helplessly watch a patient die. But all in all, at least
we now had a sense of direction, or so I thought. So lung cancer was killing
all these people? But why? What was common among all these people that was
exposing them to what was definitely a very potent lung carcinogen? Could they
all be smokers, even the young children? The questions were just endless.
A single furtive glance
at one of the photographs of a severely damaged lung convinced me we were
facing a crisis. By law, the hospital had a statutory duty to notify the
government of any suspected epidemic but after discussions amongst ourselves, we
agreed it was too early to begin shouting from the rooftop. We did not want to
cause unnecessary public health panic in the country and now that we had an
idea of what was happening, we believed we could handle it all on our own. Now
I wish we had done otherwise.
I asked our senior lab
technician to fix one of the lungs and dismissed the meeting. Further testing shall
be required and I planned to take it to the University of Nairobi where I had
some friends in the school of medicine. My instinct adamantly narrowed down to
tobacco use that was the number one culprit for the deadly lung cancer. It
seemed very reasonable to think that majority of these people either smoked or
were exposed to tobacco smoke. But if that was truly the case, then the cancer
should be all over the country and not concentrated only in a small peasant
village.
After two futile hours
of racking my brains and combing through acres of pages of medical books and
journals, it occurred to me that travelling to the village could unravel the
mystery; getting a first-hand experience of these individual’s way of life
could answer all my questions.
*********
The village was more
humble than I had expected. Immediately I arrived there, I instantly knew that
my tobacco smoking theory would not stand a chance. Majority of the people
there were way too poor to afford such an expensive habit like chain-smoking.
Furthermore, there was no tobacco cultivation on site. Driving slowly down a
dusty road in a government land rover, I met a young friendly man who after
listening to what I had to tell him, offered to guide me to the local
dispensary.
The compound was well
kept even though the building was old and colonial. The matron grudgingly
offered to take me around the premises as the other staff inexplicably
vanished, perhaps thinking I was some very senior official from the ministry of
health. As we settled down in her tiny office, she explained how baffled the
community was by the disease the locals called ‘slim.’ No one knew what was
causing it and speculations had driven stigmatization of victims to absurd
heights. The dispensary was overwhelmed and admitting no more, the staff
demoralized and terrified by the prospect of contracting a mysterious fatal disease.
Informed by their fear of the unknown, almost all the staff had deserted duty,
preferring the sack to an untimely horrible death. The dispensary didn’t have a
morgue and so most people relied on the services of a daring trade embalmer who
plied her trade from her home.
“Do you know what this
disease is?” she asked, her eyes carefully searching my face as she walked me
out of her office. When I told her it was lung cancer, her jaw dropped and she
sighed heavily.
My new found friend had
been patient enough to wait for me inside the land rover, listening to the
stereo. How much did he know about ‘slim’? I asked him as we drove out of the
compound. He answered by saying that he had a sick brother at home and that he
had lost two others to the disease. All of them had been working at a local
quarry before they fell sick. He asked me if I could pass by his home and greet
his mother and driven by compassion, I readily obliged.
We found the mother—a
pleasant woman of small stature—leaning against a rickety door overlooking two
mounds of auburn soil that were clearly graves. She was at first suspicious—the
kind of suspicion haboured by villagers who are well acquainted with each
village member and thus very wary of strangers. I had packed the land rover on
the main road since the home could only be accessed by a footpath. She
immediately broke into a wide grin and shook my hand vigorously when the proud
son said I was a friend of his and ‘a big man from the city’ who was just
passing by and wanted to say hi.
Twenty minutes later
and of course my pocket feeling a little bit lighter, I hit the highway and was
on my way back to the city. It was now drizzling eerily and traffic had
completely thinned out. I sat thoughtfully with my right foot easy on the gas
pedal as the sheets of rain hammered the windscreen. Had I found what I came
looking for? I wondered in silence and yawned loudly without caring to clasp a
hand over my mouth. The odometer reading showed I had only done seven miles; a
hundred and twenty miles still lay ahead.
The following morning
after a night that had seemed like an eternity, I arrived at the hospital and
found that we had lost two more patients to lung cancer. Once settled in my
office, I immediately placed a call through to the University of Nairobi’s
school of medicine and asked for a doctor Karanja. He had been my professor
back in college and we had remained friends ever since. Soon a familiar husky
voice came on line and after the exchange of the usual pleasantries and a
little tête-à-tête, agreed
to an immediate impromptu meeting. In the meantime, I had the fixed lung
delivered to my office in a closed thick glass jar full of formaldehyde.
“This looks bad,” said
the doctor with a long unkempt beard as he carefully examined the lung through
the glass.
“What do you think
could have caused cancer in this particular patient?” I asked, peering
assiduously through my glasses.
“Definitely not
cigarettes,” replied the old good professor after a deep breath. Seeing the
surprise registered all over my face, he went on to explain that he couldn’t
see any tell tale signs of a smoker’s lung—black soot to be precise.
“So what else could
cause mass lung cancer,” I literally asked myself under my breath, tapping my
incisors with the tip of my thumb nail.
“When you visited, what
was the condition of the dispensary’s morgue?” asked the professor, catching me
off guard.
I went on to explain
that the dispensary didn’t have a morgue and the community around relied on
trade embalmers to help preserve their dead before burial. The professor nodded
his head sagaciously before calmly stating: “I think we have a culprit!”
A culprit? How? Where?
The professor smiled gently and said he was cork sure that the trade embalmers,
in their ignorance and innocence, were perpetrating a silent genocide.
“How?” I asked in awe.
The professor sat bolt
upright and explained that the self-styled trade embalmers were most likely to
be using formaldehyde in preserving the dead bodies, and a hypochlorite
disinfectant to clean up their places of work. Now, an inadvertent mixing of
these two chemicals—the hypochlorite disinfectant that provides a source of
free chlorine and the formaldehyde—results in formation of a potent lung carcinogen
called bis(chloromethyl)ether. And owing to the lack of a sewer system in the
village, the clinical waste might be finding its way to all the wrong places.
All my life, never before
had I felt so silly and ignorant. After the professor had left my office, I
asked the secretary to draft a memo on her typewriter, requesting an urgent
meeting of all the top hospital officials early tomorrow morning. You see, back
then, the personal computer, just like the smart phone was not yet a reality
and the internet was twenty years away. I had to drive down to the university
and sit like a student in the library, trying to research on bis{chloromethyl}ether.
What I found out was
interesting to say but the least. The professor’s theory checked out a hundred
percent. Furthermore, I was amazed to realize that exposure to
bis{chloromethyl}ether abbreviated as BCME in the voluminous chemistry books,
resulted in the very symptoms our patients were presenting with. So this is it?
I later thought, driving out of the library parking lot in my funny VW bug with
big rounded headlights. Why had I not thought of such before? I wondered, engaging
a gear. Unbeknownst to me, a week later, the situation would get out of hand to
the extent of involving the country’s intelligence service. . . .
(To be continued)
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