My father, Henry Magu Ngugi, died on 3rd June from bile duct cancer.
It began last December when he complained of stomach ache and vomited incessantly. He itched all over and lost a lot of weight. Yellow eyes became his signature look.
His situation deteriorated in January, and health workers at Kirwara Health Centre in Gatanga, Murang’a County referred him to Thika Level Five hospital.
Later that month, he was referred to a gastro-intestinal surgeon in Nairobi, who recommended an endoscopic ultrasound. It finally brought a diagnosis: Stage IV bile duct cancer (cholangiocarcinoma).
According to Dr Miriti Kiraitu, who diagnosed and treated my father, along with pancreatic cancer, bile duct cancer is often diagnosed at an advanced stage when treatment options are few.
Moreover, the routinely used ultrasound is not recommended for diagnosis; CT Scan or magnetic resonance imaging (MRI) works better.
However, hospitals back home where my father first sought treatment lack these equipment. They also lack endoscopic ultrasound and other endoscopy equipment that would ensure faster diagnosis and treatment of digestive cancers of the oesophagus, colon, pancreas and bile ducts. And because the latter two respond poorly to treatment, it would be best if they were detected early enough for intervention.
Past stage III, they are lethal ailments with less than five per cent survival rate.
My father underwent an endoscopic retrograde cholangiopancreatography (ERCP), a procedure that uses endoscopy and x-rays to view the patient’s bile and pancreatic ducts.
After that, doctors can either restore the flow of bile by opening the duct collapsed by cancer or re-route it around the cancer — a process called biliary drainage.
The cancer would not respond to chemotherapy or radiotherapy, but biliary drainage would relieve symptoms.
After diagnosis, my father was admitted at the Kenyatta National Referral Hospital, where he underwent biliary drainage. It costs Sh400,000 without NHIF cover.
The doctor unblocked his ducts and placed artificial drainage pipes called stents. He recuperated for two weeks, then he was discharged with advice that the only mitigation was to eat healthy (less red meat and more vegetables) to check the growth of the cancer.
He also needed regular check-ups for the artificial bile duct, to ensure that the bile was flowing unobstructed. The plastic duct had to be replaced every three months, but a metallic one would have lasted at least a year before replacement.
In May when my dad went to hospital to have the stent replaced, we decided that he should get a metallic one. However, when he was being wheeled back to the ward from theatre after the procedure, the doctors told us that they could not place the metal stent because my father had an infection.
They had placed a plastic stent instead because it was best in controlling infections. He would be reviewed in a month, then if possible, the metal stent would be put in. We were devastated, but my father was most affected. He did not want to go to theatre again.
He told us: "I will not go back to theatre. At 76, God has given me a bonus over the 70 years he gives us to live. So take it from me; I won’t go back."
A week after he was discharged, dad fell ill and was pronounced dead upon arrival at Kirwara Hospital in Gatanga, marking the end of his short battle with cancer.
Mr Magu is a freelance health journalist, who campaigns for more tools in public health facilities to fight cancer in early stages.
