Treating Pediatric Cancer in Rwanda

This past spring, a writer and I spent a few days at Butaro District Hospital, up in northern Rwanda. The hospital treats children for cancer, one of the few in all of east Africa. We talked with anyone who would give up their time for us — everyone from patients to hospital staff — in side closets and over shared meals. But what resonated the most with me were the quiet moments.

Below, bits and pieces of our visit. (Please note: patient names have been changed to protect privacy.)

We walk to the hospital with Dr. Cyprien Shyirambere, who is the director of pediatric oncology. All of the patients and their caregivers are wrapped up in hoodies and scarves and big puffy jackets to ward off the chilly and damp March air.

Blandine Umurisa, who is 12 and lives in a refugee camp, is on her last day of chemotherapy for acute lymphoblastic leukemia, a type of blood cancer. Last November, she was diagnosed with pulmonary tuberculosis. Despite all of this, she wants to be an engineer. When I see her the next morning, she is making sure to complete her math homework and even tries to explain it to me, which is a sweet gesture but ultimately unsuccessful. (My fault, not hers.)

After physical examinations in the morning and before chemotherapy in the afternoon, the healthier and more mobile children gather to play with toys or color with crayons. This sudden descent onto one bed temporarily displaces some of the caregivers, who either watch or take a few minutes to nap.

Dr. Alexis Manirakiza is another pediatric oncologist at Butaro, originally from Burundi. He arrives on the ward in the morning and greets each child crowding the door with fist-bumps and high-fives, a quick clasp of hands and soft-spoken pleasantries. When he asks the children, “Amakuru?” or, “How are you?” in Kinyarwanda, he gets a response. When I try, I get giggles.

Dr. Manirakiza conducts the morning’s rounds with a quiet gentleness and with the utmost patience for questions — questions from students about patient histories, and from families about medications.

Nurse Bea Sauda Nyiramahirwe is one of two nurses on the ward today. She mixes chemotherapy, helps manually aspirate a patient with a tracheotomy, does the billing. Tomorrow she will do it all over again.

While sorting through photo prints that I brought for patients I met on previous trips, she shares brief updates. I just missed this patient’s follow-up. This patient is doing well. This patient’s family had to sell all their furniture. She pauses on the photo of a young girl who had been doing so well when I met her in September. This patient passed away at home on Monday, she says, and I feel like I’ve been punched in the sternum.

When you spend a few days in the same place, chances are you’ll keep seeing the same patients over and over again and eventually (if you’re lucky!) you become part of the background. They ignore you, and you can catch a quiet moment like this that has nothing to do with children being sick.

Six-year-old Frank Mugisha just completed 30 months of treatment for acute lymphoblastic leukemia, only to be diagnosed with malaria, but neither of those diagnoses seems to hold him back much. Over the next few days, I catch glimpses of Frank cavorting around both inside and outside the ward, and I wonder how I ever got a photo of him lying still with his aunt. Even though he tends to ignore me and my giant camera, each time I leave the ward we wave good-bye to each other.

A few beds down from Frank, we meet Theophile Bizimungu, a 17-year-old with T-cell lymphoblastic lymphoma, which is a cancer of the lymphatic system. He has a large tumor on the side of his face. I assume he’s going to say it’s not alright for me to photograph him, or that it’s alright but he wants me to photograph around his tumor, but surprisingly he says both are OK.

When I ask about the procedure — fifteen drops of spinal fluid out, fifteen drops of chemotherapy in — Theophile says that it hurts. (The doctors say it’s quite painful.) But this is not obvious from Theophile’s face, because he looks brave, cringing a few times but barely crying out.

I take a photo of him and his step-brother so I can give it to them later, and he surprises me yet again by asking if he can also have photos during the procedure. Really? Sure, I say.

He grins, flips his hood back up, and walks back to the ward with his step-brother, holding himself straight as if the treatment had never happened.

Every day, children at Butaro take on the biggest fight of their young lives. In honor of Childhood Cancer Awareness Month, join us in sending get-well messages to show that we’re with them.