FATHERHOOD WHEN IT COUNTS!

Saruni* was the flower in our ward. She was 19 months old, admitted with a history of fevers that were unremitting for three weeks prior to admission. She sat patiently on her bed every morning during the ward rounds in the paediatric unit, in a bright pink dress, her face glistening from the freshly applied Vaseline. She demonstrated maturity beyond her years.

Saruni had been noted to feed poorly the past month, with weight loss, fevers mostly at night and an associated abdominal swelling. She had been referred from Kapenguria hospital to the teaching and referral hospital for specialized care. She stayed with us for weeks on end as we sought a diagnosis.

As expected in the paediatric unit, Saruni had to be accompanied by a caregiver. In most cases, the caregiver would be the mother. In Saruni’s case, it was her father! I have never seen such dedication by a father. He knew his daughter’s needs in and out. He woke up every morning at the crack of dawn, washed their clothes, bathed her and patiently coaxed her to take her porridge. She was the neatest baby in the entire unit!

With her symptoms, Saruni had all manner of tests done without arrival at a definite diagnosis. Her father, from the outset, was adamant that his daughter was suffering from kala azar. Kala azar, also known as systemic leishmaniasis is an infectious disease common among the pastoral communities in Kenya, most especially the men. This is primarily because it is spread by the sandfly, a vector that is found around anthills out in the open grasslands where the herdsmen spend their days caring for their livestock.

For long, Saruni’s dad’s opinion was disputed solely on the grounds that Saruni was too young to be out in the fields hence it was uncommon for her to come into contact with the sandfly. She was investigated for all manner of conditions and they were all negative. Eventually she was scheduled to have a bone marrow aspirate done to rule out possibility of leukaemia and kala azar. However, her platelet count was too low to allow the procedure to be carried out safely.

Whereas platelets are much more available now, back then, access to blood products in our teaching hospital was uncommon. It took a few weeks to get platelets for Saruni. She was transfused overnight and the next morning the dreaded bone marrow aspirate was done. It took another week to get the results back. Suffice it to say, the father was spot on and Saruni had kala azar! We could finally start definitive treatment for the little princess. By then she was almost 21 months.

One afternoon as the children were napping or in the playroom and the ward was fairly quiet, I had a chat with Saruni’s dad. We still had not figured how she got kala azar. I asked where her mom was and how come she never visited. He informed me that the mother had a newborn baby at home and hence was unable to travel all the way. He further informed me that Saruni was his first baby and the bond between them has always been very tight.

From the moment she could walk, Saruni would follow her father around. He would feed her, give her a bath and play with her as often as he could. He learnt to go out to the fields with her when he was grazing his cattle and he would place her on an anthill when he had to attend to an animal. It was suddenly very clear how she had come into contact with the dreaded vector. Kala azar, being common among his people, he recognized the signs early enough.

As doctors, sometimes we expect our patients to fit into text book descriptions, making it difficult to comprehend how they could carry certain diagnoses. But cases such as Saruni’s remind us that we are treating people who may or may not conform with what science has prescribed. We are also reminded that sometimes the answer lies with the patient if only we could take the time to ask.

And as for those who underestimate the capacity of fathers to nurture their babies, amazing stories like these abound. Illness makes one extremely vulnerable. In the case of a sick baby, dads are pushed to the limit and you would be amazed at the mountains they can move to ensure their babies get well.

I have seen dedicated fathers in the newborn units with their shirts off, giving kangaroo care to their premature babies, willing them to grow and gain that extra 100 grams that is critical to enable them to get out of the incubator and attempt to breastfeed. Fathers are the first to offer to donate their organs to their children when the need arises. They will queue with their cranky toddlers at one o’clock in the night at the outpatient department when the fever strikes. And yes, they will stay in hospital for weeks on end, nursing their babies back to health when called upon.

It is certainly not unafrican to do so. As much as we may complain about dead beat dads who have abandoned their responsibilities and neglected to care for their children, there are real fathers out there who will demonstrate their commitment during the toughest times. Fathers who understand that caring is more than providing a good medical insurance cover or pay bills. Fathers who will not trade physical presence for anything. Fathers who will clean up all manner of bodily fluids from their toddlers without missing a heartbeat.

It may not be fathers’ day today but let us celebrate these fathers. They deserve a round of applause!