DNA threat that settled an old score

The chickens have come home to roost — this phrase came alive when a young, Yankee-looking Kenyan man came to see me a few weeks ago. His story, which had now come full circle, drove home to me that the wheels of justice grind exceedingly slowly.

Twenty years ago, Josephat’s mother came from Molo to see me about him. I remember seeing the little boy clinging to his mother as they entered my outpatient clinic.

I waved them both to sit down as I studied his file and read the letter from the doctor at the local district hospital.

There was foul odour emanating from where Josephat was seated.

“So what’s your problem, young man?” I asked the little boy. He became suddenly withdrawn at the unexpected overture on my part and his mother came to his rescue.

“He was born without the normal passage to pass a motion,” she explained. “Within a day of birth, his tummy blew up like a drum and they had to bring his colon out on the skin so that he could discharge his faeces.”

“You mean they did a colostomy?” I asked.

“Yes, that’s what they called it,” she replied.

“Did they tell you that it was a temporary emergency measure and in about a year’s time he would need a major operation to enable him to pass motion from below?” I asked.

“Yes.”

“So why did you wait till he is 10?” I asked, looking at Josephat’s birth date on his file.

“I could not afford the treatment,” his mother replied. “I was doing a typist’s course at the time and had to continue so that I could get a job and look after him and me.”

“All this took eight years while the poor little boy was managing a colostomy?” The question sounded heartless after I had uttered it.

“I had no choice,” the young mother admitted. “Jobs were not easy to find. In any case, he was doing well with cotton wool and bandages and his teachers were helpful and sympathetic.”

“You mean he goes to school with a colostomy?” I asked utterly surprised.

“Oh, yes.” For the first time there was a trace of pride in her voice. “He is in standard four and top of his class. His teachers expect him to make them all proud when he does his KCPE in four years’ time.”

I examined Josephat and decided that he was ready for a “pull through” operation in which we pull the colon down and out at the point where the anal opening would normally be.

“Better late than never,” I said to the mother whose face beamed with relief and gratitude at what I said. “I will arrange his admission straightway and proceed with surgery.”

But it was not be, because a shortage of blood to correct Josephat’s anaemia, lack of drugs to sterilise his colon for surgery and other setbacks delayed his surgery. It was a blessing in disguise because while waiting, Josephat lost his frightened look and generally became a help to the nurses.

It also created a rapport between the two of us.

The surgery was uneventful and soon Josephat started passing stool normally.

It was a totally new experience for the 10-year-old boy, and he went to the toilet more often than he needed to!

According to the Sister, he wanted to be constantly reminded that he could do it like other people!

Then Josephat’s mother asked me: “When will that artificial passage be closed, now that he can do the job normally?”

“Next week,” I said and carried out closure of Josephat’s colostomy.

A week later, I discharged him. Surprisingly on my ward rounds, I still kept on seeing Josephat in the ward, though not in a bed as he continued helping the nurses.

“What’s going on?” I asked the Sister.

“He has been officially discharged but nobody has come to collect him,” she replied. “But we need the bed, so the poor lad doubles up or sleeps on the floor.”

“What about food?”

“There is always extra food sent from the kitchen and I save some for him,” she said. “Mind you, he earns his keep because he helps my staff.”

“Not only that,” my intern chipped in, “he is always with me as I examine patients, collect blood and fill forms. Being a quiet boy, nobody minds him.”

“Who knows?” I looked at the bright side. “This might arouse his interest and he might end up doing something medical. The mother tells me he is very bright.”

“If he does, it will be haematology,” the intern replied. “He always tags on to technicians from the blood lab, accompanies them and watches them doing blood tests.”

A month later, Josephat went home. His mother came to see me and explained. “I suddenly lost my job and couldn’t pay my rent. The landlord in Korogocho threw me out. So there was no home to take him to.”

I was saddened because though as a Rotarian I had often used the cliché that half the world lives on less than a dollar day and half the children in this world go to bed hungry, the statement until then had remained rhetoric.

“Thank God,” she continued, “I have found a new job, rented new lodgings — this time in Kibera — and have enough money to pay part of the hospital bill and take him home.”

Josephat’s long pre and post–operative stay in the hospital and the story behind it created a special bond between the surgeon and his patient and it continued.

Josephat came to see me when he scored high marks in his KCPE. His mother’s face was glowing when she remarked, “If he had not spent such a long time in the hospital, he would have been the highest in the country.”

He did an encore in KCSE and obtained very high marks in science subjects.

“I hope with these marks, you will take up medicine,” I remarked.

“Too long a course,” replied the young man. “Five years to qualify and another five to specialise. I haven’t got that sort of time.” His comment about time did not mean much to me then.

“I will be very closely connected with your science, however,” he said to me before he left Kenya after his KCSE. “I have managed to get a bursary to qualify in haematology at the Sloane Kettering Institute in the USA.”

“Where will this lead you?” I asked.

“In three years, I will be a blood specialist, an authority on all aspects of blood, its composition, blood groups, transfusion, blood chemistry and determination of parentage based on blood DNA.” Josephat was bubbling with enthusiasm. “With this qualification and training, there is nothing about blood you won’t know.”

“Good luck,” I said and bid him a fond goodbye.

I got regular Christmas cards from Josephat updating me on his academic progress and practical laboratory experience. In the last one he wrote: “Passed with honours. Home, sweet home and soon.”

A month ago, Josephat walked into my office. When he told me that he had been in the country a few months, I asked, “What kept you so long from seeing me?”

“I had some old scores to settle.” As I looked at him puzzled, he added, “It’s a long story.”

“I want to hear it,” I said. “Let’s schedule a lunch in the hospital canteen one day.”

“It all started while I was a patient in your ward,” Josephat started his saga. “I asked my mother why no father came to see me. I saw both parents coming to see other children. My mother tried to explain in her own way but over the years I gathered and understood the whole truth.”

He cut his beef burger with the side of his fork, obviously something he had learnt in the US. “In the village where my mother lived near Molo, she got involved with two brothers. So when she conceived me, those rogues told her that they were twin brothers and it would be difficult to decide who the father was. So she was left high and dry.

“Then to make matters worse, I was born with what I now know was imperforate anus. You know the rest. But I was not going let those two crooks get away with it. I took haematology so that I could confront them with academic authority.

“On my return from Sloane Kettering, I went and saw them. I told them that I was going to file a suit on behalf of my mother because the Affiliation Act was in force when she conceived. I also threatened to go public. They both are big shots now and they couldn’t afford to face adverse publicity.”

I couldn’t take my eyes off the young man. He was as far from the little Josephat I knew as Nairobi is from New York.

“I employed a lawyer and with his collaboration made the two men cough out a lot of money to compensate my mother and me.”

“So you never needed to use your science to decide your paternity and identify your actual father?” I asked.

“Just as well,” he came close to me and whispered. “These tests can sometimes be inconclusive and if so, could have ruined my case. Also since I was getting the benefit of two fathers, why settle for one?”