Saruni* was the flower in our ward. She was 19 months old, had been admitted following three weeks of unremitting fever.
Adorned in a bright pink dress, she sat patiently on her bed every morning during the ward rounds in the paediatric unit, her face glistening from freshly-applied Vaseline. She demonstrated maturity beyond her years.
However, Saruni fed poorly, lost weight, had night fevers and an associated abdominal swelling.
She had been referred from Kapenguria Hospital to the teaching and referral hospital for specialised 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 was the child’s mother. In Saruni’s case, however, the caregiver was her father!
I have never seen such dedication. He knew his daughter’s needs in and out. He woke up 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, but we failed to arrive at a diagnosis. Her father, on the other hand, was adamant that his daughter was suffering from kala azar.
Also known as systemic leishmaniasis, kala azar is an infectious disease common among the pastoral communities, and especially men. This is primarily because it is spread by the sand fly, a vector that is found around anthills out in the open grasslands where herdsmen spend their days tending to their livestock.
For long, we disputed Saruni’s father’s opinion, 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 sand fly.
After being investigated for all manner of conditions all of which turned negative, Saruni was scheduled to have a bone marrow aspirate done to rule out the 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, her father was spot on. Saruni had kala azar! We could finally start definitive treatment for the little princess, who was now almost 21 months old.
One afternoon when 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 the child’s mum was and why she never visited.
He informed me that his wife had a newborn baby at home and hence was unable to travel all the way. He also told me that given that Saruni was his first baby, the bond between them had 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 went out to the grazing fields with her and placed her on an anthill when he had to attend to an animal. It became suddenly clear how Saruni had come into contact with the dreaded sand fly. And because kala azar was common among his people, Saruni’s father recognised the symptoms early enough.
Sometimes doctors expect patients to fit into textbook descriptions, making it difficult to comprehend how they could have a totally different diagnosis. Cases such as Saruni’s serve to remind us that we are treating people who may or may not conform to 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 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 grammes that is critical to enable them 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 fever strikes. And they will stay in hospital for weeks on end, nursing their babies back to health when called upon.
It is certainly not un-African to do so. As much as we may complain about deadbeat dads who have abandoned their responsibilities and neglected their children, there are real fathers who demonstrate their commitment during the toughest times. Fathers who understand that parenting is more than providing a good medical insurance cover or paying 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!