by Hans Rosling
“Maybe the law will pass, maybe not,” the boss said.
I shuffled away and didn’t say anything about it over supper. Afterward, when we were sitting on the sofa together, I mentioned having seen the head of the clinic.
“Oh, that’s good,” Agneta said.
“Yes, well. But if I go on leave I won’t be allowed to keep the job,” I explained.
“But you seem to land locum posts easily.”
“Yes, perhaps, but I thought it might be best if I carry on working this autumn after all.”
She just looked at me.
“If you stay at home this autumn,” I went on, “I’ll have an extra qualification. It will be helpful when I apply for junior doctor posts.”
“But what about me completing my training?” Agneta said.
“Perhaps you could do that next year?”
At that point, she got up and went to the wardrobe in our bedroom. She came back a little later, carrying our small suitcase into the hall. She put it down by the front door.
“There you are,” she said in a firm but calm tone. Agneta never raised her voice.
“What’s that for?” I asked, feeling confused.
“I’ve packed some things for you, like underwear and socks and shirts. You can get out of my life right now. Don’t come back. We agreed about the parental leave and I have notified the course organizers.”
The following day, I went to see the head of the clinic again and said I wanted to resign effective from the last day of September. I stayed at home with Anna, as arranged. My wife had placed a packed case by the front door and told me to get out of her life. Regrettably, I admit that this was what it took to make me realize that I really wanted to be at home with my first child.
* * *
During these years after Anna’s birth, the Swedish anti-apartheid movement responded to requests from African state bodies, including the Ministry of Health in Mozambique, and set up a recruitment center. Its acronym was ARO, which stood for the Africa Recruitment Organization. I was a very active participant in its creation. It took another four years, from the morning when a bloodless military coup ended Portugal’s colonial war, before Agneta and I were ready to work in an independent Mozambique.
In November 1975 our son, Ola, was born, while we were living in the northern city of Hudiksvall. Agneta had a job as a midwife and I as a foundation year doctor. We both felt that working in a small Swedish hospital would be a perfect part of our preparations for Mozambique.
These preparations had been intensive. We had taken a year-long combination of courses on topics like risk management and aid organization work in a specialized school at Sandö, some four hundred kilometers north of Stockholm. We had learned to speak Portuguese, arguably one of the most important steps. Another seriously important course, which had taken ten weeks to complete, was the Uppsala-based training in healthcare management in poor countries. To round all this off, we had attended a two-week seminar run by the ARO. After that we were ready to sign the contract. The relevant authorities approved us and the Mozambican health service employed me straightaway. By then, I had begun my specialist training as a physician and both of us had a good three years’ experience working as, respectively, a doctor and a midwife. We received our plane tickets, scheduled for August 1978.
We were ready. Then we were abruptly, brutally stopped in our tracks.
* * *
In May 1978, I made an alarming discovery when taking a shower late one evening.
“Hans, I’m sorry to have to say this. But … yes, the tumor is malignant.”
Lasse Wickström, consultant surgeon and head of the department, gave me the verdict later that month. He had asked me to come and see him in his office and his face was serious as he offered me a seat.
The pathology test results had been printed on a piece of yellow paper. He pulled it out from under a desk pad made of green rubber. While Lasse Wickström waited for my reaction before going on to discuss what would happen next, I had time to observe that the shade of green didn’t go at all well with the light wood of the desk.
Perhaps ten days had passed since I had made my discovery in the shower. I had been busy soaping my body when my hand stopped and my mind went blank. My fingertips went back to the surface of my right testicle. Yes, a small lump. It was deep under the scrotal skin so it must be on the testicle itself. I compared sides. The left one was smooth. The quick realization grew overwhelming and terrifying. It was almost certainly some form of testicular cancer.
I was alone at home with the children—Anna was four and Ola two years old—while Agneta was on a two-week Portuguese course. By then, we had been granted leave from our Swedish jobs and replacements had been employed. We had signed a contract with a tenant who would rent our apartment for two years and the flights to Mozambique were booked for August. Now it was May. And I had an illness that might kill me in a few years’ time.
Luckily, the children were asleep when I made the discovery. I can’t tell you how I spent that night because I don’t remember.
I do remember how Lasse Wickström examined me the next morning after the ward round.
“Look, because you are going to Mozambique, I need to be 100 percent certain. I’ll have a closer look and see what can be done,” Lasse had said, and he asked a nurse to book a theater. He scheduled a time for two days later. I decided to keep it to myself and told Agneta that I’d be fine, and she mustn’t leave the course early. On the day of the operation, I took the children to nursery as usual.
When I opened my eyes after the surgery, Lasse was leaning over me. He looked serious.
“Can you hear me, Hans?” I nodded. “It wasn’t possible to cut the lump out,” he said. “Most of it was inside the gland so I removed the whole right testicle. It has been sent to pathology and I’ll call you the moment we have the answer.”
Walking was painful afterward but apart from that, the days passed as usual. Agneta carried on with her language course. I took the children to nursery in the morning and worked during the day in the department of internal medicine.
And now I sat in Lasse’s office, confronting this newly confirmed knowledge.
“Listen carefully to me now,” Lasse said. “It is a seminoma, the nicer kind of testicular cancer. It responds well to radiation therapy, so you have a good chance of being cured even if it has spread a little. I’ve had a word with the radiologists in Uppsala. They will look after you, do some more tests. The radiation therapy can start next week. I’ve fixed you up with three months’ sick leave. But you will have to postpone the journey to Mozambique.”
Lasse Wickström was a truly kind, thoughtful man. He had already called my department and made things easier for me. I walked from the surgery outpatients to the internal medicine clinic—all of 130 meters—and had a chat with my colleague Per, who was not with a patient just then. He asked me about the outcome of the op, took it on board and discreetly adjusted my fully booked timetable for the afternoon. My colleagues shared the appointments between them. I left because I wanted to collect the children from nursery.
I didn’t cry when I made the children’s supper, or when we were playing with building blocks on the floor. We were together in the here and now. I read and sang to them as usual.
I finally broke down when Agneta came home that evening. She spoke to the children and invented a story about how I had been working very hard and needed to be left in peace. They were too young to grasp what was going on anyway and were simply pleased that Daddy was home early and had played with them. And Mummy had come home early, too. It made their day.
But then, we did not really grasp what was happening either. Had I received a death sentence? I was a twenty-nine-year-old man, father of two children. I had cancer.
Would I see the children grow up? Would I survive? Agneta and I hugged and cried together. My mind was filled with the darkest chaos and the strongest love.
When your entire life has changed, you need a
plan. What happens next—right now? Tomorrow? Agneta dealt with everything. She thought things through, solved problems and carried me through the days, weeks, and months.
It took her just an hour to arrange three months’ unpaid leave from her job. She decided that we would move to her aunt Eda’s farm, near Uppsala. She explained this to the children as an alternative to going to Africa, which made sense to them because we used to celebrate Christmas at Aunt Eda’s. We packed up the car together. My job was to be with the children and pack their toys. Agneta had only just got her driver’s license and was not particularly keen on driving us to Uppsala but she did it all the same.
We arrived on a Sunday. As we approached Uppsala, I was touched to see the castle and the cathedral towers of the place where I had grown up. Suddenly, I felt very sad. Agneta stopped the car so I could go outside and calm down.
The tests and the radiation therapy started the following week. It was hell. It was likely there were cancer cells in the local lymph nodes and there was a suspicion that it had spread to the liver, because some of my liver test values were abnormal. The radiotherapy could deal with any infiltrated lymph nodes. Liver metastases would kill me within the year.
My whole life stopped. Mozambique no longer existed. Survival was all that mattered.
I wept for days while Agneta looked after the children and comforted me. The illness made me want to hurt people around me. They cheerfully carried on with their lives while I was burdened by grief, by misery. All I could be bothered to do was lie on the hammock in the garden and read Inspector Maigret books—all of them. My mother could not bear being around me. She was too grief-stricken to be any kind of support.
On the other hand, Eda and her husband Per pretended that I wasn’t ill and that was very restful. They didn’t ask me how I felt and concentrated on being helpful in practical ways. Per, who was the deputy harbormaster in the Sigtuna marina, found a small sailing boat for us. Their house was large and we had two rooms to ourselves on the upper floor. It was easy for me to travel from the farm to my treatment sessions in the Uppsala oncology department.
I decided my goal was to live long enough to see the children start school.
A few days of this new existence had passed when something struck me. I was sitting on my bed on the second floor of Eda’s farmhouse, looking out over the apple trees, when I suddenly remembered an important fact. Ten years ago, a doctor had spoken to me about my elevated liver values and advised me to stop drinking so much alcohol. Which was irrelevant, because I was teetotal. It should have been followed up but wasn’t.
My notes, I thought, should still be in the infectious diseases unit where I had been working at the time. I knew the charge nurse, who was very efficient. In less than a minute, I decided what I must do: speak to the nurse about locating the old records and find out exactly what the lab results had been.
I never give up if there is something I want to know. It’s why many people find me unbearable to be around. This trait was obvious even in my teenage self. When I was hitchhiking in Europe, I once stayed in a youth hostel in Marseille. I was the youngest of the backpackers and would go to sit on my own outside, studying my copy of the Swedish Automobile Association’s informative Atlas of Europe. The others began to call me “the boy with the blue book.” Half the atlas comprised a collection of facts about European towns and cities. I memorized a lot and could verify what people said in general conversation, making helpful comments such as: “No, you’re wrong, Prague is much older than that.”
My fact-finding drive is the key to my entire research career as well as the teaching to which I have dedicated so much of my life.
I drove to the hospital. After an hour, I had got permission to search the basement archives, and instructions from the nurse about how to find old sets of handwritten notes. When we found it, we placed the folder on a small table in the archive. A beam of light reached us through the narrow window above our heads. Yes, there it was. Ten years ago, I had had the same pattern of elevated liver values as now. It followed that the current results were probably not due to metastases in the liver.
I had a chance to survive. I didn’t want to become too emotional about it and I was still in a dark space. But what was really going on? A week later, I had a new diagnosis: not liver cancer but chronic hepatitis. It was a great leap forward.
Two weeks after that, the lymph node results came in. The nodes showed no infiltration by cancer cells. No metastases? The second round of radiotherapy sessions was called off. Once more, everything was turning upside down—would life begin again now?
We moved back to our home in Hudiksvall. I went for hospital checkups monthly and then every second month. Time passed and the cancer did not recur.
Going back to work was surprisingly taxing. Many of my colleagues were not even aware that I had been ill. I met one of them in the elevator who exclaimed: “Are you back already?! How was Africa?” It was tiresome to inform each one in turn or, in some cases, to decide not to.
Life rumbled on and my desire to go to Mozambique grew stronger. A year passed. Now other questions had to be answered. Had the radiotherapy led to a full recovery? Would my new diagnosis of chronic liver disease affect my ability to cope with traveling to Africa and working there?
In the evenings, Agneta and I talked with deep, loving concern for each other. To travel or not to travel? How do we want to lead our lives? We both wanted to go. It was, we felt, what we were meant to do, and we had devoted so much of ourselves to preparing: our traveling in Asia, our professional training, our engagement with the ARO. If I had only a few more years to live, would it not be best to spend that time doing what we wanted?
Or perhaps we ought to stay at home and spend time with the children? People close to us tried to stop us from leaving Sweden.
In the end, we made the decision entirely independently of others. We would go.
Getting health insurance for me was a crucial factor. The oncologists decided that they could not underwrite the assurance of health that was required. I was referred to Folke Nordbring, head of the infectious diseases unit, where I had previously worked. I outlined the situation in a letter to Nordbring and he arranged for me to see him. When I entered his office, I was very conscious that this man’s judgment would determine the rest of my professional life. However, I truly trusted Folke Nordbring and felt good simply to have my chances evaluated by a medic of his authority.
“Please take a seat. There’s no need for a physical examination. We’ll just have a talk. I have been through your notes already,” he said and placed his right hand on the pile of documents on his desk.
He asked about the kind of work I would do in Mozambique and what the conditions would be like. Was it likely that I would be exposed to infectious diseases in contaminated food or water, or carried by mosquitoes or other insects? I answered yes to all these questions. If I fell ill, would I have access to effective healthcare? Doctors ready to treat me? Good laboratories? I answered no to all of these.
He nodded calmly and let me talk on. As I heard myself speaking, my mind told me I was on a hopeless quest.
Next, he asked why I wanted to work in such conditions. I explained that the recently independent Mozambique desperately needed qualified doctors and that I had spent a lot of time and effort preparing myself. Also, my wife was prepared to go and work as a midwife.
He kept looking at me but did not speak immediately. Then he said: “I can’t see any reason why you shouldn’t go. I will sign all the necessary forms.”
* * *
Many years later, I met Folke again at an antibiotics conference in Vietnam. I sought him out to thank him for making that crucial decision. His first reaction surprised me: “Wow!” he exclaimed. “You’re still alive!”
“Of course! I wanted to thank you for confirming that the radiotherapy had done the trick and I was well,” I said. “It meant that I could go off to practice in Mozambique. And then carry on doing the interna
tional work I’m doing now.”
“Look, Hans, I actually felt very dubious about signing a statement to say that you were well. I rather thought you might die pretty soon from an aggressive cancer. Or something. But I could see in your eyes that you truly wanted to go and work in the way you and your wife had been preparing yourselves for. So, I thought ‘If he has only got a few more years, why shouldn’t he go and do what he wants most of all?’ That’s why I wrote a fake assurance that enabled you to go to Mozambique.”
Folke Nordbring had dared to take responsibility.
* * *
On October 23, 1979, Agneta, Anna, Ola, and I boarded the flight to Maputo, the capital of Mozambique.
3
To Nacala
It was afternoon when our plane landed in Maputo’s modest airport. I looked around as we stepped into the hot air and saw palm trees. Strong sunlight was reflected off the pale cement of the runway. The children were so excited. On the journey we had been reading them crazy stories about Soda Pop written by the Swedish author Barbro Lindgren, until they had fallen asleep. Now they were ready for anything. My mother had made them each their own little rucksack and when we entered arrivals, they wanted to hold on to their own passports.
A Portuguese slogan had been painted on the side of the plane: “We carry not only passengers but solidarity.” Indeed, about half the passengers were from aid organizations. People were flooding into Mozambique and we pompously called ourselves “solidarity workers.”
Twelve years ago, I had promised the first leader of the Mozambican independence movement that I would go to his country and work as a doctor. A year earlier, I had been ready to keep my promise but been stopped by testicular cancer. If the children had not been so infectiously delighted with everything, sentiment might have overwhelmed me. Now, they left me no time to ponder.
