The “Last Mile” to Treatment Access: Constantine’s Story
We enter the room of white coats. Cheerful banter and smiles are all around and it’s easy to overlook the frail man in the corner. His name is Constantine. He is from Inhambane, an area approximately 400km from Maputo, the capital of Mozambique.
A Long Journey
The distance itself is not so far but the journey is long – 8 hours by public buses and transport. Constantine is a security guard and a father of seven. He has not been feeling well for months now and has symptoms similar to malaria and bilharzia. Unsuccessful treatments at a clinic in his hometown have seen him referred to specialist physicians in the capital city. Presenting with a protruding spleen and increased white blood cell counts, he was finally confirmed to have the Philadelphia chromosome following a bone marrow biopsy. Constantine, like so many others around the world, has a rare form of leukemia called CML (chronic myeloid leukemia).
His Temporary Home
He has made the ward his temporary home and shares the space with four other patients. He does not get many visitors as the trip to Maputo is expensive and simply unaffordable for his family. Life outside the hospital goes on with news filtering in from his wife, children, and grandchildren. He will only be discharged once his white blood cell count comes down and his spleen has returned to normal size. Constantine is now one of 70 leukemia patients seen at the Maputo General Hospital.
The “Last Mile” To Treatment Access
For many people facing cancer, the “last mile” in treatment access is a long, expensive, and recurring journey. But in Constantine’s case, even this journey may not be enough. Many low- and lower-middle income countries are celebrating access to second- and third-line treatments through Max Access Solutions, but Mozambique and at least 10 other countries still lack access to any effective medications. I look at the empty shoes next to Constantine’s bed and wonder how far they’ve already carried him to seek help. I can only hope they’ll be able to make the long journey back to Maputo over and over again, and that one day soon, there will be effective medication waiting for him when he gets there.