Swinging between hope and despair

Over a year since the advent of a bloody war that has ensued in Yemen, dna revisits the condition of a cancer-stricken girl from the ravaged land. Dna had first reported about Hanadi Ali Mosa in April last year - "Will Yemeni girl keep her tryst with Tata Memorial?"

Since last year, all efforts to bring back Hanadi (14) to Mumbai for treatment to Tata Memorial Hospital have failed. Hanadi suffers from Acute Myeloid Leukemia (AML), a blood cancer condition which entails replacement of normal bone marrow cells with leukemic cells. This results in drop of red blood cells, platelets and white blood cells of the patient to the extent that it can cause fatal internal bleeding. Hanadi was to come back for a follow up to Mumbai in November last year. It has been over six months now, but she has been unable to keep her date with the doctors here.

"We are co-ordinating with oncologists at Tata Memorial in Mumbai, who are remotely guiding us to ensure that Hanadi receives basic care in Hadhramout," Ali told over telephone, from Yemen, to dna.

In March 2015, after the girl's interim treatment, Hanadi and her family landed in their home town of Aden from Mumbai. The war immediately ensued. Ali saw his neighbourhood being brutally bombed. Since the past year, Hanadi's father Ali has been on a move with his family. Ali (41), his wife Ifthekaar (31), daughter Hanadi, and three sons Mohanad (13), Ahmad (12) and Hadi (3). They are presently staying in Hadhramout, a town which is over 650 kilometers to the north east of Aden.

Only last month, Hanadi fell very sick. "She developed high fever. Her platelet count precariously dropped," Ali said. The nearest pathlology lab from their home in Hadhramout is nearly one hour away. The physician indicated that Hanadi would require an urgent transfusion of platelets.

"Hadhramout does not have the facility of a Platelet Apheresis Machine as exists in Tata Memorial Hospital. The machine extracts only platelets from the donor's blood for transfusion into the patient. It takes almost five whole blood donations to match a single donor who only donates platelets. In the absence of advanced technology where only five donors would have sufficed, I had to gather 25 donors to donate whole blood for my daughter," said Ali.

The family ran out of oral chemotherapy medications that they had gotten along from Mumbai in November last year. "We try to procure medicines locally, but most of the times they are out of stock," Ali said.

Dr Brijesh Arora, paediatric oncologist, Tata Memorial Hospital, Mumbai said, "She was supposed to come to Mumbai for a follow up but her family has not been able to get a visa. We have couriered a batch of oral chemotherapy medicines."

Hanadi went without medicines for over two months in February and March.

"It took two months and traversing through four countries - India, Oman, Jordan to reach Yemen for a friend who was bringing us medicines," said Ali. A prescription from Ibn Sina'a General Hospital in Hadhramout reads that Hanadi should be urgently taken out of Yemen for treatment on a life saving basis.

Dr Arora said that sixty percent of ALM patients are cured with chemotherapy and radiation treatment. Others may require a Bone Marrow Transplant. "Hanadi has to comply with medication. She has to take oral chemotherapy drugs for up to five months more," he said.

Two weeks ago, Hanadi had stopped eating or drinking. She could not move. She could barely talk. "After a drastic dip in her platelet count she was admitted to Bashar Aheel Hospital for two weeks. Her condition is better at present. She is eating fruits. We are in touch with the doctors at Tata Memorial for remote treatment," said Ali.

Ali wants get Hanadi's Bone Marrow Aspirate tests conducted in Tata Memorial Hospital for a sound opinion. "I am trying to get a visa to come to India so that Hanadi's treatment progresses smoothly. This war has destroyed everything. We do not have an expert to check the bone marrow in Hadhramout," he said.

"The process of issuing visas has restarted," said an official from Yemen Consulate in Mumbai. "Ali will have to submit all the documentation including the letter of invitation from Tata Memorial Hospital to the Indian Embassy in Sana'a. The paperwork will be shipped to the Indian officials in Djibouti for approval of visa," said the official.

The journey from Hadhramout to the Yemeni capital of Sana'a entails an overnight bus ride spanning over twenty five hours. "It is risky to go to Sana'a. The main roads are closed by the fighting sides. I will however attempt the journey whatever the risk maybe. I hope my trip fraught with risks is not a waste. We need the visa so that Hanadi can be brought to India for treatment," Ali said.