Discussion Questions for “Yeyuka”
What new trend does the narrator, Martin, observe on Bondi Beach, and what is its
significance? (1)
Solar tattoos; the undeveloped pigments is put on the skin and the sun’s rays (UV light)
render the colors and designs visible. This shows that people are now boasting of the
amount of UV radiation to which they have been exposed, because skin cancer has now
been beaten.
What medical technology has made it possible to defeat cancer and detect and destroy
almost all harmful bacterial and viral infections in the bloodstream of a human who has
the technology? (1)
The HealthGuard ring.
What effect did getting the HealthGuard ring have on the narrator’s life expectancy and
financial status? (1)
It added fifteen years to his expected lifespan; he’ll be paying off the loans he needed to
afford it well into his sixties.
How many Ugandans have to share access to one HealthGuard machine? (2)
Forty million people.
Why does the narrator, Martin, think about removing his HealthGuard ring before
journeying to Uganda, and then decide against it? (2)
He feels it would be insensitive to wear the ring in front of Ugandans who don’t have
access to that kind of technology, since there in Uganda cancer has definitely not been
defeated. Then he realizes that the malaria parasite is notoriously variable, and having the
ring on would offer far better protection than just having it immunize him against all the
diseases he’d be likely to encounter there before going to Uganda. He realizes he was just
being overly-sensitive since most Ugandans won’t even recognize—let alone resent—the
ring.
Why will this trip to Uganda be one of very few opportunities the narrator, Martin, will
have in the future to perform cancer surgery? (2)
The HealthGuard ring will prevent most cancers from ever happening (in the First
World).
Why do the narrator, Martin, and his girlfriend Lisa both believe that doctors will soon no
longer be able to find work? (2)
Soon the medical technology will make doctors obsolete; there are computerized
safeguards that now prevent most traffic accidents, and Lisa believes that within the next
twenty years the HealthGuard ring will be able to prevent all pregnancy complications,
premature births, etc.
Who meets the narrator (Martin) at Entebbe airport? (3)
An oncologist, Magdalena Iganga.
What is the organization that put together the small team of oncologists, which includes
Magdalena Iganga, to help overburdened Ugandan doctors deal with all the cases of
Yeyuka? (3)
Medecins Sans Frontieres (Doctors Without Borders).
What were Magdalena’s experiences with the World Health Organisation in Nairobi like?
(3)
She tried to persuade them to set up an epidemiological database for Yeyuka, so they ask
her to put together a detailed proposal to the cancer epidemiology expert committee, so
she did. That committee told her to submit it to the contagious diseases expert committee
instead. She’d missed their last annual meeting by a week. She and some colleagues
ended up doing it themselves on an old computer and a borrowed phone line.
According to the narrator, Martin, what do some virologists believe about the origin of
Yeyuka? (3)
Some virologists believed that Yeyuka had arisen from a less virulent ancestor after
gaining a foothold within the immune-suppressed population who’d been affected by
HIV. Also, the crowded conditions, poor sanitation and chronic malnourishment set up
the shanty towns to bear the brunt of the epidemic.
What does Martin say about Mulago Hospital? How does he describe it? (4)
Everyone was busy but friendly. The wards were all crowded, with patients spilling into
the corridors, a few in beds but most on mattresses or blankets. The building itself was
dilapidated, and some of the equipment must have been thirty years old, but there was
nothing squalid about the conditions; all the linen was clean, and the floor looked and
smelt like you could do surgery on it.
What are some of the technological limitations the narrator (Martin) will face at this
hospital compared with what he is used to having? (4)
The hospital did have a CAT scanner, but it had been broken for the past six months,
waiting for money for replacement parts, so flat X-rays with cheap contrast agents like
barium were the best they could do.
Why is it that the hospital’s sole HealthGuard machine can’t help create custom-made
molecular cures for even a few Yeyuka victims, as far as the narrator knows at this point?
(5)
Yeyuka wasn't yet well enough understood for anyone to have written the necessary
software.
How many years has the Yeyuka epidemic been going on? (5)
Seven years.
Why is it that foreign surgeons—who have so little experience with Yeyuka—are being
brought into Uganda to help the Ugandan medical professionals who are already there?
(5)
Foreign surgeons were always going to be inexperienced, but no one else had so much
time on their hands (because they have fewer patients because of HealthGuard rings).
Ugandan medical students had to pay a small fortune in fees—the World Bank had put an
end to the new government's brief flirtation with state-subsidised training—and it looked
like there'd be a shortage of qualified specialists for at least another decade.
The narrator, Martin, observes a surgery being done by the Irish volunteer Ann Collins
(whom he will be replacing). What simile does the narrator use to describe the way she
removes the tumor from the Yeyuka-stricken patient on whom she is operating? (5)
She removed it as fastidiously as if she was removing a leaky bag full of some fatal
poison.
How is Yeyuka different from other kinds of cancers? (5)
Ordinary cancers grow in a single location first, and then a few mutant cells in the
primary tumour escape to seed growths in the rest of the body. With Yeyuka, there are no
"primary tumours"; the virus itself uproots the cells it infects, breaking down the normal
molecular adhesives that had kept them in place, until the infected organ seems to be
melting away.
What is the origin of the name Yeyuka? (5)
It comes from a word that means ‘to melt.’
What does the narrator (Martin) say about how his fellow medical professionals feel
about him being there, versus his own feelings about why he is there? (6)
No one cared why he was there. It wouldn't make the slightest difference whether he'd
volunteered out of genuine compassion, or just a kind of moral insecurity brought on by
fears of obsolescence. Either way, he'd brought a pair of hands and enough general
surgical experience to be useful. He condemns himself, though, for his lack of altruism.
When Martin mentions to Magdalena Iganga how exhausting it is for him to perform six
operations a day, six days a week, what does she offer him the chance to do? (6)
She offers to line up a trip to Mubende for him, to treat patients who are too sick to be
moved. They have multiple tumors, and they’re all nearly terminal.
How does Martin, our narrator, feel about that? (6)
He regrets having opened his big mouth; he knows he hasn’t been seeing the worst cases,
but hadn’t thought about where all the worst cases were.
What does Magdalena Iganga tell Martin about why she went into medicine? (7)
Family expectations; it was either be a doctor or a lawyer, and being a doctor seemed less
arbitrary to her; nothing in the body can be overturned by a higher court.
What does she tell Martin about how she ended up working with Yeyuka patients? (7)
Seven years ago, she was all set to make her fortune in one of the private clinics in Dar es
Salaam. Rich businessmen with prostate cancer, that kind of thing. Before that market
vanished completely, the Yeyuka fanatics were nagging her, bullying her, making little
deals. They promised her she’d be co-author of a ground-breaking paper in Nature
Oncology if she just helped out at some field clinic in the middle of nowhere. She was
dragged into this, kicking and screaming, just when all her old dreams were going up in
smoke.
What does Magdalena Iganga tell Martin about what a doctor must be able to do in order
to cope with having to deal with so many thousands of seriously ill patients? (7)
They have to emotionally separate themselves from their patients and see them as a series
of clinical problems; otherwise, they’d go insane from the emotionally wrenching
experience of watching so many people for whom they cared dying in such agony.
When the narrator (Martin) operates on a teenaged girl, his two-hundred-and-fourth
operation, what happens, and why can he not do anything about it? (8)
He messes up and releases infected cells into her bloodstream to affect new, previously
unaffected areas. He has no emergency tools available to him to deal with this crisis.
What does Okwera tell Martin to do about his mistake, and why? (8)
He tells Martin to tell the parents that he found evidence of leakage so she’ll need to have
regular follow-up exams, to not tell the patient or her family about his mistake, because if
they found out, it could cause trouble that could negatively impact the hospital and the
volunteer program and interfere with the work they’re doing to save lives.
After having botched his two-hundred-and-fourth surgery, what does Martin say to
Masika about what he is willing to do to help end the Yeyuka epidemic? (8)
He says he’ll raise funds for research: champagne dinners, etc.
What does Masika reveal to our narrator, Martin, about their understanding of Yeyuka,
and what they need to fight it, and why they need it? (9)
They do understand Yeyuka; they have HealthGuard software written for it, ready and
waiting to go. They can’t run it on the machine there. They don’t need funds for research;
they need another machine. The software is unlicensed; if they use it on the hospital’s
machine, they would void their agreement with HealthGuard, and they’d lose the use of
the machine entirely.
What is the Makerere supercomputer, how was it made, and how much did it cost? (10)
It is five hundred and twelve computer processors working in parallel, and it cost fifty
thousand shillings, or, about fifty dollars.
Why were there so many extra computer components available to help make the
Makerere supecomputer? (10)
Twenty or thirty years earlier, the computer industry ran an elaborate scam: software
companies wrote deliberately inefficient programs, to make people buy newer, faster
computers all the time — then they made sure that the faster computers needed brand
new software to work at all. People threw out perfectly good machines every three or four
years, and though some ended up as landfill, millions were saved. There's been a
worldwide market in discarded processors for years, and the slowest now cost about as
much as buttons.
How would the Yeyuka software work if they got it on to a real HealthGuard machine?
(10)
First, the software characterises any damaged surface adhesion molecules it finds —
there are always a few floating freely in the bloodstream, and their exact shape depends
on the strain of Yeyuka, and the particular cells that have been infected. Then drugs are
tailor-made to lock on to those damaged adhesion molecules, and kill the infected cells
by rupturing their membranes.
If the software could be put on to a real HealthGuard machine, what would be possible
that is not possible with their only current approach of surgical removal of tumors? (10)
If they can get this onto a real machine ... they'll be able to cure three people a day.
How did the woman who wrote the software get the raw data to use to create it? (10)
An insider at HealthGuard found it in the company archives and sent it to them over the
net.
How did HealthGuard’s parent company get that data, and why did they gather it? For
what purpose were they gathering that data in that particular way? (10)
The parent company collected blood from 5,000 people in Southern Uganda in 2013,
supposedly to follow up on the effectiveness of their HIV vaccine. What they actually
wanted was to collect a large sample of metastasizing cells so they could perfect the
biggest selling point of HealthGuard: cancer protection. Yeyuka offered them the
cheapest, simplest way to get the data they needed.
How does the narrator feel about what the parent company of HealthGuard has done in
terms of gathering data dishonestly and then burying the information that’s half-way to a
cure just so they won’t have to pay for what they’ve taken? (10-11)
He feels it is unspeakably awful.
Why does the woman who wrote the software that would cure Yeyuka (and those who
are working with her) not want to file a class action lawsuit against HealthGuard? (11)
They have no proof. The files were sent anonymously, there's no way to authenticate
their origin. HealthGuard would spend a lot of money on their legal defense. They can't
afford to waste the next twenty years in a legal battle, just for the satisfaction of shouting
the truth from the rooftops.
What does the narrator, Martin, say to Masika about the HealthGuard ring on his finger,
and what is Masika too polite to reply? (11)
He says, “I’d give you this, if it was mine to give. But that’s thirty years away.” Masika is
too polite to reply that if he’d owned the ring outright (instead of having to make ongoing
payments on it) he wouldn’t have even raised the possibility/made the offer. In other
words, he only says this to look generous, but has no intention of parting with the ring.
What does the narrator (Martin) tell Masika about what he is willing to do to help? (11)
"… I don't have connections to any black market, I don't have a clue how to go about getting
a machine. But if you can find out what I have to do, and it's within my power ... I'll do it."
What is the Mubende Yeyuka clinic like? What are the conditions there like for the
medical professionals, the patients, and the patients’ families? (12)
It was starved of funds, under-staffed and over-crowded. Patients’ relatives were required
to provide and wash the bedclothes, and half of them also seemed to be bringing in
painkillers and other drugs bought at the local markets, some genuine, some ripoffs full
of nothing but glucose (sugar) or magnesium sulphate. Most of the patients had four or
five separate tumors. He treats two people a day, with operations lasting six to eight
hours. In ten days, seven people died in front of the narrator; dozens more died while
waiting for surgery.
The morning the narrator, Martin, leaves the Yeyuka clinic in Mubende, how does he
feel, and what does he realize about himself? (12)
He is exhausted and feels guilty about abandoning his colleagues but happy to be leaving,
like a deserter from a pointless war; he knew he was not strong enough to stay for years.
When armed bandits stop their truck, how does the narrator (Martin) react? (12)
His heart starts racing and he wonders if it’s really bandits. He grabs Magdalena Iganga’s
hand. They both tremble.
Why does the narrator (Martin) try to exit the truck before Magdalena Iganga does? (12)
He is worried the bandits might try to rape her so he tries to get between her and the
bandits to lessen the chances of this happening. He hopes that he’ll be able to protect her.
What does Masika reveal to Martin (the narrator) about the ‘bandits’ who appear to be
holding up the truck? (13)
He has paid them to stage this so that they can pretend the ring was taken by the bandits.
Why is this method the best way for them to get the HealthGuard ring that they need in
order to be able to use the software they’ve already developed to actually cure Yeyuka?
(13)
HealthGuard is constantly monitoring (and collecting data on) Martin’s levels of cortisol,
adrenaline, endorphins, prostaglandins, and so on. The data would show if he was being
anesthetized and the data will show his experiencing stress, fear, and pain (later, when
they remove the ring without anesthetic) during the robbery. If his insurance company
believed he had freely given away the ring (which would be the obvious conclusion if
he’d had it taken off under anesthetic), then they would never pay for a replacement ring
for him. This way, Martin’s insurance company will pay for a replacement, and they will
get the bootleg ring they need to be able to cure people of Yeyuka.
William Gibson once said or wrote, “The future is already here—it’s just not evenly
distributed.” How does that apply to this story and to reality?
Answers will vary.
http://news.bbc.co.uk/2/hi/programmes/this_world/4924012.stm
http://news.bbc.co.uk/2/hi/south_asia/4932188.stm
http://www.washingtonpost.com/wpdyn/content/article/2006/05/06/AR2006050601338.html
http://news.bbc.co.uk/2/hi/business/1517171.stm
http://www.cbsnews.com/stories/2003/05/22/health/main555154.shtml
http://en.wikipedia.org/wiki/Bayer
http://en.wikipedia.org/wiki/Contaminated_haemophilia_blood_products
http://www.youtube.com/watch?v=CaB5qB8yoZk
http://siliconangle.com/blog/2011/08/18/a-tattoo-that-monitors-your-heart-ratethe-future-of-data-collection/