True endurance

Jamil was ten when he started chewing ‘khat’. As he entered his 20, Jamil was detected with liver disease. In 2017, Jamil underwent a successful liver transplant, with his wife as a donor.. A few days ago we did a video call. He introduced us to his children, something he had never done before

Sanjay Nagral
Jul 24, 2020, Mumbai Mirror

Jamil was ten when he started chewing ‘khat’. Growing up in Yemen’s port city of Aden, it was inevitable that he would munch this plant, an intoxicant. Banned in many countries, in Yemen it is a national pastime. Jamil grew up in the 1990s. After a protracted civil war, the north and south of Yemen had just buried the hatchet to unify.

Aden is Yemen’s gateway to the world. Bustling with trade, it stands guard over the Gulf of Aden as the Red Sea joins the Arabian Sea. Aden was once under British rule and part of the Bombay Presidency. Indian traders have visited Aden for centuries. Cawasji Dinshaw, an enterprising Parsi, made Aden his base. Later his family, the ‘Adenwalas’, returned to Bombay. Named after the family, Adenwala Road, a leafy street in Mumbai’s Matunga area, leads to the Five Gardens.

Yemen is not the typical wealthy Arab country. Protracted tribal and geopolitical wars have taken a heavy toll. It is now ranked amongst the poorest countries of the world with the biggest humanitarian crisis. Its health care system is in a shambles, forcing people to seek treatment in other countries.

As he entered his 20s, Jamil got unwell and started vomiting blood. He travelled to Jordan to seek diagnosis and was detected with liver disease. Khat has been associated with ‘autoimmune’ disease of the liver. An Indian businessman in Aden known to his family suggested that he travel to Mumbai.

When he was first seen in around 2005, he was a frail, shy person visibly devastated by a failing liver. After confirming the diagnosis, he was put on medications. He soon got better. Over the next 10 years he travelled to Mumbai every year for review. Of course, every visit was accompanied by gifts of raisins, almonds and ‘attar’.

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In 2015, another civil war broke out in Yemen, which continues till today. As the fighting intensified, Jamil was finding it more and more difficult to travel to India. He would take a boat to Djibouti or Addis Ababa and then fly to India. He described how during one of his crossings a bomb landed a few metres away but he escaped unhurt.

By 2017, Jamil’s liver had considerably worsened. With some hesitation we informed him that the only option to live was a transplant. Given the costs and need for a related donor we thought it was a non-starter. His large family, especially those working in the Emirates, gathered money. Within weeks Jamil arrived with his wife who was willing to donate. He underwent a successful transplant in 2017.

The war in Yemen got worse. Aden was a hotspot of the conflict. Unable to travel, Jamil kept in touch over the phone. He was doing well. In February, he suddenly called saying he was unable to swallow food. He was struggling for a way to travel to Mumbai. Finally he flew via Amman. As soon as we examined him, we saw a large mass in his throat. A biopsy confirmed our worst suspicions. This was a cancer called lymphoma, which is known to occur after transplantation. He was started on chemotherapy. By April he showed some response.

This meant Jamil and his brother were stuck in the lockdown. They managed a room at Bombay Central where they cooked their own food. In spite of the lockdown, Jamil managed to complete five chemo cycles by June. In early July, he was admitted for the final cycle. An episode of fever and he tested positive for Covid. He now had to be isolated. He stayed confined to his room while his brother moved out to a hotel and sent food once a day. We did periodic video calls. Fortunately, Jamil’s infection was mild in spite of the chemotherapy. By mid-July he recovered. His cancer was also under control. The liver too was holding up.

He had now run out of money and patience. For the first time he seemed distraught. ‘I have to go back to my family. Things are not good there’, he pleaded. Jamil and his brother managed a flight from Delhi to Aden.

A few days ago, we did a video call. He had reached Aden. ‘How are you’? we asked. ‘Inshallah’, he said in his shy manner. He introduced his children, something he had never done before. ‘I will come next year’ he said. ‘When war goes away from Aden, and Covid from Mumbai’. He managed a smile.