• Retina
• public health
• pathology
• neoplasia
• child health (paediatrics)

Imagine two children with unilateral retinoblastoma. One lives in North America, while the other lives in sub-Saharan Africa.

In North America, a mother notices a funny white-eye reflex in photographs of her child. It is consistently present in various photos taken over the last month. Curious, she surfs the internet and discovers that a white-eye reflex could be a sign of cancer. Mother and child visit their family doctor, who confirms the mother's worst fear: it is retinoblastoma. Two days later, the affected eye is removed at the local children's hospital. The next week, histopathology results confirm no risk of tumour spread, while a few weeks later, genetic testing of the tumour and blood indicates the RB1 mutation was sporadic. The child is fitted with a prosthetic eye and goes on to lead a normal, productive life.

In Africa, a mother notices a white reflection in her child's eye, most prominent at dusk. Since it does not cause her child pain or discomfort, she ignores it at first, distracted as she continues to care and provide for all of her children. Months later, the white reflection is still prominent. She takes the child to the local dispensary, where the healthcare worker reassures her that there is nothing wrong. When the eye appears to worsen, she consults a traditional healer. He prescribes a herbal medication for the child, and instructs her to administer it twice daily. The eye shows no improvement, and it eventually begins to protrude from the socket. The mother takes the baby to the city hospital, struggling to gather the funds needed for transportation to the city. The hospital doctors tell her the eye must come out; it is cancer of the eye. When the eye is removed, mother …