Besides the pains victims of breast cancer go through in Nigeria, the stigma they contend with in the face of poor access to quality health care sends dozens of them to early graves, writes Eric Dumo
Petite and dark-complexioned, she is quick to flash a smile whether it is a known face or not. Soft-spoken and calm, she radiates warmth all around her. But beyond the bright grin that sits on her cheeks is a scar that Funmilayo Oluwagbamila has lived with for the past three years. Since first discovering a tiny growth on her right breast in May 2014 to eventually having the entire section removed through a painful and expensive surgery a few months later, life has not been the same for the Ilesa, Osun State-born woman. Apart from now surviving from hand to mouth after losing her main source of income and other material assets, the mother of three has had her entire physiognomy changed, staring death in the face on several occasions. The wounds are far from healing.
Once a bubbly and very agile woman, Oluwagbamila had everything going for her prior to the time the shocking discovery was made. Besides running a school for academically challenged children from humble homes and also supplying educational materials to most schools in Akure, capital of Ondo State, where she resides, the 44-year-old also had her hands into other money-spinning ventures. Her husband, Michael, who had a thriving job in Lagos and journeys to Akure often to be with them, was also doing well. Everything was in place. There was no need to worry. But one fateful morning, things fell apart. It has been tough picking the pieces.
“I wish the day I felt that tiny growth on my breast which I thought was mere fat cyst never came,” the middle-aged mother said, nodding her head dejectedly. “If I had known that it was a cancerous lump growing in my breast, I would have paid more attention. Maybe that would have made the difference,” she added painfully.
Even though her husband had always urged her to take the tiny growth more seriously by going for mammography, the mother of three never really found much reason to do so, instead channelling her entire time and energy into growing her businesses. But after hitting her chest on her car’s steering during an accident one day and subsequently visiting the hospital for a cardiology test, she knew the strange swelling wasn’t a joke. Sadly, it had become too late then. The cancer in her breast had reached stage three – beyond redemption, according to doctors. The race to save her life began in earnest.
“By the time I was examined, the cancer had affected my lymph nodes already,” Oluwagbamila said, almost bursting into tears. “I was told I had to do a complete mastectomy to save my life and that the surgery and chemotherapy would cost an initial amount of N500, 000 but at the time, I couldn’t even boast of N50, 000 cash because of the way things were.
“In no time, all that we had vanished as a result of the problem. We had to withdraw our children from the school they were attending to a cheaper one. We were living in an estate then but had to move out to stay in a less developed area where accommodation was cheaper. Also, we had to sell our car and land to fund part of my treatment. There was a foundation on the land already but we had to sell it just to raise enough money for my treatment. This was aside from the financial support we got from our church, relatives and other kind-hearted individuals. The disease sucked up all those funds,” she revealed.
Living with one breast
But if the 44-year-old thought that having the affected breast removed was the end of her problems, she was wrong. Instead, the surgery marked the beginning of her journey into a world filled with pains, tears and constant heartbreaks. Like a multi-storeyed building shattered and swallowed by an earthquake, everything around her began to crumble – and very fast, too. In flesh and in spirit, she wasn’t the same anymore.
“After having my breast removed, I was left between life and death,” she said, slowly taking a deep breath. “The side effects of several sessions of chemotherapy I underwent and the drugs I was placed on turned me into a living corpse. I lost all the hair on my head, I became seriously overweight, I saw my nails growing black and falling off. I had memory loss while a constant headache became my lot.
“Chemotherapy killed both the cancerous and normal cells in my body. It was like a drug killing me to keep me alive.
“My life changed from that point. I felt incomplete and unattractive. Whenever there were visitors in the house, I couldn’t move about freely in my pyjamas because it would show that I am one-breasted.
“I remember one day our landlady came around to ask for the house rent and because I was carried away, I rushed to open the door for her. Immediately she noticed that one part of my breast wasn’t there, she shouted and almost passed out. She quickly went away without talking about the rent again.
“The ill treatment I have suffered at the hands of people since losing one breast is too numerous to mention. As a matter of fact, it took a while and a lot of counselling for our children to accept the fact that I had lost one breast. The experience has been that bad,” she said.
Passing through fire twice
Despite being bombarded with torrent of challenges after undergoing the breast removal known as mastectomy in medical parlance, the worst was not yet over for Oluwagbamila. Instead of the reprieve that she expected, more heartbreaks greeted her. In fact, only a few words can describe her ordeal.
“Early this year, I started having a strange feeling on the side of the breast that had been removed. I went to my oncologist for a test and when the result came out, it was discovered that another cancerous lump had grown on that same spot,” the 44-year-old cut in sharply. “It was the worst news I had received in my entire life.” “At that point, I lost hope. I called my children and told them that I was going to die and that they must love and take care of each other when I am gone. They cried endlessly that day but my husband remained strong. He told me that I was not going to die. As a matter of fact, he had to resign his job in Lagos to come to stay with me in Akure. He encouraged me a lot and told me how my health condition wasn’t going to change his love for me. It was this support he gave me and the assistance I received from others that have helped me to stay alive. Without these, the pain I had been through and the stigma I have faced could have killed me a long time ago,” she said.
Rejected for choosing life
Like Oluwagbamila, Funmi Osiegbu has also stared death in the face. But unlike the former, who came out with her life and marriage intact, the latter only has one to hold on to today – her life. In the midst of her battle with breast cancer, Osiegbu’s husband of 13 years and father to her three children walked away. That was in 2013. Four years down the line, she lives in a quiet world, confronting several obstacles by the day in her quest to forge ahead.
“It is not easy when your image has been tampered with,” the Abuja-based businesswoman and advocacy expert, told Saturday PUNCH. “As a woman afflicted by breast cancer, you lose your hair, femininity and so many other things in the course of the battle. It’s a huge price victims have to pay and live with for the rest of their lives.
“There are some relationships I had to cut off because they became some kind of emotional burden on me. Every woman wants to remain in their marriage but because I chose to live, I lost mine. I didn’t really get the type of understanding that I needed even though initially, my husband did support me. The truth is that the psychological and emotional support is a long-term thing, I didn’t get that.
“Every marriage has its own issues but if not for the path I have been through, we would have been together still. But I lost that marriage because I chose to stay alive,” she added.
As is the case with most breast cancer patients in Nigeria, Osiegbu’s resources suffered serious depletion in the process of looking for quality medical care to save her life. After realising that the facilities with which to attend to her case weren’t available in the country, she had to be moved to the United Arab Emirates where she spent several weeks in the hospital. It wasn’t a cheap venture. But beyond the resources that had gone into her treatment, the mother of three says it is the way the society has reacted to women like her that has saddened her most.
“There are people who sometimes think it is a curse for you to have one of your breasts removed as a result of cancer,” she said with a firm voice. “A few days ago, I was somewhere sharing my story and trying to encourage other women battling cancer, some people abused me for even having the courage to speak about my experience. They said I was exposing my scar when I should have hidden it from the public. They thought I would feel bad but I didn’t because my speaking has helped a lot of women stay alive. People try to stigmatise me a lot of times but I deflate them with my positive attitude.
“The truth is that living as a breast cancer survivor in Nigeria comes at a great cost because the way people treat you thereafter can kill you if you are not strong and close to God. As a person, I have developed coping mechanisms to stay alive; if not, it would have been a different story entirely,” she revealed.
Bimbo Osifala has also seen life fall like a pack of cards before her eyes. At only 30, she has tasted some of the bitterest aspects of existence. Even though born into a humble background, it was until her encounter with breast cancer in 2015 that she truly understood the real meaning of suffering. Diagnosed with a lump on her left breast in August of that year, she had no idea what was to come in the following months. By December of that year after enduring bouts of crushing pains, she had to face the sad reality. The affected breast was removed. The after-effects of the surgery and the stigma she has faced since then have combined to make her life a living hell.
“Sometimes I just wish this is all a dream and that I could wake up to a different reality,” the mother of one told Saturday PUNCH. “People who know what you have been through sometimes want to take advantage of you and make you feel inferior. At the slightest opportunity, they want to kill your confidence and remind you that you are no longer complete. This is one sad situation that I have had to live with since losing one breast to cancer,” she added.
Like many women who lost one breast to the dreaded disease, Osifala and her family also lost their entire life savings and other valuables in the process of trying to save her. Apart from selling almost every item in her hairdressing salon, the business and other sources of income by the side eventually shut down as well. Survival has become a lot more critical for her since that period.
“I had at least four stylists working in my salon before this problem began,” she revealed. “This was aside from the four other trainee-apprentices I also had under me. But when this cancer issue started and my health worsened, I had to sell everything in the shop gradually until the business collapsed. My parents had to also sell off a lot of their possessions, including jewellery just to save my life. Each chemotherapy session that I went through cost at least N100, 000, I had to take six. This was aside from the drugs I bought every month which sometimes cost between N40, 000 and N50, 000. We are not talking of the supplements I had to take and the cost of the surgery itself.
“But beyond that, it is the way people have treated me since I lost one of my breasts that has broken my heart the most. If not for God and the type of family I have that have encouraged me, maybe I could have committed suicide a long time ago. What I have experienced at the hands of people, I do not wish same even for my enemies,” she added.
But while Oluwagbamila, Osiegbu and Osifala have lived to tell their stories even though life has taken a completely different turn for them since having one of their breasts removed as a result of cancer, a handful others have not been quite lucky. The lack of quality medical care, emotional support and stigma they faced after going under the knife combined to snuff the life out of them.
Forty-nine at the time of her demise in June 2016 and a civil servant with the Institute of Agric Research and Training, Ibadan, Oyo State, Mrs. Juliana Adedara’s ordeal is a sad reminder of the havoc breast cancer continues to wreak across Nigeria. Apart from battling for life until her last moments, she never fully recovered from the emotional and psychological effects the surgery and consequent stigma she faced left her. According to her husband, Michael, she could have remained alive had the health care facilities been up and running.
“Even though we detected the lump in her breast quite late, my wife could have survived if there were good medical facilities in the country to take care of her.
“Despite the fact that I spent all the money I had on me at the time, sold one of our two cars and one of our plots of land, the doctors couldn’t save her life because the facilities weren’t just there. My wife suffered a lot of emotional pains as a result of how people behaved towards her after the surgery. This contributed in killing her faster,” he said.
A system designed to kill
According to the World Health Organisation, cancer is the most common killer of women in sub-Saharan Africa; it kills more people than malaria, HIV/AIDS and tuberculosis combined. The global health agency says that over 100, 000 cases of cancer are recorded in Nigeria annually with one in eight women likely to die of breast cancer.
Professor of Radiotherapy and Oncology at the College of Medicine, Lagos University Teaching Hospital, Aderemi Ajekigbe, says that Nigeria currently has about two million recorded cases of cancer with women accounting for around 40 per cent of that number due to breast cancer.
According to Dr. Kingsley Udoh, a Clinical Assistant Professor of Global Health at the University of Washington, Seattle, Washington, United States of America, the poor state of health care facility in Nigeria and the high cost of accessing treatment where available are part of the factors responsible for the high mortality rate among women afflicted with breast cancer.
“Many women don’t go to the hospital for necessary checks because they feel it is expensive and that people go there to die. As a result, they go to their pastors or herbalists for help. By the time they are later rushed back to the hospital, it is already a late stage cancer.
“The health care system in Nigeria is weak, so even when the disease is detected early, we don’t have the facilities to manage it. Even when such are available, the majority of the victims cannot afford the cost.
“Sometimes people have to wait for as long as six months to undergo radiotherapy after paying. By the time it eventually gets to their turns, the machine would have broken down. But then, the cancer doesn’t wait, it keeps growing. It is like a system deliberately designed to kill women,” he said.
A pathetic situation
The International Atomic Energy Agency and the WHO recommend one radiotherapy machine per one million people. According to the 2006 national population census, Nigeria has a population of 180 million – meaning it needed at least 180 radiotherapy machines working at every point to service the people. But sadly, of the about eight currently in the country, only one or two functions occasionally, rotating among the University of Lagos, Sokoto and sometimes Benin. Eko Hospital is the only privately-owned facility that boasts of a functional one. Therefore, at the moment, there is a deficit of around 172 radiotherapy machines.
A standard radiotherapy machine, according to proton-therapy.org, costs $4m in the market today – about N1.4bn when converted at the rate of N350 per US dollar. This is aside from the $1m experts say is required to set it up and employ experienced and adequate personnel to operate.
To close the gap, Minister of Health, Prof. Isaac Adewole, said the government had earmarked around N9bn in 2017 for the purchase of additional radiotherapy machines in some tertiary health institutions in the country.
“We have made provision for radiotherapy machines in the 2017 budget; it was put under strategic intervention for tertiary hospitals.
“We know that is not enough, we are looking elsewhere to generate more funds for radiotherapy,” he said.
When calculated, the amount budgeted for by the Federal Government can only buy six machines – nowhere close to the number still needed to avert more avoidable deaths among cancer patients especially women who continue to lose their breasts and lives to the disease.
“Government must invest in acquiring these technologies and also establish cancer treatment centres where there would be comprehensive care for victims.
“Radiotherapy, being the primary treatment for cancer together with others like chemotherapy, is very vital if a victim must come out alive,” Dr. Udoh pointed.
Angels of hope
But in the face of government’s inability to shore up the deficit, a few non-profit organisations across the country have stepped into the fray to give hope to victims of the disease especially women whose breasts were stolen by cancer. Apart from embarking on regular awareness campaigns to sensitise them on the need for frequent checks through thorough screening, some have provided financial assistance to dozens in this category to undergo vital medical care. Though a huge strain on their resources, these groups are not relenting in their efforts to give hope to all those afflicted by the disease.
“I cannot put a figure to the amount we spend annually raising awareness on the disease and providing medical support for those affected by the scourge,” First Lady of Ondo State and founder of Breast Cancer Association of Nigeria, Mrs. Betty Ayanwu-Akeredolu– herself a survivor of the sickness –said. “We do this from the little funds we pool together because we cannot continue to wait for the government while our women die.
“Cancer patients are not being cared for in Nigeria, they are left to fight their battle on their own. This is evident in the poor medical services available to them. Radiotherapy which is a key element in cancer treatment is not available here, forcing a lot of victims to travel to Ghana to use the machine. This is shameful for the country the size of Nigeria.
“Imagine a situation where every state of the federation has one of these machines and combine with the seven the Federal Government has, the story would have been different.
“Apart from the intervention BRECAN has been doing over the years, we have begun the process of establishing a world-class cancer treatment centre in Akure so that our people can have more access to quality medical care at affordable cost. Cancer patients are increasing in Nigeria every day; if we must cater for them, then we need to put in place the right type of infrastructure for such purpose,” she said.
Speaking during a four-day symposium as part of activities marking the 20th anniversary of BRECAN in Akure recently, a consultant surgeon and senior lecturer, Department of Surgery, Obafemi Awolowo University, Ile-Ife, Osun State, Adisa Adewale, said that apart from the lack of adequate infrastructure like radiotherapy machines to cater for breast cancer patients in Nigeria, the prevalence of quack surgeons, who mutilate women’s breasts carelessly was also a major reason for the number of deaths recorded annually.
“We need to develop specialisation in breast oncoplastic surgery to aid the delivery of quality surgical techniques and improve the outcome of breast cancer surgery in Nigeria,” he said.
Hundreds of Nigerians lose their lives annually and or suffer permanent disabilities as a result of patronising quacks, who parade themselves as surgeons to carry out cheap operations. According to the majority of the experts, who spoke at the BRECAN symposium, the failure of the government to rid the system of these conmen is part of the reasons why more women continue to die in the country.
“The menace of these quacks has led to the mutilation and death of many women; this must be stopped. Apart from the poor health care facility in the country, this issue is another major area the government must quickly address to save our women from losing their breasts unnecessarily and also dying,” Anyanwu-Akeredolu said.
According to recent statistics, at least 40 women die in Nigeria every day as a result of breast cancer with 85 per cent of persons in this category not having a family history of the disease. Apart from not being able to afford basic treatments like chemotherapy and radiotherapy as a result of the relatively high cost, many of the victims die of the effects of poorly conducted surgeries and the psychological breakdown arising from societal rejection after losing one breast in such manner.
Professor of Gynecology and Obstetrics, Friday Okonofua, says except the society changes the way it treats victims, more women who lost their breasts to cancer will continue to die of depression and not the pain of the surgery itself.
“Though the causes of breast cancer have yet to be fully known, early detection and treatment can reduce the number of women killed in the country.
“The type of care available to women who have lost one breast to cancer is very important. It marks the thin line between their staying alive and giving in to depression,” he said.
While there have been calls for the government to criminalise stigmatisation in the country and also increase the annual health budget so that many ordinary citizens can have more access to quality medical care, victims of cancer especially women, who have lost their breasts to the disease, contend with their new fates, living with the scars in the face of growing societal rejection.
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