Due to poor health services, women in rural Tanzania face a hard time finding medical care for breast cancer
Musoma. October is Breast Cancer awareness month, and even though several activities and initiatives have been conducted to increase awareness to the public concerning the deadly disease, more effort is still needed, especially in form of public education and awareness to rural women so that they too can seek medical care at early stages.
A report carried out on behalf of the Ministry of Health, Community Development, Gender, Elderly and Children of the United Republic of Tanzania predicts that by 2030 there will be an 82 per cent increase in number of new breast cancers diagnosed in Tanzania.
The report further states that following cervical cancer, breast cancer is the second most common cancer and second leading cause of cancer mortality among women in Tanzania.
Praxeda Pande, 47, is a breast cancer survivor living in Musoma in the Lake Zone. In April 2010 Pande felt a lump in her left breast after touching it. Three days before she found a lump in her breast, she had gone to Mara Regional Hospital for cervical cancer screening that was carried out by the Medical Women Association of Tanzania (Mewata).
She explained that even though she is a nurse by profession, she had no habit of regularly checking her breasts by either visiting the hospital or doing self-examination, but on that day it happened that she touched her breasts in the morning and found a lump. She was very shocked to find the lump, even though she wasn’t experiencing any pain at that time.
She decided to go to the regional hospital where she works as a nurse and met with the doctor who was given a refresher course concerning cancer in general by Mewata and she explained to him that she has found a lump in her left breast, the doctor told her that it was normal and that the lump has no effect at all.
Being cautious about her health after finding the lump, Pande didn’t believe the doctor that the lump is harmless. She demanded medical care and the doctor administered medication for Pande to use for ten days and he insisted that after the dosage was finished, then the lump will have disappeared.
“I was very anxious when I first found the lump in my breast. Even though I had no pain I kept having these thoughts running through my mind. It was a very tough time for me, one that I will never forget for the rest of my life. I thought that my life was coming to an end sooner than expected,” she explains.
After ten days of taking medication, the lump was still there. Pande then went back to the hospital and after discussing with her doctor on May 5, 2010 it was agreed that she will have to undergo an operation to remove the lump. The operation was successful and the lump was removed. A sample of the lump was taken for breast cancer diagnosis at Bugando Hospital in Mwanza region. This exercise required a month for results to be confirmed.
“After one month, a colleague from Mara Regional Hospital was on official duty in Bugando, I asked him to help bring back my results from the test. I was very nervous, not knowing what the results will say,” Pande recounts.
Ms Pande says that her colleague had to go through the results and he was shocked to realise that his fellow workmate had been diagnosed with breast cancer. It took him some days before he garnered the courage to hand over the results to her. Pande was distraught upon receiving the results and finding out that indeed she had breast cancer.
“At first I thought that maybe they had made a mistake and that the results weren’t mine. I double checked the name just to be sure. I couldn’t believe that I tested positive for breast cancer. My world came tumbling down. I started sweating with fear, I had to control myself from completely losing it, my mind was going wild,” she says, adding, “After a while I pulled myself together and went with my results to the hospital matron.”
After arriving at the matron’s office, she was then taken to see the doctor. The doctor was shocked upon reading the results; he immediately referred Pande to Muhimbili National Hospital (MNH) for more checkups and further treatment.
This referral shades light on the state of medical care in other regions in Tanzania, Pande, a resident of Mara region had to travel all the way to MNH in Dar es Salaam so as to get required medical care. There are a host of women who fail to get good medical care in other regions due to lack of health facilities.
One week after the referral Pande went to MNH in order to continue with other medical procedures. On June 26, 2010 she was operated on, two weeks later she started cancer treatment at Ocean Road Cancer Institute (ORCI).
Not enough awareness
After receiving treatment, Pande was later able to go back to Mara region. Today she is in charge of a cancer unit at Mara Referral Hospital. She says that despite the efforts taken by different stakeholders in collaboration with the government, many women are still not aware of cancer and often go to the hospital at advanced stages of the disease.
Pande says that there are a number of factors which hinder women in rural Tanzania from seeking medical care when the disease is still in its infancy. A number of key challenges impede availability and access to care. These challenges result in fragmented, unclear and inefficient clinical pathways for women with breast health concerns and create significant delays in detection, diagnosis and treatment.
She points to myths and traditional beliefs as being part of the hindrances deterring early treatment. “Most women in rural areas prefer seeking medication from witch doctors, or using local herbs than going to a hospital,” she says.
Another factor that she pointed out is the cost of treatment. She says that breast cancer treatment can be very costly thereby making it not an option for many women across the country. She was able to afford the treatment because she has health insurance, but the case is different for many women. Most women living in rural areas depend on farming to sustain their living, and cannot afford health insurance. Such a situation further aggravates the painful reality of having a majority of women who don’t get breast cancer treatment on time.
Pande explains that more inclusive awareness campaigns need to be carried out so that the community may be aware of the effects of breast cancer as well as how they can overcome it, including empowering the community so that they can have health insurance.
She says that experience shows that women, especially from rural areas, go to hospitals at a very advanced stage of the cancer and that once they are attended to by doctors, the only option that is left is to remove the affected breast (mastectomy) as well as recommend chemotherapy treatment. But after removal of the breast and chemotherapy, the pain still persists, at times leading to death, a situation that has resulted to negative perception on medical treatment.
“Some women have a misguided perception that once you go to the hospital for cancer treatment, you are bound to die. But what most don’t acknowledge is the fact that these cases of fatalities are for patients who go to the hospital at an advanced stage of the disease,” she says. It is as a result of this that some women opt to go to witch doctors. “Later they realize they made a mistake when the cancer has already spread to other parts of the body,” Pande speaks.
She says that some residents of Musoma have urged the government to invest in containing cancer as it has done for HIV/Aids campaigns; this is one of the ways the situation of breast cancer can be addressed.
More awareness needed
Mr Felix Kalisa, a resident of Musoma and advocate for cancer awareness says that strategies that are used by the government and other stakeholders to address HIV/Aids should also be used to address and create awareness to the community concerning the growing threat of breast cancer and cancer in general.
He said that currently organizations that are fighting against cancer are found within the big cities while other areas have been left without any help, a situation contributing to reasons why the public is not well aware of the dangers of cancer.
Medical reports note that cancer is deadlier than HIV/Aids but the community tends to believe that HIV is the most dangerous disease and that is due to endless campaigns carried out countrywide concerning the spread and dangers of HIV, but if such efforts are applied on cancer as well, the community will be made more aware and take appropriate measures at early stages.
“We have free medication for HIV in form of ARVs, but when seeking cancer screening a patient has to travel a long distance to access the screening. In rural areas, accessing screening for breast cancer is a hurdle. This inevitably reduces the chances of having breast cancer survivors in Tanzania,” Kialisa speaks.
He further stated that even the hospitals that provide cancer treatment are not easily accessible, explaining that the only hospital that is popular is Ocean Road Cancer Institute in Dar es Salam, adding that due to financial constraints many people fail to go to the hospital to get the right medication, thus resorting to alternative means of medication.
Furthermore, protocols and guidelines for breast cancer early detection, diagnosis and treatment are not standardized. An inefficient and hierarchical referral system adds delays and costs and increases rates of attrition. Economic issues—both at institutional and at individual levels—also present significant barriers to care. While health care for women diagnosed with breast cancer is free of charge, women are still expected to pay for essential services and commodities.
Kalisa suggests for the government to make huge investment on cancer so that services may be readily available at least at regional level and that it will be wastage of time creating awareness to the community on the importance of screening while the treatment itself cannot be easily accessed.
Another resident, Mr Bigambo Binaisa said that it has reached the time where government has to introduce cancer centers at regional levels so that citizens, especially women who have a lot of complications, including breast and cervical cancer can get the services they require promptly.
Having to travel to Dar es Slaam for treatment has led to many fatalities because some families cannot even foot travel expenses to the big city.
MaraRegional Medical Officer, Dr Francis Mwanisi said that 469 women were found with breast cancer out of 111,733 women who were examined from January 2016 to September 2017 in the region.
He said once a woman is screened and found positive with breast cancer she’s immediately engaged in treatment because breast cancer is curable if diagnosed at an early stage.
Dr Mwanisi said that most patients from the hospital have been given referral to Bugando, Muhimbili and Ocean road for more and advanced treatment.
He said that this year Mara Regional Referral Hospital started providing breast cancer treatment, especially for those detected at early stages. The hospital has managed to conduct surgery to four women at the hospital and that all surgeries were successfully done.
He said that is as much as there are screening facilities within the region, turnout is too low and that’s due to various factors including lack of awareness in the community.
According to the doctor, another factor hindering treatment is lack of skilled health workers, especially at peripheral areas, who can identify women suffering from breast cancer at early stages so that they can link them with regional referral hospital for further procedures.
In order to create awareness on the importance of screening, the regional health management was in the process of organising a mass campaign that will involve awareness on screening and that currently they are looking for funds so that the exercise can be conducted as soon as possible.