No radiotherapy, delays in treatment: cancer in Gaza  

by
21 October 2016

In Breast Cancer Awareness month, Jemima Thackray hears about patients who face special challenges

Charlotte Marshall

Self-examination: using a prosthetic device, women are taught the correct way to feel for lumps and other changes in the breast

Self-examination: using a prosthetic device, women are taught the correct way to feel for lumps and other changes in the breast

IT IS Breast Cancer Awareness Month. During “Rosy October”, as the campaign organisers have named it, 3000 pink ribbons are distributed, there are radio advertisements about the importance of regular breast-checking, and brochures about self-examination are given out in community centres and hospitals.

This has all the hallmarks of a well-run awareness campaign in the UK, where the survival rate for breast cancer is now around 87 per cent. But this is in Gaza, the third poorest country in the Arab region after Sudan and Yemen, according to the World Bank. Here, a woman diagnosed with breast cancer has less than a 50-per-cent chance of being alive five years later.

Mahmoud El Hendy is one of the project managers of a cancer-screening programme that operates out of Ahli Arab Hospital in Gaza City. “To be sick in any part of the world is bad,” he said. “But to be sick in Gaza is catastrophic, because patients have to deal with the absence of medication, the Israeli blockade, the challenge of travelling outside Gaza seeking treatment, and the lack of money.”

THE Christian charity Embrace the Middle East helps to fund the programme, as does the Australian agency Anglican Overseas Aid. The regional manager at Embrace, Su McClellan, tells the story of how the lack breast-cancer treatment in Gaza suddenly became very personal: “It was just before the last Gaza war, and I was about to go out to Bethlehem when I found my lump. I was diagnosed with a very aggressive breast cancer, but all the time I was coping with it — because of my job — I just kept thinking: ‘What would happen to me if I lived in Gaza?’ Every woman in Gaza has to have a radical mastectomy straight away because there is no radiotherapy equipment.”

The main reason given for this is Israel’s objection to the importing of radioactive materials into the area; but there is also the lack of expertise in handling such equipment. “Chemotherapy drugs are allowed in, but the supply is very erratic because of the political situation. The same goes for hormone therapy: in the UK, the gold standard is to take the drug every day for 20 years. It is very common for women in Gaza to start a course of drugs but never finish them.

“Some women get a referral to Jerusalem for radiotherapy after their operation, but to obtain a permit to travel from the Israeli authorities they must produce documents from the hospital where they are to be treated. One doctor I spoke to said that by the time the necessary travel permits arrive, it’s often not about cure: it’s about palliative care.”

DESPITE the critical need for early detection, there is no sustained government-run screening programme, and the Palestinian Health Ministry reports that 60 per cent of women diagnosed with breast cancer in the Gaza Strip were diagnosed after the disease had already spread to other parts of the body.

Over the past five years, however, the Ahli Arab programme has been working hard to improve the statistics. Despite the challenges in Gaza — there are only four-to-six hours of electricity a day — 519 women with suspicious results have been followed up for further investigations and surgery in the past year.

There is an education programme, providing training in self-examination, but also targeting men to help destigmatise the issue for their wives and daughters. “There is a lot of stigma, you know, because that part of the body is private in our culture, and also there is a lack of knowledge about the disease,” Mr El Hendy said.

“People think it is infectious: they think their kids will catch it, especially the girls, and that this would make them unable to get married.” Others do not realise how serious it is; there was a recently a sharp drop in attendance for the simple reason that it was the exam season and most mothers prioritised staying at home to help their children revise.

There are also workshops for doctors in surgery, pain management, and palliative care. A “Mind and Body” programme offers psychological help after a cancer diagnosis; and there is nutrition and personal-hygiene training for women receiving chemotherapy.

Mona Hegazy was a patient at one of these clinics: “I have had nice times at Al Ahli Hospital, where I have attended the Mind and Body sessions,” she said. “I also had group therapy, where I have met a lady who also has breast cancer, and I cannot forget her collapsed situation where she got divorced and now she does not have basic food to eat.”

“The breast-cancer issue is so huge,” Mr El Hendy said. “The demand is high, and the resources are very scarce, and we can hardly meet the very basic needs of breast cancer. But we are expanding the services year by year, depending on the availability of funds. Our vision is to be one of the finest health institutions supporting ladies with breast cancer.”

For more information about Embrace the Middle East’s work in Gaza, see www.embraceme.org/gaza.

 

Mona Hegazy, age 68

“I NEVER had any lump or pain, but it was an obsession that I had something wrong. After doing the scan and the biopsy, I was told the bad news of having breast cancer. This news caused a complete collapse: my family, my daughters, sons, and husband were in a state of shock and crying all the time, as if they were mourning me.

“I had the mastectomy and seven chemotherapy doses. I was supposed to receive eight, but due to the war on Gaza the chemotherapy drugs were not available. I had to travel to Jerusalem for radiotherapy, but first I had to get permission from the Israelis to pass through Eritz checkpoint. Though I had passed through the security machines, the Israeli security asked me to be naked for further security checks. The checks took me more than three hours, which made me late for my appointment, and I could not get my radiotherapy that day.

“Then, three month ago, I had abdominal pain. I had a CT scan and received more sad news: I have cancer in my liver and now I am having more chemotherapy. I am supposed to have another scan in November, but the appointment took more than 35 days. It is so sad that an urgent scan should take this long due to lack of machines in Gaza and when the number of patients needing the scan is huge.”


Latifa Saydam, age 62

MRS SAYDAM is a widow living in Nussairat Camp, one of the poorest areas in the Gaza Strip. She was unable to conceive earlier in life, and now, without children to support her, she is fully dependent on state benefits, and receives a total of $39 per month.

“After the screening, I needed more tests, and I had to ask people to give me money to do the breast biopsy. It costs around $120, which I cannot afford. I decide not to do it and ignore the issue, but my neighbours and relatives managed to collect some money to cover the cost. The news of cancer was extremely shocking. I never expected to have any problems as I never had any pain in my breasts. But breast cancer can come to any lady. This is a catastrophic disease that no one expects until it happens.”

Her community also clubbed together to pay the $580 for the mastectomy. The course of chemotherapy was free, but there was then the financial challenge (again met by friends and neighbours) of paying for transportation to the hospital every day. “It is easier for the person to die rather than meeting the treatment costs of this disease,” Mrs Saydam said. The final hurdle was securing a permit to travel to the Augusta Victoria Hospital in Jerusalem for radiotherapy; she had to wait for 20 days to hear back from the Israeli authorities.

Despite these struggles, Mrs Saydam is now in remission. “I thank God for discovering this disease early and treating it to save my life. I do thank all who supported me, in particular those who help from distance and the staff at the hospital.”

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