By Dr. Anthonia Sowunmi
A pretty girl in her early thirties, she passed on two weeks ago and my heart bled. She first saw she had breast cancer, went and saw a doctor and they told her: “We are going to cut off your breast.”
Here was somebody not yet married. The way and manner they put it to her got her scared and she ran away. She thought to herself: “Why should I remove my breast? I am not married. I don’t have children.” So at the end of the day, she left. What they didn’t do was to counsel her and give her options. I realise that here in Nigeria, everybody is looking for money. All they want is to grab, grab, grab. What I mean is, do your work, make your money but give your patients the options they have. Since she didn’t have options, she left and ran away. Nobody told her that if she doesn’t take chemotherapy, the thing will continue getting bigger and probably spread to different parts of the body. So she ran away. When she noticed her breast and chest were getting very hard, she now went to meet another doctor, a surgeon. Instead of beginning with chemotherapy, the surgeon went and cut her breast just like that. You won’t believe it! Then somebody gave her my number (08027712811). When she came here, I almost wept. This time, when we did the necessary baseline investigations or tests, the cancer had spread to the lungs and to the liver. And then we started treating.
If you see how they cut her breast, you will feel sorry for her. Usually when you cut the breast, there should be enough free skin to close the gap or space created by removal of the breast tissue. But they cut the breast without free skin to cover the gap and open wound was left and she was told it will heal with time. I said to her: “Who did this to you?” She was looking at me. She and her mum. But somehow, we were able to keep her alive for about two years. It becomes very difficult for a patient to have a long survival period when the cancer has spread to the lungs and the liver. About a month ago, when her condition deteriorated and she came in for admission, I said to her mother in private: “Your daughter is going. I am very sorry but I have to tell you the truth. I don’t know when but it looks short. Within that period, whatever you can do, do it, make her happy, make her comfortable.” She didn’t believe me. Nobody wants to give up on life. She now went away. Later, I heard she went to another doctor for a second opinion and the doctor told her the same thing. And last week, she passed on. I wept.
As an oncologist, I have seen a lot. I have seen a boy of 14 amputated in the leg because he has cancer of the bone. I was giving him chemotherapy and he asked me: “Mummy, what did I do?” Tears started flowing from my eyes. I quickly stood up and left. I didn’t want the little boy to see me in tears. To be honest with you, we oncology doctors need psychologists. You see so many things which almost drive you crazy and make you depressed. Especially with over seventy per cent of cancer patients coming to the hospital for help when the cancer is at an advanced stage. Every time, you see people dying.
As a doctor, there is no how you will not have attachment to your patient. It will pain you deep down to the marrows of your bone when you lose a patient. I have seen a two-year-old who had cancer. I have seen an eight-month-old baby who had cancer. This profession is like a battlefield where you see casualties upon casualties. I always tell people that to survive cancer, you need both spiritual and the physical. The rate at which people die of cancer is alarming. It’s all because they come in when the cancer is at an advanced stage. Initially, I was more or less the only female clinical and radiation oncologist there in LUTH (Lagos University Teaching Hospital). So when you go on ward rounds and you see people that have cancer, especially the younger ones, your heart bleeds. You know they are going to die. Because of the stage they came in. And when you know they are going to die, you really don’t know how they will respond to the truth that their case is terminal, especially with our cultural beliefs. I realised that most patients’ relatives would turn away from the male doctors who are usually stern-faced which some of them put up as an appearance so as to avoid breaking the news to them. You find most of them coming back to me.
One of the things I notice is that we don’t tell the patients and their relatives the 100 per cent truth about their prognosis in Nigeria as they do in developed countries. But that is fading away. When I see somebody and the cancer is advanced, I prepare their mind. One of the major issues we have is that Nigerians don’t know their rights. You have a right to a second opinion. You have a right to know what is wrong with you. You have a right to ask every question.
Honestly, this thing is alarming. As I said, over seventy per cent come in at an advanced stage, either because of ignorance. Basically, we don’t have a health culture. Everybody is guilty. Abroad, you do serial checks as you grow older. You do comprehensive checks. But here, until something is wrong with you, before you come to the hospital. Even when they come to the hospital and you tell them, some would first go to church or mosque to meet their pastor or imam who would say: “Don’t go, I will pray for you.” My point is that even if pastor is praying for you and there is no change, you should retrace and come back. The pastor or imam can continue praying and you come for your treatment. But a lot of our patients come in at an advanced stage.
To be honest with you, nobody knows the cause of this killer disease. What causes the mutation in the gene, in our cells, nobody knows. Till date, the white man and top scientists don’t know. We can only say there are risk factors. What we know is that there is mutation. What causes the mutation, we do not really know but some factors have been implicated.
My dad wanted me to study accountancy but I chose medicine. I passed out in General Medicine from the University of Ibadan in 1987, completed my residency at LUTH and now work as a Senior Consultant Oncologist and lecturer at LUTH and College of Medicine, University of Lagos respectively. It was a senior colleague and friend then working in Chevron who talked me into doing oncology. I prayed about it and the rest is history. Abroad, the ratio, according to International Atomic Energy Agency is one oncologist to 250 people. We have less than 90 oncologists in Nigeria, a country of over 200 million.
My advice to Nigerians is that people should do comprehensive medical examinations regularly. There are certain things you will detect through CT scan and MRI that you didn’t know were there. A stitch in time saves nine. The joy of being an oncologist is when you treat people and you see them doing well when they come early. You feel happy that you have made a difference, you have saved a life. Success for me is making a positive impact in people’s life. I know how many doctors I have trained in oncology. The journey to success is not easy. It takes perseverance, persistence, patience and love to your patients and trust in God the total Healer and the way maker.
(Dr. Anthonia Sowunmi, pioneer and most senior female oncologist in Nigeria, was talking to Mike Awoyinfa for his forthcoming book ‘When Doctors Cry’) .