In June 2019 I joined millions of women diagnosed with breast cancer; in 2018 alone, 2.1 million globally and 26,310 in Nigeria.
I accidentally felt the lump in my right breast in April, a brush of my hand at an unusual angle while in a small shower cubicle that requires contortion. I was startled by the size. How did it get there? It took me till May to see a doctor in Dakar where I live. I was busy settling into a new job I love and there was the ostrich factor.
Cheek to cheek with the cold mammogram machine, it occurred to me that if this lump was what I saw in the doctor’s eyes during the ultra sound scan, my breasts would never be private again.
I needed a biopsy to clear or confirm.
‘Run; don’t walk’, the doctor said. He was disbelieving and apoplectic that my last mammogram, in Abuja 10 months earlier, did not reveal the lump.
Breast cancer when detected early is not the life sentence it used to be and the survival rates are good when you have the best that advanced medical science can offer. Although the data available indicates that women in sub-Saharan Africa are diagnosed with breast cancer at lower rates than in the Americas and Europe,cervical cancer and breast cancer are the biggest causes of cancer deaths among women in sub-Saharan Africa with mortality rates as high as 70% in Senegal. In 2018, breast cancer, considered a leading cause of death in Nigeria, killed 11,564 women.
Being ill can make you vulnerable to a host of things: denial, anxiety, loss-of-control-induced-vertigo and as I navigated these feelings, I realised my knowledge was limited. Good health is an insulator that keeps you in unknowing bliss; what I knew of cancer and cancer treatment was outdated and limited to anecdotes and movies.
As I processed the diagnosis and considered my options, my enduring thought for a while was that I would get treatment in either of the two places I consider home: Nigeria or Senegal. With time, I reconsidered. It was less about the scary stories of queuing for access to medical equipment and more about the promise of beating cancer successfully. For instance, instead of searching for a vein for each of my 16 chemotherapy sessions, increasing the chances of infection, I had a port implanted under my skin. This devise attached to a major vein, accessed only with special needles saved me from the pain of tricky veins, either for drugs or the countless blood tests I needed.
Cancer treatment is harsh and patients need constant monitoring of blood count and organs and the body’s immunity must be kept strong even as each dose of chemotherapy destroys the blood cells that play important defence roles in the most sophisticated machine on earth — the human body. Chemotherapy and radiation are corrosive — they have terrible side effects that often lead to lasting damage to other otherwise healthy organs and the body’s system. It is in this extra care and monitoring and early detection that many health care systems are failing patients.
It is this desire, to not die from avoidable medical reasons, that makes many of us medical refugees allegedly spending over a billion dollars in 2018. In Germany, the country in which I sought medical care, over 11% of GDP is spent on health each year, yet government plays virtually no role in direct delivery of health care. In many African countries those who shape and implement health policy feel no shame about accessing the health care of countries who have made the right investments while ignoring the fate of millions who cannot afford any alternative health care.
Now, with COVID-19, the world knows what I started struggling with in July 2019: health is political because it is personal and the personal is political. Resilient, quality, accessible health care matters. I know that as precisely and painfully as all the times the nurses here have struggled to access my veins.
My life experiences as I navigate societies and how they are structured, the impact on me — and the enjoyment of the freedoms I was born with and my rights and responsibilities as a citizen are all personal but also political since the formal and informal institutions, public policy, belief and reward systems all have profound impact on me. The global structure today ensures the accident of birth– geography, gender, race, skin tone, religion and wealth predetermine how marginalised, oppressed and unprotected we are. These form the roots of the gravest forms of injustice that billions of people suffer and a good, orderly society is supposed to alleviate and improve. The emotional and psychological strain of being a medical refugee is incalculable. At a time when I am most in need of the loving support of family, friends and the familiar, I am miles away from home because in Nigeria those who force themselves into positions meant for leaders refuse to make the right decisions.
A wise person visited a sultan and when the latter requested for a cup of water, asked him, “if you were refused this drink would you bargain for it with half your empire?” The Sultan said yes and drank. The wise person then asked, “if, due to some sickness, you were unable to discharge this cup of water from your body, would you pay half of your empire to be able to do so?” The sultan said yes. The wise man said, “there is no value in a kingdom that is not even equal to a drink of water”.
Those whose bodies do not function like they used to or should, whose bodies are attacking them, will give anything to be well; whole again. We are one serious illness away from being impoverished and changing the fortunes of our families. Decent, accessible public health is a right not a privilege.
Next: Why Germany?