Pain of cancer through a surgeon’s lens

Breast cancer is the leading cause of cancer in women. Each year, an estimated 4,500 women get breast cancer and 2,000 patients lose their lives.

About 80 per cent of these cancers are diagnosed in late stages. In terms of human capacity to combat cancer in Kenya, we have four radiation oncologists, three oncologist nurses, four paediatric oncologists, five radiation therapy technologists and six medical oncologists to handle the whole country’s cancer conundrum. The fight looks gloomy.

Then there is Dr Joseph Githaiga, a breast surgeon, trained at the University of Nairobi and in Israel and in Germany.

He has been battling breast cancer in his own small corner for over 30 years now. He sees about five to eight breast cancer patients in his clinic every week. More at Kenyatta National Hospital.

We met at his Nairobi Hospital office.
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How does cancer look like? Describe it for me.

The common picture of cancer we know is a festering wound that’s open, discharging and bleeding. But that’s fairly advanced cancer, otherwise cancer is mostly an impressive lump, a small swelling and normally the biggest problem is that it’s painless.

How do you break the news to someone that they have cancer? How do you do it every week, every month, for many years without it not changing you as a human being?

(Sighs) It’s a delicate process. People react differently, Most break down. You tell them what can be done, you always tell them what can be done, not what can’t be done. There is always hope even in the most desperate situation, so you lean on that even though you remain as forthright as you can. It’s not easy and it doesn’t get easier even after many years because cancer is such a dreadful disease.

Do you feel frustrated at the speed at which cancer is being managed in the country?

There’s a lot of frustration. You know, unfortunately, in this country we have two sets of medical care; for the rich and the poor. The rich can get treatment abroad. If they come in here, I can send them through investigations— mammograms, biopsies, CT-scans etc, and have a conclusive diagnosis in slightly over a week and they can start interventions immediately.

For the poor, it's desperate. They will see a medical personnel in a health centre who doesn’t have a high index of suspicion and they will ignore signs, until it’s too late. If there’s a doctor there, he’ll probably not do a biopsy because most of these places don’t have a pathologist. We found out that it takes the poor an average of three and six months to get treatment from the time they come.

Of course you can’t save the whole world, but how does all this put your frame of mind in, this suffering and desperation?

You actually rationalise and say, you’re doing your bit. I don’t know if that’s what they call developing a thick skin. But you get affected a lot. Like there’s one time a lady came in and I said, “You need to do this ultrasound to see how far this disease has advanced.” That’s Sh2,500. So she goes and comes back six months down the line because that’s when she was able to raise that money. By this time the disease has taken the entire breast and there’s nothing much we could do. That makes you so sad, taking half a year to raise Sh2,500! (Shakes head).

You need to talk to a professional about all these, for your peace of mind; lie on a couch in your socks and talk about your feelings.

(Laughs) That’s what we need to do. I think a lot of medical professionals need to go for therapy. They say the incidences of alcoholism and drug abuse is high among doctors.

Do patients who walk in here already high on Google piss you off?

(Laughs) You see our patients are not only educated – they’re very well involved. Most of them come to see you after they’ve gone to Dr. Google. (Laughs). Google patients are a challenge because the problem with Dr. Google is that it causes a lot of panic. I see people who walk in here already panicked because of what they read. Information is only good if you know how to utilise it.

Is there a breast cancer case that you’ve not been able to forget in your career?

Yeah. (Pause) There was this well educated lady doing a PhD. She comes in and she has this really huge breast tumour. We sat down and we looked at the options of treatment and she just tells me, “You know what, there’s no way I can live without my breast.” She refused to have the breast removed and for sure, eight months down the line, she was gone.

That’s haunting! She chose death over losing her breast?

Yes. Breasts are very emotive. No woman likes to lose their breast, so if they can save it they will.

Now that our young daughters are starting their periods much earlier and of course that’s one of the risk factors. Does that mean they are more susceptible to breast cancer?

Traditionally, that’s what I’d say, but I think from the research that has been done, those things don’t have much of an impact. But you see, because the whole issue about breast cancer and the periods and menopause is that, you know that estrogen plays a major role in cancer such that, the longer you’re exposed to high levels of oestrogen, then you have a higher chance of getting breast cancer. That should be expected. But no one has come up with concrete studies to show for it.

Have you ever had a man walk in here with breast cancer?

Yes. Not one. At least in a year, we’ll see around five and 10 men. The mode of treatment is the same.

Are you scared for the females in your life?

You know, sometimes you just have to have the attitude that mostly cancer is just bad luck. I say this because when you look at all the factors, most of us are exposed to more or less the same thing, but how come not everyone gets it?

Has anyone in your family ever gotten it?

No, I’ve not had a family member with cancer but I think it really is very devastating for people whose family members have cancer.

What do you fear the most?

What do you mean, as a doctor?

As a man.

I suppose losing my manhood. (Laughs)

Not even getting cancer?

You know… maybe it’s because I live with it I’m sanitised – I know there’s something that can be done. At the end of the day for most people with cancer, however advanced, there’s always some hope you can give them. There’s always something you can do to improve them.

And that doesn’t apply to manhood?

How?! That’s a yes or no kind of situation.(Laughs)

You have children?

I have four kids. One girl, three boys. My eldest is 27- years- old now. He’s from a previous marriage. My youngest is seven- years- old.

Being married twice, is it better the second time or it’s pretty much the same forest?

I think when you have a second marriage, you look at things slightly different and maybe, you don’t want to do the same things you did previously.

What does a man like you dream of?

For me right now, the biggest dream is to set up a cancer centre – which I’m in the process of trying to do. And to set up a place where within a week or so, you’ll have your diagnosis and your plan for treatment.

What has cancer taught you about human nature?

I’ll tell you what. One, it’s taught me to live a day at a time and actually it brings to reality that the only time you really have in life is the moment. The future is not assured. Plan, yes, but live today.

Cancer has taught me the importance of a sound support system, because cancer affects the entire family and friends. I have seen cancer patients whose friends disappeared. There are situations where women are diagnosed with breast cancer and their husbands disappear. The support is very important.

And what has cancer taught you about yourself?

Patience and a bit of compassion. Quite a lot actually. It’s taught me how to handle people going through difficult situations.

Do you fear death or has being close to death made you more bold in its face?

Obviously, I fear death. Nobody wants to die. If death came to this room and I had the room to negotiate with it not to take me, I would. (Laughs). But you also get the attitude that when it happens, then it’s going to happen.
From what I’ve seen, actually the person who dies has no problem. It’s the people who are left that have problems. Maybe that’s why we fear death. When most women learn they have cancer the first thing they say is, “what’s going to happen to my children..?”