MAP’s breast cancer care in Gaza: Alia’s story

At the start of this Breast Cancer Awareness Month, Medical Aid for Palestinians (MAP) sent a multi-disciplinary team to the West Bank and Gaza, to assess the provision of diagnosis and care for women affected by the disease, and to teach new techniques to improve outcomes and quality of life for patients.

One member of the team was Dr Philippa Whitford, a British MP and specialist breast cancer surgeon. She worked alongside a local team and Dr Omar Abdul Shafi, a surgeon from the Augusta Victoria Hospital in East Jerusalem, to provide surgeries for women who had been diagnosed with breast cancer. They operated at the Al Ahli Hospital in Gaza City, where Philippa and her husband previously volunteered with MAP more than 25 years ago, during the First Intifada.

Among the patients who were operated on during the team’s week in Gaza was Alia*. She is just 36 years old – younger than average for a breast cancer patient. She spoke to MAP’s team a few weeks after her surgery – a mastectomy to remove one of her breasts – to tell us about her disease, the difficulties of accessing care in Gaza, and her recovery journey.

Can you tell us about your diagnostic process, and how you felt when you were told that have breast cancer?

"In February this year I felt a lump in my right breast. I went for a check-up and my doctor sent me for a biopsy. The results, as I was told, were clean, but a few months later the area that was biopsied was hurting me, and I wasn't feeling well. At this moment I had a dark feeling that I had breast cancer.

A few days before MAP’s medical delegation arrived in September, I went back to my doctor and he sent me for a scan. When he saw the results he told me: “sorry, you do have a tumour in your breast. It’s been there since February, but you were mistakenly diagnosed.”

I felt so angry and disappointed. If I was diagnosed earlier, with better equipment or more experienced doctors, I would have gone through a partial-breast-removal surgery. But now, as a 36-year-old woman who loves wearing dresses, I am left with one breast because of a medical mistake."

How are you recovering after the surgery?

“I feel better now; 24 days have passed since the surgery, and the doctor prescribed me painkillers and a cream that would help to heal the surgery scars.

The removed breast was examined after the surgery. After 15 days the results of my hormone tests were negative, which means my body will respond well to the treatment.

My arm feels constantly numb since the surgery, I can hardly move it.”

Were you able to get other treatment you needed in Gaza?

“On 15 October, I started the first of eight sessions of chemotherapy.

It's the worst thing I have ever experienced; as a highly energetic person, it has destroyed my life and routine. Sometimes I cry over my condition, I feel suffocated and unable to move the way I want.

I have experienced severe pains after the chemo, and even though my doctor has prescribed painkillers, they did nothing. They are the same ones used when people have headache, and the pain is just not comparable.”

Was there any after care for you after the surgery, for example physiotherapy?

“A local women’s health organization has provided me with both a physiotherapist and a psychologist.”

Do you have any history of cancer in family?

“My sister died one year ago because of colon cancer, she was only 27 years old. I still cry about her death now. She left two children. My husband and I contribute in raising them.

Also, my mother had breast cancer and went through a breast-removal operation eight years ago. Fortunately she survived.”

What are your biggest fears and concerns?

“Sometimes I feel afraid… no, I feel terrified that cancer will spread out in my whole body.

When I look at my sister's children, growing up without a mother, I feel terrified that my children might experience the same. I exist for the sake of them."

What have your family or children done to make it easier for you?

“My husband read on the internet that carrots and pomegranates are healthy and essential for breast cancer patients, so he bought me a juice squeezer machine; he wants to see me recovering fast.

I am afraid to talk with my children about having cancer; I don’t know what to tell them, it's a tough step to make, but sometimes I feel they understand without saying.

In the last few days, they have been studying without my help; they can tell how much I am in pain. I feel helpless and weak for not being able to help my children in their homework.

My children and I are really close. I don't want to break their determination or to feel powerless and afraid to lose me like we lost my sister.

When my daughter saw me after the surgery she was surprised, she told me spontaneously: “Mom! Where did your right breast go?” She made me laugh to the bottom of my heart.

Every morning, our youngest child wakes me up while trying to check if my other breast is still there or is gone like the first one. So, when she finds it there, she kisses my breast as an expression of happiness. This makes me laugh too. Children are so innocent, and they are the best ones to ease my pain.”

What are your hopes for the future?

"I plan to fight cancer, and to win over it. My biggest wish is to be there at my children's weddings, and to be there for them at all times.

I wish there was a nutrition specialist to tell me what to eat and what not to eat exactly. There is a lack of this kind of specialist in Gaza.

I don’t know if there are any breast prostheses available in Gaza, but I would love to have one instead of having an unbalanced look in my chest area. That would help me in raising my self-esteem a lot.”

*Name changed to protect identity.

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