Credit: Newsday

SIMBISAI Chiume (not real name) still recalls the distressing events of 2009 when she was diagnosed with breast cancer.

For several women diagnosed with cancer in Zimbabwe, it sounds like a death sentence, but Chiume’s experience with cancer displays the possibility of survival if treatment is administered early.

She has lived as a cancer survivor for 13 years, and she narrates her ordeal for the benefit of other women.

“As I was taking my regular bath in 2009, I observed a small hard lump on one of my breasts. It felt so hard like a stone. At first I ignored it, but the following day I touched my breast again and still felt the hardness. My mother-in-law instantly advised me to go for tests.

“I live at a farm in Chegutu, were I am mostly busy farming. I then decided that I will visit the doctor the following week in Harare. That same week I started experiencing shortness of breath, that is when I visited a general practitioner who recommended that I go for a mammogram,” Chiume said.

She had to undergo a biopsy where a piece of tissue or a sample of cells was removed from her body so that it could be tested in a laboratory for cancer.

“It was a small surgery, and the samples were taken to a laboratory in South Africa. The results came after three weeks. I was scared and anxious. The doctor had a very sad look on his face as he told me and my mother who had accompanied me that I had cancer and needed to undergo surgery in a few days to remove the breast. I went numb before bursting into tears. I was still in my 30s.”

“I was in shock and my relatives had to gather and decide what was in my best interest. I had no medical aid and the sugery was urgent. The operation to remove my breast was going to take about two hours and after surgery, it was difficult to accept that I had lost a breast,” Chiume said.

“I was then referred to an oncologist, Anna Mary Nyakabau. Back then there were only two oncologists in the country. Nyakabau’s intern Nomsa Tsikayi had a very positive attitude, which I attribute to the hope that I had of full recovery.”

Chiume said a very positive attitude was pivotal for cancer patients to fully recover.

“Tsikayi told me that I had to undergo chemotherapy, and explained that I would be taking heavy drugs and experiencing several side effects after treatment; such as the possibility of loss of hair, emotional breakdown, going into early menopause and that I might not have any more kids. I did go through 95% of these symptoms, but Tsikayi had counselled me well.

“I went to chemotherapy at St Annes Hospital in Harare for six months and it was not pleasant. Later I went for radiotherapy and I have lived to tell my story. The procedure was very expensive.”

“What haunted me during chemotherapy was that during each visit we would get reports that one of our colleagues undergoing chemotherapy had passed on. I was blessed that my husband was supportive. ”

Chiume said radiotherapy was not as painful as chemotherapy, but the problem was obsolete machinery, which resulted in cancer patients often going back home unattended to.

“Radiotherapy was supposed to take only one month, but it took me three months to complete the sessions because of equipment shortage. We would also go for routine heart checks. I met my mother’s friend who had one of her breasts removed and it gave me hope that I would survive. As a survivor, I now only go for a mammogram and CT (computerised tomography) scan every two years. It is imperative to have a positive attitude.”

She notes that there is a lot of stigma associated with cancer as patients experience hair loss, weight loss, early menopause, and dark gums, among other side effects.

“People think it is actually a white man’s disease, but it can happen to anyone. If one clocks five years after treatment, chances of the cancer recurring become low. Now I am able to carry heavy loads, I can work like every other person. I watch my diet and avoid fizzy drinks, eat less salt, sugar, and during chemotherapy, it is important to avoid crowds to prevent other infections. We have to maintain a positive attitude and avoid stereotypes. My message to women is that they should frequently get screened because if detected early, cancer can be treated unlike when it has spread. It is not wise to seek treatment at a stage when one is bed-ridden.”

Chiume is one of the few cancer survivors that are now activists in a bid to encourage other women to seek early treatment. She joins women in Chegutu in a cancer awareness campaign, which is aimed at teaching women about breast and cervical cancer, as part of commemorations of the Breast Cancer Month.

Organiser of the Chegutu #PinkOctober event, Sarah Mnyamane said it would be a breast cancer talk, which would be attended by cancer survivors in the town, counsellors, women and members of the medical profession.

“The key issues to be discussed include the high cost of cancer treatment, unavailability of psychological support, and lack of support for women who have lost their breasts to get artificial ones. Women that have lost breasts due to breast cancer should fall under the category of people with disabilities. We will also advocate for grants for cancer survivors of up to US$50 per month to assist them get treatment and  that women diagnosed with cancer should get free services.” Mnyamane said.

Public health expert and executive director of the Community Working Group on Health, Itai Rusike said there was need for the country to emphasise preventive care as the most cost-effective intervention.

“Thirty to 40% of cancers are preventable by avoiding certain known risk factors. The main factors contributing to the increasing incidents of cancer in Zimbabwe include infectious agents, increasing tobacco use, harmful alcohol use, unhealthy diets, physical inactivity, and environmental factors. 80% to 90% of cancer patients present at an advanced stage when management is more costly and treatment outcomes poorer. This is mainly due to lack of access to early detection compounded by human and material resource constraints,” Rusike said.

On treatment, Rusike said Zimbabwe had two functional public health centres offering diagnosis and treatment facilities for cancer; the Parirenyatwa Hospital Radiotherapy Centre in Harare serving mainly the northern region, and Mpilo Hospital Radiotherapy Centre serving mostly the southern region.

“Unfortunately, cancer treatment machines for radiotherapy at our two public health institutions have not been working for over a year now, exposing cancer patients to exhorbitant health expenditure. Only a few privileged Zimbabweans with the financial resources such as the political elite can afford to travel outside the country for specialist cancer treatment in South Africa, India and China while the majority of poor cancer patients have to just wait to die at home,” Rusike said.

He said a majority of cancer patients were uninsured, or under-insured, hence they could not afford private health institutions.

“We need a well-defined and well-crafted national health insurance scheme, and that our government should finance health beyond the 15% of the national budget as prescribed by the Abuja declaration,” he said.

Community health workers (CHWs) were key to Zimbabwe`s successful expansion of primary health care (PHC) in the early 1980`s. CHWs played a central role in closing the gap between public health services and communities at local levels, bringing health services outreach to communities, and facilitating community roles in the health delivery system. For example, CHWs and Community Based Distributors were instrumental in implementing the successful Zimbabwe Family Planning Programme, as they helped raise awareness on family planning methods such as condoms and combined oral contraceptives (commonly known as “The Pill”), as well as the advantages of child spacing. These efforts are reflected in the expansion of coverage of contraception and reported decrease in fertility rates in the country from 6.5 children per woman in the early 1980`s to 4.3 children per woman in 2001.

CHWs continue up to today to augment the work being done by the mainstream health sector, raising awareness, giving health advice, monitoring growth of children under five years, mobilizing communities during out-reach programmes and for immunization including as trusted sources of information for community literacy on Covid-19.

Community health workers reflect on their work

Mrs. Kaseke a CHW in Mwanza Ward (Goromonzi District in Zimbabwe) echoes these sentiments. One of her roles as a CHW is to mobilize food for chronically ill and home based patients in her area. She also runs community based growth monitoring clinics on Saturdays. “I have a scale that was allocated to me by the clinic when I started as a CHW. Women from my area bring their babies at my homestead. I weigh the babies and record their weight on cards, as it is done at the clinic. I then use the weight records to check if the child is growing well; otherwise I refer the child to the clinic for further assessment”.

CHWs see an important role for themselves in bridging the gap between the community and the health services, as explained by another Village Health Worker from Mangwe District in Zimbabwe, Mrs. Portia Moyo: