September 15


1 cancer, 3 experiences


Example of the fundamental unit of primary care – a health post

I’m 2 months into my PULSE assignment. My experience has been made up of wonderful little moments, generally positive and light-hearted (e.g. successfully learning a few Wolof phrases, trying the infamous Senegalese Touba coffee, making some good progress at work with the Ministry of Health).

This week however, these generally light-hearted experiences were overtaken by a heaviness that I will try to describe by painting the journey of a female cancer patient in Senegal… in 3 ways:

57 year old Canadian woman working at a Global NGO in Senegal

I had a physical, including a mammogram, before leaving Canada. It was clear. Since I know how to perform a self-exam, I recently did one and noticed a lump. I got another mammogram and an x-ray at a specialty centre close to where I live in Dakar. The lump is suspicious and I am told that I need a biopsy to confirm the diagnosis. Unfortunately, there is nowhere in Dakar that can do this biopsy. After a few logistical arrangements, I am on a plane back to Canada where, I am biopsied, my diagnosis is confirmed and since it was caught early, I undergo the required treatment and I am on my way to a full recovery.

57 year old Senegalese woman – high socio-economic class in Dakar

I am a senior Professor at the main University here in Dakar. My husband is the CEO of a successful agriculture enterprise in Senegal. As a family, we have access to the upper level of luxuries in Senegal, including health care. I suspect breast cancer after a self exam and mammogram. Though the oncologist also shares my thoughts, unfortunately there is no confirmation as there are no biopsy services available in Senegal. I unfortunately cannot secure a Visa for Europe, though we can afford the flight and potential treatment. After several agonizing and emotional weeks, my husband and I are still unsure of whether I should undergo what might be unnecessary surgery or chemotherapy.

57 year old Senegalese woman – peri-urban/rural, low socio-economic status outside Dakar

I live 400kms from Dakar. I am the wife of a well-respected farmer. The lumps that first showed up on my breast 2 years ago have now spread; they are infecting my entire chest and I am always tired and getting sick. I’ve exhausted all local health services, including the community healer, the health post and the larger health centre. I have been referred to the regional hospital, from which I am sure I will be referred to the central hospital in Dakar (where cancer services are located). I do not have the money for transportation, never mind for any diagnosis or treatment fees. I am increasingly unwell and I worry about what will happen to my children should anything happen to me.

Thinking through these different situations is the reason why the heaviness of month 2 has settled in.

As part of my work at PATH is focused on women’s cancers, I have also been able to witness the huge efforts that are being applied in this area. Bravely and persistently, the Ministry of Health is tackling several of the enormous challenges inherent in the pictures painted above through; disease awareness raising, education on prevention and early screening, implementation of low-cost and effective tools for diagnosis, and evaluation of potential treatment improvements as well as palliative care services.

2 months in and the light is balanced with the heavy. It does weigh you down but does ever provide a good source of motivation.