This document discusses the importance of listening to patient stories in cancer treatment. It shares the story of a young woman who was diagnosed with breast cancer in 2007 but did not receive treatment due to misinformation. As a result, her cancer progressed severely over two years until she presented with an ulcerated, foul-smelling breast. The document also discusses how rural communities in South Africa have high levels of illiteracy and believe in traditional myths that can delay cancer treatment. The author founded an NGO to provide education on breast cancer screening and early detection in rural areas.

1. 23Winter 2012 Buddies for Life
Every patient has a story
to tell about her breast
cancer and I have to listen
to the story that brought her
to me. At times the story is
not told in the manner,
language or order that we
expect but, together with
proper examination and
medical investigations,
good listening skills,
patience and compassion,
we end up with the full
story - leading to
appropriate treatment
and care.
This column is dedicated
to telling the stories of
patients, patients who have
had a profound impact on
my life, made me think
outside the box and given
me an appreciation of the
many health challenges that
often result in breast cancer
patient’s late presentation
at health facilities.
December 2009, the nurse called the
next patient. A strong, foul smell
preceded a clicking of high heels. A
beautiful young woman, impeccable in
a long white dress with a fashionable
coat entered. She was filled with sorrow
and embarrassment because of the
smell. In her hand, a bottle filled with
what looked like maggots or worms.
She began her story.
She was a young 33 year-old, with
four children and a wonderful husband
who was a taxi owner. As she told her
story, I realised that the foul smell was
coming from her left breast where
cancer had been diagnosed in 2007. She
had been admitted for a mastectomy
but, on the advice of family and friends,
she opted to escape the hospital the day
before her life saving operation.
She had heard that a left breast could
not be operated on since it is close to the
heart. If it were removed her heart
would stop pumping and she would die.
She ran away to save her life from the
doctors who were going to kill her. It
was this myth that led her to presenting,
two years later, with a deep, foul
smelling ulcer infested breast with
worms. Now she was begging me to
remove her breast. Examination showed
that the ulcer was so deep that the ribs
were exposed and she had chest, liver,
brain and bone metastasis. She still
insisted on an operation.
The Rural Reality
In South Africa millions of people
have never heard of cancer and how
deadly it is. Rural communities face a
“survival of the fittest” health
management approach. The majority
of these patients are black, illiterate and
poor. To complicate matters even
further they have a complex belief
system - based on culture, religion and
myths - that are central to their
understanding of medical conditions.
Traditional patients seek a cause for
illness within the framework of
indigenous beliefs. Cancer is interpreted
as conflict, particularly in social
relationships. Many patients believe that
witchcraft caused their cancer, and their
first priority is to reverse the sorcery.
Seeking help from a traditional healer
first, in their views, does not imply a
delay in medical treatment.
The concept that a painless breast
lump is potentially fatal is difficult for
many rural women to accept. 80% of
black women with breast cancer refrain
from modern medical treatments
(Vorbiof et al, 2001).
I founded an NGO, called
Sinomusanothando Community
Development, to address this poverty of
knowledge and screening in my village
and beyond. Education and self breast
examination from an early age is critical
and can be done for free at home.
listen
to the stories
Asilalele
Dr Thandeka Mazibuko is KZN’s first
radio-oncologist. A registrar at Grey’s Hospital she has started
an NGO, Sinomusanothando, that encourages medical students
to teach school pupils, and thereby the community, about early
detection and screening for cancers.
As a child in the rural village of kwaNyuswa, KZN, I grew up listening to
stories around the fire, told by my great-granny, uMachonco. In oncology I
soon realised that listening is central to patient management.