Dr Sheena Geness fills us in, on working with breast cancer patients in Johannesburg CBD.
Does it take sheer guts to drive into a crime ridden area, synonymous with poverty and derelict housing, to get to my medical practice? No, it takes passion and an infinite desire to protect and heal the citizens of this concrete landscape. I’ve been working in the Johannesburg CBD for 15 years and I’ve learned so much regarding the demographic patient population that I serve.
Even though cervical cancer reigns supreme amongst South African black women, breast cancer seems to be foremost on their minds in this community. I’m not sure if social media has played a role in this. People have heard about self-breast examinations and mammograms; however, most are not sure about the relevance and exact detail of how it’s done.
There are certainly fears of getting breast cancer as it is often branded as something ‘dirty’. I’ve also come to realise that patients are afraid of being ostracised by their communities and usually opt to keep their diagnosis a secret. Extended family meetings are often held to decide on the course of treatment for the family member diagnosed with cancer. Sometimes this involves travelling to a rural village in another province before medical or surgical interventions can take place. Sadly, I have seen very advanced cases of breast cancer as women have often kept this ‘dirty’ secret for a long time – simply out of fear.
In this community, there seems to be less concern with the aesthetic devastation of the disease, or the hormonal and fertility ramifications. There are greater adversities for the patient than their hair loss or the loss of breast tissue.
Many of these breast cancer patients are single mothers, who are breadwinners of their school-going or university-going children. The enormous financial burden and inability to care for her children optimally during the chemotherapy treatment is of massive concern. This is often expressed during consultations. Thankfully, there are holistic therapy centres that can often serve as a backbone to a promising recovery.
Most of my breast cancer patients have co-morbid diseases, most commonly HIV. Even though the viral load is undetectable in compliant patients on antiretroviral therapy (ART), the diagnosis of breast cancer is often taken with a ‘pinch of salt’. These patients are tenacious and they’re valiant soldiers in this less trodden journey of life.
Traditional healing plays a major role in the therapeutic options of the patient, and if there are no real threats to their vital organs, but it is the mere adjunct of spiritual prayer, then I certainly allow it. Most patients believe that they have been bewitched by jealous family members, co-workers or friends. Even though they accept the Western medical or surgical intervention, there seems to be a greater power and belief that comes from the traditional healer. While we, as medical practitioners, may help the patient in scientifically treating the cancer, the patient still feels the need to rid their body of this ‘evil dirt’.
Due to the devastating effects and stigma that HIV has brought to this community, many patients tell me that they would rather live their lives being overweight! If you are fat, you are viewed as being healthy. Unfortunately, this attitude has led to the development of many chronic lifestyle diseases. While we know that exercise remains a great asset in decreasing your risks of breast cancer, the concept of keeping physically fit has become a challenging health promotion for me.
There are also very limited healthy food options in the CBD. Most people commute by taxi and need to be at work early, so the only options at this hour are the fast food restaurants, which has been such a travesty in the Urban Renewal Project. Women living in this area are not big alcohol consumers and neither do they smoke rampantly, however, the majority are on a hormonal contraceptive. I’ve also found that the average age of menarche for my patients is around 15 and that of menopause is around 48. Whether these factors play a role in the risk factor profile for breast cancer of my patients remains to be postulated.
I haven’t seen a single male with breast cancer in this community. Men are fearful of breast cancer for their partners. Most are very supportive, often accompanying their wives or mothers to the doctor. Even young school-going children pitch in to help with cooking or with the childminding of their younger siblings. These children have had to grow up in a flash. Once their mothers or aunts or grannies are diagnosed with breast cancer, there is simply no question that the domestic chores will befall these children irrespective of their schoolwork load, or age.
There is a beautiful character of the people who live in the Johannesburg CBD. I enjoy understanding the poetic meanings of their African names and learning the dialect. The same pains and celebrations of patients in this area, suffering from breast cancer, are like that of anyone, anywhere in the world. However, it’s that great African spirit that transcends through all of us that seems to be an established nucleus here. Even though patients surrender to the burden of breast cancer, they refuse to wallow in self-pity.
MEET OUR EXPERT – Dr Sheena Geness
Dr Sheena Geness is a general practitioner, who qualified from Wits University and continues to teach medical students in the Family Medicine Department of the University of Witwatersrand. She runs a family medicine practice in Johannesburg CBD, is a businesswoman (CEO of Geness Consulting) and a philanthropist (Founder of Geness Foundation). She is a wife, and mother to two daughters.