A normal sexual life with one breast
By Omwa Ombara
As other women try on clothes, shoes and beauty products along Nairobi's Kijabe Street, Veronicah Mburu shops around for a prosthesis, that is, a spare breast. She wants to get the right one before she dashes for a date at the New Stanley Hotel with her boyfriend of five years, Albert Juma.
Veronicah, 35, a retired Senior Manager in the Managing Director's Office, Barclays Bank, lost her right breast to cancer a year ago after living in a fool's paradise for two years. She believed that the lump in her armpit was harmless and would one day disappear into thin air. Like many women who live in self-denial, she refused to go for a mammogram; no relative of hers had suffered from cancer before and she therefore thought she had no risk factors.
Before the scar healed, the former head-girl of Loreto High School Limuru would make a breast out of a pair of her boyfriend's socks and stuff it inside a pair of stockings then wear it inside her bra. But she experienced discomfort as the object shifted positions from one spot to another until one day it dropped in the middle of the street causing her great embarrassment.
Now she smiles as she tries on one artificial breast after another. As she adjusts the prosthesis, her wig falls off revealing patches of fallen hair, now turned white from chemotherapy. She picks it and places it back more firmly.
The salesgirl tells her the prosthesis costs Sh16,000 after discount. She frowns, but goes ahead and pays for it.
She knows that as soon as Albert sees her he will tease her in his usual way: "You are the most beautiful woman in the room, if only everyone here knew that those things you wear are fake!" Then they will both burst out laughing as he hugs her carefully and helps her sit on the comfortable leather armchair.
Later, he will drop her home and when she has removed the wig, he will caress her bald head which he says resembles a popular movie character Kojak. Usually, they will spend the night together.
The wig, which she has named after her favourite nephew and which she takes particularly good care of often evokes in her bitter sweet memories. When she first bought it after her hair started falling off - a normal occurrence after chemotherapy, friends and relatives tried to be nice about it, even though they knew it was ugly. In short it was a disaster.
"I felt the wig was not right. But it is only when my little nephew Brayooh declared that I resembled 'Reddykyulas.' that I knew I had to change it." A close friend and hairdresser Nancy Wettstein came to her rescue and suggested a visit to a trendy wig shop in town. She loved the results.
Things may appear easy now, but she has indeed come a long way. Says Veronicah "the worst thing about Breast Cancer is the initial lack of pain."
Her experience started about March 2000 with a painless swelling in the right armpit.
She recalls playing around with it and wondering to herself what it was all about. She even invited one of her friends to feel it and they agreed that it was probably a swollen lymph node due to an infection or other and it would go away by itself. What further encouraged her was that the boil was painless.
At the time she had just lost her four-and-a-half month old son Stanley through miscarriage.
But in February 2002, the lump started to hurt and so did the right breast, which also developed a discharge.
Then follows what Veronicah describes as a 'comedy of errors' in which doctors diagnosed one thing after another following a biopsy. Some said the results indicated no signs of cancer while others said the results pointed to Uterine cancer.
In April 2002, she became increasingly worried and saw yet another doctor. He admitted her to hospital and what is called a Fine Needle Aspiration was done. It was positive for breast Cancer.
Yet despite the positive results, Veronicah decided to go on normally with her life, ignoring calls by her close friend Mary Onyango, a Breast Cancer Survivor, her mother, a nurse, her father who had sleepless nights on account of her and other friends and family to have the breast removed. She also warned them to keep off her affairs and that she be left to enjoy her dear life.
Meanwhile, she opted for herbal treatment and was put on fruits and vegetable juices, syrups, pills, deep muscle massage for a month. The last herbalist she visited gave her jelly to apply on the wound and herbal tea to boost her immunity.
Like every other woman who is diagnosed with breast cancer, thousands of questions shot through her mind like a thousand painful needles. She dreaded a future without a breast, without ovaries, without hair, without everything that makes one a full woman.
She was worried about her sex life - whether she would be able to make love with only one breast, whether her libido would go down drastically. She just could not envisage herself without her femininity. Would she be able to have children and if her current boyfriend left her would she be able to get another one? When she woke up in the morning her bed would be flooded in tears - tears of fear, pain and unanswered questions.
She was afraid to die.
For the next three months she lived in denial as she dressed the open wound, now oozing, all by herself, daily.
Says Veronicah in retrospect, "I was not ready to lose a breast. I preferred to go to my early grave intact. With all parts of my body." But it was not going to be such an easy death as the breast got worse, the pain unbearable and sleep became elusive. "I thought this was the end of the world. I was scared of the impending changes in my life."
With the support of her boyfriend Albert, whom she initially thought would abandon her, she was able to face surgery under Dr. Kodwavwala, and then chemotherapy under Dr. Abwao at the Nairobi Hospital.
Veronicah is grateful to Albert whom she describes as a model of patience throughout her trying time. Her heart also reaches out to her family members - to her mother for her prayers, her sister Anastasia, Aunt Njambi, to her niece Shiro who wrote her a beautiful letter, her brother James who sent a message declaring that all his life he had had no breasts and was not the worse off for it, and his wife Justine who were quite supportive. Lasoi who took up her duties at a moment's notice and with a smile on his face, and other family members, friends and colleagues.
Her brother John was however so disheartened by this turn of events that he never went to see her in hospital - not even once
Veronicah recalls her seven-month chemotherapy period as one of the most trying moments of her illness. Her loss of hair was devastating, and she cried uncontrollably when the hairdresser combed her hair gently to save it and masses of it came out with the comb. Her skin also darkened, she had excess salivation, nausea and vomiting, diarrhoea and sometimes constipation.
Veronicah says the hair loss has made her scalp very sensitive to temperature extremes and especially cold whether. Thus she will still be spotted in her woollen caps from time to time despite a whole inch of hair of which she is very proud.
Talking about his experience with his girlfriend, Albert recalls that when Veronicah first showed him the painless boil, he dismissed it like any other passing cloud.
But when the reality dawned on him that she actually had cancer he was at first afraid. "We were both scared. I felt for her but I didn't want to show her my fear. I also refused to discuss death with her though she tried to raise the issue. She would cry a lot."
Albert, 40, a financial controller with an Insurance Company first met Veronica in 1998 in the course of duty. It was love at first sight.
Says Albert, "She was a very tiny woman who weighed only 42kg. This worried me a bit because I was a massive frame of flesh weighing about 110kg. But within seconds I discovered that behind the small body was a very powerful personality.
Albert was soon teaching Veronicah how to prepare well-balanced and tasty meals and having the time of their lives. They lost their first baby and the grief made them stronger and even closer.
When she was diagnosed with cancer two years later, Albert admits that it was difficult to comprehend the sudden changes in their life.
She had sudden mood-swings, cried a lot and the pain was too much for her to handle.
"I accompanied her to hospital for the mastectomy. The whole thing was a shocker to me and I wondered how I would deal the situation.
"I decided to face it. Next morning, I went to the hospital and decided to see the removed breast. I was shocked but I held up my surprise.
"To be able to deal with the situation, I decided that every time I visited the hospital, I made it a point to look at the healing breast. I soon became used to the sight.
"She was discharged from hospital. And soon our lives were back to normal. We had sex as usual and nothing has changed.
"Vero is a courageous woman. She accepted her fate and went through it with a lot of dignity. She was not afraid to talk about it, which I believed helped her a lot to deal with the situation."
Fortunately for Veronicah she had an insurance with her bank which took care for all her medical expenses. The Bank has continued to take an interest in her progress and still caters for her medical fees, and her colleagues have continued giving her support, especially her Managing Director, Mr. Adan Mohamed. But not every person diagnosed with breast cancer can afford the expenses.
Veronicah has joined the survivor lobby group - the Kenya Breast Health Programme (some of which activities the Bank now sponsors) and will be participating in their October 4, walk to help raise funds for survivors of breast cancer. KBHP will also avail a free breast examination to all women in Nairobi.
Side-Bar
Dr. Yusuf Kodwavwala, a breast surgeon is happy with Veronica Mburu's progress but quite disappointed that the patient took too long before getting surgical attention from him.
The surgeon has handled breast cancer patients for the last 25 years and says the cases are increasing annually. The youngest Kenyan Cancer patient so far in his experience is 23 while the oldest is 93.
According to the surgeon, women are attached to their breasts because that is where they feel their femininity lies and because in late cases of breast cancer, the breast is removed, they would rather hide when they feel a lump on their breasts.
Unfortunately breast cancer is a painless lump and it usually would not make sense to go to hospital when one is not in any pain.
Again women fear reactions from male partners such as boyfriends, husbands and children and how they will relate without breasts. The social consequences especially at work, in sports can be devastating.
If someone were therefore to lure women into alternative medicine (such as herbs, acupuncture, quacks and preachers) that gives an alternative to mastectomy, this is an attractive proposal.
Although Dr. Kodwavwala does subscribe alternative medicine in cases such as backache, migraine etc, He does not believe it is effective in the case of breast cancer.
The surgeon says that if only women could go to the doctor, they would be quite pleasantly surprised because only 1 out of 10 lumps is breast cancer. The rest are benign tumours.
If patients are properly counselled, their fears are easily dispelled. Veronica went around for two years in search of treatment but finally had surgery that made all the difference.
The causes of increased cancer in Kenya can be attributed to changes in life-style. These have increased our risk factors.
Risk Factors:
- There is an early start of periods (menarche) and the late finishing (menopause) due to better nutrition levels.
- Late first pregnancy, fewer pregnancies, and lack of breastfeeding contribute to the risk. Most women are opting for careers and universities resulting in delayed marriages and delayed pregnancies. Such women have no time for breastfeeding and especially those in the urban areas and its surroundings, where cases of breast cancer are reportedly higher than in the rural areas.
- Use of high hormonal contraceptive pills
- High fat intake in the diet.
- High alcohol consumption and heavy smoking.
- Use of hormonal replacement therapy. A number of modern women are afraid of side effects of menopause such as hot flashes and nausea and opt for more comfortable alternatives.
Mastectomy charges range from Sh20,000 to Sh200,000 depending on whether it is a government or private hospital.
Symptoms:
The surgeon says that in the very early stages when the lump is very small there is no need to remove the breast and the survival rate is quite high.
It is only in late stages that a mastectomy has to be done. The breast is an easy organ for self-examination and a lay person can easily identify them.
Women who regularly examine their breasts and go to the doctor at the earliest opportunity stand chances of being diagnosed early and having an improved outlook. Mammography is generally encouraged in women who are 40 and above.
The Executive Director Of Kenya Breast Health Programme (KBHP), Mary Onyango is concerned that there are only two hospitals in Kenya with Radiotherapy facilities and only one of these is government owned. Both hospitals are in Nairobi and therefore all cancer patients in Kenya must come to Nairobi for Radiotherapy.
So far only five hospitals in Kenya have mammography facilities and out these, four are in Nairobi and one is in Mombasa.
All the mammography facilities are under-utilised and the ministry of health can therefore not justify to the government why this money should be included in the budget.
The cost of treatment is out of reach for most patients. Most women do go for annual medical check ups and neither do they carry out regular breast self examination (BSE) despite knowing about it. Shops do not stock prostheses as most women cannot afford it.
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