Beating Breast Cancer in Bangladesh

Clutching her baby, breast cancer survivor Basanti Majumder speaks of a pain in her left breast and fears her cancer may have returned. She stares briefly at the floor and giggles nervously. "I'm not going to the doctor now for financial reasons," she says.

The World Health Organisation (WHO)  estimates approximately 1.38 million new breast cancer cases each year, resulting in 458,000 deaths annually. Unsurprisingly, mortality rates are much higher in the developing world where women often only seek medical assistance and diagnosis in the late stages—unaware of what is wrong and reluctant to shell out on medical costs. In Bangladesh, poor access to medical facilities, stigmatisation and a lack of knowledge about the disease mean that a mere 11 percent of Bangladeshi women receive diagnosis in the early stages. Like in much of the world, breast cancer is the most common cancer amongst Bangladesh's female population, with 32.8 percent of female cancer patients suffering from this strain of the disease. The nation's public medical services—overstretched and underfunded—simply cannot provide the care required by breast cancer sufferers.

Yet encouragingly, one organisation has taken up the plight of these suffering women. Active since 2007, Amader Gram Breast Care e-Health Centre aims to provide expert medical assistance to any woman, regardless of her economic or social situation. Having originally set up in the Khulna region of Bangladesh, the organisation now boasts one other centre in the sub-district of Rampal in the Bagerhat region, as well as a small coordination office in Dhaka.

Reza Salim, founder and director of the organisation, started off working in ICT as a government communication consultant. "I have worked primarily in ICT, and never initially planned to work on cancer," he explains. Yet whilst working on computer literacy programmes in rural communities, Salim and his team were alarmed at the vast number of women turning up at the centre complaining of chest pains. "We also started taking small initiatives to help our localisation on the aspect of non-communicable diseases, as we realised that it was highly neglected and unattended," says Salim.

And now in 2017, ten years after Salim created Amader Gram Breast e-Health Centre and staffed with 13 dedicated medical employees, the organisation receives anywhere between 90 to 150 new patients with breast-related health issues a month. In 2016, the organisation treated 1,968 woman and followed up with 426 of them. Salim is keen that women undergoing treatment at the centre receive all the required care in the same place—something that is a rarity in state run hospitals where patients are sent traipsing from one pricey medical centre to another.

"A big step towards treating cancer is to actually know about the prevalence of the disease and take action accordingly," says Salim. In this conservative nation, little is known about breast cancer and women are reluctant to come forward and discuss any health concerns they may have. In order to overcome such obstacles Salim has several female physicians at the centres to help female patients feel more at ease.

Aware of the economic hardship many of the patients live, Amader Gram Breast Care e-Health Centre's prices are adapted to their patients economic situation. A diagnostic biopsy costs Tk 12,000 (US$ 143) and a chemotherapy session around Tk 1,000 (US$ 12). The organisation even provides all breast cancer patients with a free mobile phone so that they can liaise with medics throughout their treatment. 

Breast cancer survivor Mahmunda believes that she owes her life to the organisation. "When I first started noticing lumps around my breasts, I started taking homeopathic medicine. When more of them appeared, I came to this facility where Mozammel sir [a surgeon at the Khulna campus] redirected me to the correct treatment. Now, by grace of God, I am doing fine." 

Keen to put a range of pedagogical tools at the disposal of patients and their families, the organisation has also drawn up a series of guidelines for effective palliative care for those women who arrive at the centre too late and for whom the outcome is not so positive. The team has even created an app called "AG Palliative Care" to help family members in remote areas best prepare for their loved ones' last few moments. The app uses a short questionnaire in which patients or their loved ones can report symptoms. The information is then sent over to a centralised computer system and read over by a doctor who then suggests the best course of action for patients.

Looking towards the future the organisation intends to expand its services across the entirety of Bangladesh, hoping to save and educate as many women as possible. For the time being it is clear that Amader Gram Breast e-Health Centre has proven an exemplary stepping stone in providing breast cancer treatment to some of the countries most vulnerable women.

http://agbreastcare.org/