breast cancer break the silence

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In The Name Of God The Compassionate The Merciful

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DR SAMIA AL_AMOUDI

Consultant Obstetrician Gynecologist & IVF.

Assistant Professor at King Abdulaziz University

Hospital Jeddah, Saudi Arabia

Ex Vice - Dean of medical collage and Allied

Science.

Ex.. WHO Temporary Advisor.

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This is to my mother, the woman who brought me up on strong faith – the same faith that I tried to instill in my children.

This is to the two lights of my life, Abdullah and Israa, whose love has been my strength and my shield in this war of mine. For them I fought and fight on, so I can be their shield, their security, andtheir compassion.This is to my uncle, whose love and compassion engulfed me, whose support lit the firein my heart and kept me going. The man without whom I would’ve crumbled under the weight of my predicament ages ago.This is to my stepdaughter, whom I took under my wing as a baby, and nourished until she developed into the beautiful young woman she is now. To precious Suzan, who’s been there for me in my most painful of moments, the moments no one has ever seen.

This is too all those who’ve contributed to my therapy, whatever role they played.

To all those who stood by me in my predicament, I dedicate this book. And how many they were. How great they were. Some I knew, some I never knew, but all of them were brothers and sisters under

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God, who gave me their prayers without even seeing me, and what a great giveaway that was.

Finally, to all those who read this book I say, please mention me in your prayers, both while I’m with you… and after I’m gone. May God make this useful.

Dr. Samia Al-Amoudi

12 - April -2007

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Having cancer: a Message from GodThis date has a special place in my heart, as well as the hearts of my children, my family and my loved ones. It was the day when my life – and my priorities – took a whole new direction.

That day, I came back home with my children after having had lunch out. I went to my room, and by mere chance, my hand touched my breast. I felt a lump. In a single moment, all my medical instincts sharpened up. I began to feel up the lump, checking the tumor and the lymph nodes under my arm. In a moment of time, I realized that God’s will has caught up with me. In a moment of time, I realized what I had. I didn’t need to get myself checked. Unfortunately for me, I am a physician, and that’s why ignorance could be a blessing in moments like these… hard moments I had to live through.I began to walk around the room in circles. I loudly prayed to God to give me strength. I asked Him for strength because I know the reward only comes at the firstshock. I called for Him, I reached out to Him with tears: ‘Do you love me so much to send me such a message of love?’

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These were the first moments I had lived throughwith my current experience with breast cancer.

My children. First and foremost. My responsibility, both as a mother and a father, made me start with them. It was inevitable that I had to lay it out to them, slowly and gradually, according to their ages. I wanted them to hear it from me. I wanted to give them security and confidence. I wanted touse the crisis to build their characters. A believer, as I always kept telling them, must be strong, and building a positive character begins with facing crises. With God’s help, I was able to put things in perspective with me, so I won the first battle againstmy ailment.

And then there were my family and loved ones. When you see all that love in their eyes, you wish you’d get sick everyday. When you hear the words of faith form those around you, it is as if they all speak a universal language – one that tells you to hang in there, for this is the highest of levels with God. Only then you taste the sweetness of faith. Moreover, you feel that the blessing of faith is the only alternative to every new thing that emerges in the world of medicine. And that is the brightest

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side of such conundrums.What next? The moment of truth came when I had to make a decision about my treatment. My uncle – the man I call my father and my whole family – was out of the Kingdom. When I called him, he said he would book me a plane ticket to take me to him. But then there was another battle – one which I decided to fight with allthe faith and confidence I could muster: I told myuncle I will only let my own colleagues treat me in my own country. I placed my trust – even my very health and my life – in their hands, because I know who they are. I told them I’m not about to get my treatment anywhere else, and for two reasons. One is that I trusted them as much as I did myself and the advancement of medicine in my own country. The second reason is that my very being amidst my own people is in itself an integral part of my treatment.

That is my story, and that was the beginning of my fight against breast cancer.

So, why, you must wonder, would I tell you about something that is very private to me and my loved ones?The reason I’m telling you my story is to tell the world of my plight. I have sense an assertion by some that illness is a secret that should not be

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let out into the open, but this is something that, I feel, flies in the face of contentment, faith and fate,whether good or bad.And this is why I’m letting on – so as for all of us to learn to best take advantage of our own conundrums, by making plenty of pleas and standing up to face crises like this one with the faith of a true believer. Such confrontation is the very moral, emotional and societal encouragement the ill need. And because illness and treatment is an eventful process, I ask you to share with me my journey through my illness and treatment – a human journey in which I implore God to grant some support to every ill man and woman, in the hope this will open one more door of divine reward for all of us. My God help us all.

A message of love:My struggle with breast cancer is a message of love I extend to every woman, and say to her: Do not forget to make regular early checks for

tumors.

Thursday, May 25, 2006

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Breaking the newsAfter I found out I had a lump in my breast, my biggest concern was how I’m going to break the news to my children, and how we’re going to deal with this.Like I said before, it was a Friday when I discovered the tumor. Within moments, I realized the magnitude of God’s will. That’s when I left my bedroom and went to see my children. I was stunned. But my fear for my children was much bigger than any shock or awe.I have three children. Abdullah is in the seventh grade, and Israa is in the fourth. There’s also my stepdaughter, who’s in college, and who stayed with me after my divorce. Those are my three children, the light of my life.

Hence, my fear for them was enormous. I know that many of you may not agree with the way I handled this with them, but upbringing is a matter of convictions. Every mother has her own convictions about how she should raise her children, every mother knows her children best, and every mother has her own way of handling life with them. So I followed my own convictions of upbringing and faith. I wanted them to find out from me, rather

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than hearing the wrong information from someone else, which would’ve frightened them and shaken their faith. More importantly, I wasn’t about to hide things from them or lie to them. Our children today learn more from TV and the internet than we think.Thus, when I first felt the lump in my breast, Icalled them around and asked them to sit down.

“I want to hear your opinions about a problem a friend of mine has been having,” I said. “She’s in the US, and doctors have discovered a lump in her breast – in other words, cancer, and she has no idea how to break the news to her children.”“Is it dangerous, mother?” my son Abdullah asked.

“Of course it is,” answered my Suzan. “Very dangerous.”“Well, they’ll definitely be scared,” hesaid. “She’d better tell it to them straight.”“She must be in pain, and they must know so they can feel and share her pain,” said my night-year-old Israa.“Mother Samia, you always told us honesty is the best policy.”

I smiled and ended the conversation at that.

That was the first step on the ladder of my breakingthe news. On the evening of that same day, I told

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my daughter Suzan what the odds were. I told her I planned to have tests done the next day. But I also told her I wanted to see the True Believer in her, the one who shows grace under pressure. Her fear and love assured me that taking her under my wing since she was a baby is paying off in this world – even before the afterlife. That God for that.

The next day, the diagnosis was unequivocal. After I had my mammogram test, and after the children came home form school, as we sat at the lunch table, I told them I ran into a relative of ours. Because my children and her children were friends, I wanted to get them closer to the idea. I told them the story of her husband, who went through cancer and eventually got cured, and how she dealt with her children positively. I wanted my children to know about him, and told them that now he’s living normally and works.

That was just a story I told them about someone they know, just so they know that there are people just like us out there.

But all that was the easy part.

That evening brought the most important part. I

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had little time, and the tests became more and closer between. I told the children I was on my way to the doctor because there’s some lump in my chest. When I got back, my son Abdullah caught me off guard.“Mom, what did the doctor say?”

“He’s going to have to take samples and do an analysis,” I said.He went eerily quiet for a moment. Then he asked me outright: “Does this mean it could be cancer?”

Form this moment on I knew I had to deal with my son like a grown man.“Probably,” I said. “Probably not. We’ll never know until the sample is taken.”

I then asked him about his homework and the like, and ended the conversation naturally.

My God! I’m running out of time! They’re going to begin treatment, and I’m going to go to hospital, either for surgery or chemotherapy. I’ll have to explain to them what they’ll have to live with from here on out. I’ll have to be a mother, a teacher, a sociologist, and psychiatrist all rolled into one. I’ll have to be a True Believer who gives doses of faith to her children.

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These are difficult moments that all of us mothershave to go through. All mothers, in sickness and in health, are most concerned about children. In my profession, I’ve seen mothers who wouldn’t go to hospitals, and some of them even put off critical surgeries during exam periods. All mothers are like that. They put their children first, even if it costthem their health, and I’m just like the rest of them. My situation is tough, and my fear is even tougher.

The next day, I knew I had to be more candid. I had to sit down and talk to them about it. I told them the preliminary tests show that the lump is malignant. I explained to them that there are many different kinds of cancer, and there are kinds with which people can live for 20 years or more. I also told them that death has nothing to do with being sick. I gave them the example of a neighbor of ours who was run over by a car a few months earlier and died. I told Abdullah: “if one of your friends tells you your mother has cancer and she’ll die, tell him it’s not true. My mother is a doctor, and she explained everything there is to know about cancer.

I told them that because their mother is a doctor, they know more correct information than most of

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their friends. We have to pray, for when God loves someone, He will test them, and this is a test for which God will reward us.

This was how they found out all about it. After that, we talked about a variety of other things. I took a vow upon myself to make their lives as normal as I can make them. Not blowing things out of proportions, not panicking and holding it all together are the only ways to keep them calm and teach them the meaning of patience and dealing with crises. I asked them to put their pretty little hands on my chest and pray for me, saying “I implore God to cure you.”

Those were difficult moments I had to go throughin this battle of mine – moments that gave me a new meaning of love with them. I used to hold them and kiss them, but today, I bury my head in my daughters hair to smell her scent. I hold my son so hard as if I’m about to melt into him. The flavorof my kissing them, the warmth of my compassion grew more intense, not because I was afraid I’d go any moment now, but because I was feeling the joy of their being with me. as if I was living every fraction of every moment so I don’t miss a thing.

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Why I didn’t find out earlierEveryone asked me the same question: how come you didn’t discover the tumor earlier?

I asked myself that same question even before they did. How did I miss it? How can I possibly have breast cancer? How come I didn’t find out earlywhen I am the one who diagnoses patients and advise them to do mammograms?

“You’re a doctor! How could you let this happen to you?

To all these questions, I have only one answer: fate.

I have to admit, though that I got so consumed by my own problems as a mother, and my responsibilities towards those around me both at work and at home. I forgot all about myself. I neglected myself. Just like every mother. Every working woman. We take care of everyone but ourselves.

That is why I call upon every woman to perform a self-check every month –and most importantly a mammogram – especially in light of statistics that

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show that breast cancer is the most common among Saudi women. What’s even more dangerous is that 30 percent of patients in Saudi Arabia are younger than 40, compared to only seven percent in the United States.

Moreover, statistics here in the Kingdom show that as much as 73 percent of cases are revealed by doctors while in advanced stages, compared to only 30 percent in the United States, which further reduces chances of complete recovery. Even though we are a nationt that believes in fate, this does not exempt us from responsibility.

My experience has turned into a cause. The message I wish to send across is to call upon all women to immediately take action for early detection. Some women are afraid of mammogram , and others tell me they would not do a mammogram because of the pain. Yes, it is a bit bothersome, but not really that painful. However, mammogram is not nearly as painful as the disease itself. Because a clump in the breast requires doing Biopsy to confirm thediagnosis , some women refuse to do it thinking that taking a sampling will cause the cancer to spread, which simply isn’t true.

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A sample is taken with local anesthesia. It was a moment of horror when the tissue sample was taken from me, because I’m paranoid about needles – any needles, big or small. I think this is a byproduct of how our parents used to scare us with needles, like when they say “we’ll stick a needle in you if you don’t do such and such!” or “the doctor will give you an injection!”

And the fear only grows. That’s why I frown when a mother or a father say to their mischievous child, “sit down or the doctor will poke you with her needle!” I totally disapprove.

All of us have our little fears. Even though the sampling caused me a lot of turmoil, it really wasn’t that hard. I remember the doctor who took the sample got so nervous when they told him I was a doctor too. He got even more anxious when they started telling him to take special care of me. I smiled and wondered if it would’ve been better hadn’t they told him I was anything more than a regular patient.

Anyway, thanks to that doctor – God bless his soul – it turned out to be easier than I thought.

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But the result was positive.Things were happening so fast I couldn’t get my head around what was happening to me. I found the lump on Friday, did the mammogram on Saturday, from Sunday through Tuesday there were blood tests, ct-scans, and x-rays to make sure the disease didn’t spread. Thank God, it didn’t. I feld God was being generous with me. The best thing about all of this – and probably the strangest – was that the sample that confirmedthat I had cancer was taken on April 12, 2006… my birthday.

My birthday coinciding with the day I found out I had cancer… I have no idea what this means, but I had no illusions about the irony.


tumors.

Thursday, June 1, 2006

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Are you susceptible to breast cancer?When I found out about my affliction, the firstquestion that came to my mind was: how could I forget that, just like any other woman, I was susceptible to breast cancer?

I remembered all the warnings we learned about in college, and which I still read about today. I finally realized that these warnings were only therefor us to be cautious. Heretofore I would like to make them clear to you, my dear readers, men and women, so each and every one of us may watch out for them and begin preventive measures.The most crucial question on each woman’s mind is this: am I susceptible?

Yes, every woman is susceptible. I’m not just saying this to scare you, but so you may be vigilant. From a medical standpoint, simply being a female makes you vulnerable. The probability of contracting the disease among men is only a fraction of a percentage point.Women younger than 20 rarely get the disease, and breast tumors between 20 and 30 years of age are mostly benign. But the older you get, the more susceptible you are, especially from 40 and up.

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Many people believe that having a family history of cancer is a major factor. A woman may say, “thank God, there is no history of breast cancer in our family.” In truth, though, the genetic factor represents only five percent of cases. In other words,the fact that there is no history in your family is no guarantee that you won’t get it, either.Obesity and nutritional habits are also important factors. Statistics say that about 50-60 percent women in Saudi Arabia suffer from obesity, which is quite alarming. Scientific research has proven thatkeeping a close watch on fat in your food and eating more vegetables and fruits reduce chances of getting the disease. That’s why the nutritional system in my home has turned into something of a war between me and my children as I try to curb down fast food and change our eating habits.

Another factor that increases the probability of breast cancer is not having children, or at least delaying having children until after 30. Women who reached puberty earlier than 12 years of age are also more prone to the disease, and so are those whose periods are still present beyond 50 years of age.My own experience with the disease contained

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many of these factors. Despite the fact that my family has no history of breast cancer, it all began with an excruciating experience. Pregnancy was years later than I wanted it to be, and I began to think that having children of my own was never meant to be. I needed to take a lot of hormones to stimulate my ovaries, which in turn caused me a lot of pain and complications as far as my health was concerned. I spent many days in intensive care at the University Hospital in Jeddah. But after years of grief and a lengthy course of treatment, God rewarded my patience with my son Abdullah and my daughter Israa.

That said, hormones are not necessarily a direct cause of cancer. Stimulants and birth control pills have not been scientifically proven to be directlyrelated to breast cancer, even though some studies claim there is a link between alternative hormones taken in adulthood and breast cancer. But it takes a lot of hormones over a long time, usually more than ten years, for them to be even a factor.

As far as I was concerned, the major factors in my affliction were my delayed pregnancy beyond 30,and age. I was within the age group that’s most

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vulnerable to the disease. And then, of course, there are our flawed eating habits.

I feel that every woman should understand and keep track of these factors. Of course, there are environmental factors as well. There is the issue of genetic anomalies to take into account, and there is abnormal consumption of alcohol, especially among non-Muslims.

These are the main factors that we as physicians believe help increase the rates of affliction. Some ofmy friends even went as far as telling me that the alarmingly high rates of cancer in Saudi Arabia may be caused by environmental pollution that resulted from the Gulf War in 1991. This is a widespread belief augmented by the unusually high rates of miscarriages, fetal deformations and cancer.

However, the absence of an accurate, detailed database makes it nearly impossible to draw robust connections according to international standards. In the mean time, what matters is that there are methods of early detection. Here, I cannot stress enough the point that it is crucial to diagnose breast cancer tumors before they can be felt by touch.

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This should be the mission of every one of us. All of us need to be aware of the factors that increase the probability of affliction and work to treat them.Again, what I aim at with these messages of mine is not to cause fear or concern, but to fulfill myreligious duty as a physician. This is part of my responsibility as a professional and as a Muslim, and every Muslim should maintain his or her health. Prevention begins with spreading the right kind of information, and this message of love comes from my own experience. God help us all.

Thursday, June 15, 2006.

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Are you afraid of cancer? Then now is the time!I said in the previous article that cancer is a big problem in

the Kingdom. I also said that there are factors that make

women more susceptible to breast cancer than men.As a

matter of fact, most women are terrified to bits of anything

even remotely resembling breast cancer, especially the pain.

Everyday, women come to me complaining about pain in

their breasts. Fortunately, however, pain mostly means

anything but breast cancer. Actually, a woman rarely feels

pain – which makes it that much more dangerous: cancer is a

silent killer.The idea, however, is not to wait until there is pain

or a tumor than can be felt by touch. It is extremely critical

to discover these cases as early as possible, way before these

symptoms appear, in order to achieve full recovery. That’s

why cancer is actually less critical than some other diseases,

such as diabetes. Cancer, if diagnosed early enough, can be

fully recovered from. Diabetes and its complications, on the

other hand, are always chronic, and can never be treated.The

first step any woman should take is monthly self-diagnosis,

immediately after the end of her period. Women regularly

ask me how they would know through

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self-diagnosis, especially that they’re not physicians themselves. I tell them that the idea of self-diagnosis is to get to know the nature and feel of their breasts, so they could tell if something doesn’t feel right all of a sudden. It is also important to know that in about 50 percent of women, the breast is lumpy by nature. It is even more difficult to diagnose whena woman is pregnant or breast-feeding. But self-diagnosis is still important.The second step is to have herself inspected by a physician on a yearly basis. I tell all my patients that every time they go to the doctor, they should take the chance to have their breasts inspected, because women in our part of the world are not keen on making regular visits to their physicians unless necessary.

The third step is to do a mammogram, which is the most crucial test that can diagnose the illness even before it can be detected manually. This is especially important, since early diagnosis can very likely help complete recovery.

What is really important for women to know, however, that there is always a margin of error in each of these tests that may be as high as 10 percent. Therefore, it is important to have the tests done at

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well known and proven clinics. That said, there aren’t enough experienced mammogram specialists all over the world, because the inherently high margins of error brought about enough law suits caused by erroneous diagnosis to turn most physicians away from the field – which made such specialists a rarityin our country. Exacerbating the problem is the fact that women in our part of the world prefer to be treated by women specialists, which are even more difficult to come by.There is a dire need for moreeffort in this field. Most hospitals in our country relyon female X-ray technicians. All the male doctor does is read the X-rays. Thus, this is a new and very important specialty, and I recommend that female medicine students focus more on this field to fulfillthe demand in their country.

In some cases, we use ultrasound for a preliminary diagnosis, and in case of doubt, a sample of the tumor is taken to determine its nature. Most women refuse to have X-rays done, simply because they are too afraid to find out that the result is positive! Afriend of mine, who is also a doctor, tells me she is

scared of doing an X-ray, because she doesn’t want to know if there is something is wrong with her.

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This is a very wrong line of thinking, and – especially in our country – tests should be done as early as possible. It is wise to begin making X-rays starting at age 35, and then making tests every one or two years beyond that. It is especially important for women over 50 to do yearly tests.

The most important signs upon which you must go to your doctor is tangible changes in your breasts, such as a lump, tumor or secretion from the nipple, especially if it was mixed with blood. Another sign is a change in the shape or color of the nipple. A third sign is swelling under the arm. All of these symptoms are extremely important. Early diagnosis could mean the difference between life and death. It could mean full recovery. It could mean a different, much less excruciating course of treatment. Do not hesitate, and remember that sheer negligence caused the writer of these lines to go through this painful experience. Don’t do as I did, and remember that I pray for you.


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The day my hair fell offI started on chemotherapy. It was a tough period in which I learned to get a thorough feel of whatever I read about the complications of therapy. As physicians, we write prescriptions or make treatment plans for patients without knowing what happens afterwards. So when I began my treatment for breast cancer – which started with chemotherapy – I experienced firsthand the complications and sideeffects every other patient feels.

Chemotherapy isn’t painful at first, but in a matterof days, it feels like you just got hit by a bus! The pain, the exhaustion, the fatigue crush you – which just about describes how I feel these days. But all of this becomes easier once a Muslim remembers God and the Day of Judgment. He or she is actually happy that God had chosen him and expedited his forgiveness in order to go to God clean and pure. This also describes how I feel today.

Perhaps the toughest part about chemotherapy is losing my hair. A woman’s hair is like her crown: it represents her very feminine nature, her very identity. Even though I expected it, losing my hair

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was naturally painful. It was like I lost a part of me – as if every single hair deserted me and left me weeping.When for the first time I grabbed a strandof hair and it got pulled into my hand, I asked my nine-year-old daughter Israa what she thought. Her answer was something I’ll never forget.

“Think of them as points on the virtue scoreboard,” she said. My little girl was the unlikely teacher who taught me that every single hair is a point – as I hope it would be.

A couple of days later I realized that trying to keep what little was left of my hair was a lost cause, so I bought a shaving machine to get rid of the rest of it. In order not to turn this into a painful memory, we made a party of it. My best friend and soul mate, Dr. Nadia Ghannam, shaved off my head with Israa and my son Abdullah joyfully helping her out, while my daughter Suzan filmed it all with her camcorder.We turned our sorrow into a party to make it easier on the little ones. Abdullah had a ball. A few days earlier, he shaved his head off when we went for Umrah. Now he said I looked like him. Suzan said I looked like Demi Moore in G.I. Jane. And then she frivolously suggested we all shave up.

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This is how my best friend Nadia helped me wrap my moment of pain in a shell of joy that concealed the depth of our wounds from our own children. I pray to God to accept my suffering.

I remember a relative of mine who’s been through the same experience. Even though her loving husband saw her all the way through with every last bit of passion he could muster. A hairless wife, however, was more than he could handle.

“I put up with your illness, and now I have to put up with your hair,” he said to her.

“I felt his pain tearing me apart,” she told me.

It’s these side effects that are devastating. But it’s really God putting our faith to the test. Perhaps the best part about God’s test is that it’s temporary. One of patients told me that after she lost her hair, it grew even stronger and thicker.

That was the story of my chemotherapy. Chemotherapy kills a part of us – not as patients, but as women. As women, sometimes all we have is pride in every sign of feminism, because women are the same anywhere in the world.

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As Muslim women, though, we’re much better off. We usually cover our hair whenever we go out, so head scarves are normal in our society, so as cancer patients, we don’t have to worry about our hair in public. For non-Muslim women, however, covering the head is an awkward proposition. My crisis taught me the real value of the Islamic requirement of the head scarf, which I found to be a blessing from God.

My illness was also an opportunity for me to research the Islamic rules that govern people in my situation. I asked about the rules for wearing a wig, not for me – because I’m used to wearing the hijab, of head scarf – but for some women, especially younger patients, because losing their hair is a real problem for them. The truth is that I found a lot of contradiction among various sources. Opinions ranged from complete disapproval to partial concession in case of temporary illness. You see, this is the beauty of our religion: it didn’t leave a single issue, in sickness and in health, for which it didn’t provide or suggest debatable solutions, even when it comes to something as private as a woman’s beauty.

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This is a case of medicine from a religious point of view. A woman’s feeling are just as valid in her time of illness as they are at any other time. May God grant us, strength especially when the crisis concerns our most intimate feelings as women, our own beaty, our own crown. May God give us a crown of His own.


tumors.


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Oh, no! Not another cancer patient!If I were one of my readers, I would’ve said to myself, this doctor is making all this up! She’s dreaming up all this improbable melodrama to turn it into a novel to draw our attention. The chain of events could work as a screenplay for a good thriller movie!

The readers may be watching the escalating events like a movie, but those are real events, with real people in a real place – right here in Jeddah!

I’ll begin the story way before April 7, 2006, the day I found out I had cancer. I’ll start by telling you about “the class of ‘81.” We were the first batch of femalephysicians to graduate in the Faculty of Medicine at the King Abdul Aziz University in Jeddah. There were 24 of us. Twenty-five years on, that day wason my mind, and I felt it was an occasion that we shouldn’t let pass quietly. It was a key turning point in the long march of female Saudi doctors.

So I sent out invitations to all the other female doctors who graduated with me on that day for dinner at my home. The big day was Thursday, March 9, 2006, about a month before I first discovered the tumor.

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Seventeen of them came from Makkah, Madina and Jeddah. We recalled in our meeting memories of love and sweet times. I floated the idea of us celebratingin a way that would allow us to leave our mark, and our reword would be the good deeds that we leave behind after we’re all gone.Their suggestions were many and good. They ranged from building charity clinics to creating a fund for patients to creating a medical website to a project for research support. There was the idea to publish a book I had started on way back when, which told the story of Saudi female physicians, among a slew of other, equally excellent suggestions.We have no clue what fate has in store for us. If we did, countless things would’ve changed in our lives. Our second – and last – meet was on Thursday, April 6, 2006, the day before I found out I had breast cancer. My whole life was turned upside down, our grand project ground to a halt, and we never met anymore.

That was the beginning, but it was never the end.

In the following period, and while I was being treated, my friends told me that one of my class of ’81 colleagues is in the hospital, and that she’s having headaches and fits of dizziness and imbalance, and

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that tests have shown conflicting results, makinga clear-cut diagnosis impossible. I anxiously kept track of her condition, and asked my friends to fillme in regularly about her. I never once thought I would end up crying for her more that I would for myself. On Saturday, June 3, 2006, one of my colleagues called me with the dreaded news. The diagnosis is positive: my friend had breast cancer .

It was as if I were struck by lightning. It almost seemed surreal for two of the 24 doctors who graduated on that historic day in 1981 would contract cancer, let alone in the same period of time. The shock caused me indescribable sorrow and made me realize just how dreadful this disease is. I also felt that God has His own scheme of things, one that we might not understand at first.

But, thanks to God, I tend to see the glass as half-full. I saw in our affliction a grace from God whichHe wanted us to spread about and let the bells toll. Perhaps he wanted us to make people aware of the true pain and turmoil we have to suffer as cancer patients. I discovered the lump in my breast by mere chance, and only after the disease had spread to my lymphe nodes. My friend was also diagnosed

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too late, and she is now being treated abroad.

This goes to show that even us doctors didn’t see the importance of early detection. So none of you should be surprised to see us break the barrier of silence and shout at the top of our voices to tell the world about the kind of pain we suffer. If I had my way, I would’ve had my voice reach out through every radio in every street and every TV set in every house in every neighborhood.

International statistics say that the rates of afflictionsin Saudi Arabia are rising at an alarming rate . This means that there is a dire need for more research and support. Over the next few years, there will be more and more women of our age – and even younger -- who will get breast cancer, whether we like it or not. These days, I wonder if what we got was exactly what we asked for the day we met. I wonder if our afflictions – may God have mercy onour souls – is the price to pay for being members of the Class of ’81.

But all of this doesn’t matter anymore. What really matters now is that our condition will provoke a reaction within a society that is obsessed to the

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death with keeping a lid on things. What’s important is that we leave a mark, a message of love, that will eventually takes us to a world free of cancer, not for our own sake, but for the sake of my daughter, your daughters, and everyone who has a daughter in this world. Do not forget our messages, and do not forget us in your prayers.

I love you all.


tumors.


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Cancer is backSo, what the end of it all?

Doctors say they cannot tell a cancer patient that he or she is fully cured . Patients know that medicine has yet to come across a fully effective, comprehensive cure. They know that the illness might come back any minute. So, for them, life after treatment is a series of periodical checks and waiting for appointments. Every second is filledwith fear of the culprit rearing its ugly head all over again. I remember a breast cancer patient who had the disease tow years ago , she called me to tell me that she found another lump in her other breast, asking me to check her up. I apologized, since I was on sick leave, and advised her to go to a specialist surgeon. I will never forget, however, the fear in her voice.

That voice – and that fear – came flashing backto me one night in the holy month of Ramadan. A few days after my surgery, I was having a massage done to my arm, which is necessary to protect my arm from a possible oedema after the surgery. That night, my fingers felt a strange lump in my arm.

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My heart sank. I thought it was a new tumor. My God, so soon after the operation, in the last ten days of Ramadan, minutes before the Fajr (Dawn) prayer!

All I could do at that time was to lay down my praying mat and ask Him for His leniency in whatever destiny he had in store for me.

The next day, my dear friend Dr. Fatima Al-Thubaity, smiled at me while she examined me – instead of my regular physician, who was in seclusion in Makkah at the time – as she told me that the lump in question was nothing more than a regular sack of fat ( lipoma ( . That day changed my life. My health became something of an obsession that dominated my daily life. and I’m one who hates being obsessed with health! But this is probably why I didn’t feel the lump was there until it was in a very advanced stage.

But the illness’s comeback in this day and age is not the same as it was in the past. Modern treatment and medication have dramatically boosted survival rates and reduced chances of tumors returning. Some of these medicines has to do with hormones,

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and some of them are even more modern. After the appearance of tamoxafin and femara ,now there isHerseptin, which best reduces chances of the illness making a comeback. It is not suitable for all patient only for those whose test showed that the tumor is sensitive to this kind of treatment. It is different from chemotherapy in that is only tackles cancer cells and does not affect normal ones like chemotherapy does. This is why it has less side effects.

However, this is a long-term treatment, and it has been decided that I take it through the veins every three weeks for a year after radiotherapy.

Because the treatment of tumors is usually long and arduous, and follow-up is for the long haul, my journey through to recovery was a long one. Maybe it was longer than I or you thought, but it is a difficultone for every woman who suffers the kind of illness I did, and the same goes for her family and loved ones who received this message of love from God. I don’t know for how long these messages to you will keep coming, but this is an all-out war I chose to jump in with both feet, drawing my power and energy from every reader, for this is your journey as much as it is mine, and we will be in it together

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as long as God shall want, and as long as we reach the goal of tolling these bells loud for a world free of cancer, free of a single tear to be shed for a loved one whom we fought for.


tumors.


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Letting men knowBecause breast cancer has to do with an intimate part of the woman’s body, and because we are a society that thinks that women’s issues can only be dealt with in total silence, awareness about this killer disease becomes that much more sensitive. Checks and treatment are regularly neglected, if not totally denounced, because government and leadership, with all its rights and wrongs, is in the hands of man. That is why women’s treatment, and even surgical intervention, and particularly in urgent cases, is bound by man’s approval, for he is the only one who may allow or disallow such medical checks, and he is the one who can shove a stick in every wheel.

Woman’s dependence on man begins with things as mundane as the car he provides to move her around. Transportation is as big of a problem as it always has been for women in this country. Their hospital appointments are completely dependent on the husband’s schedule, because he is the only available provider of transportation. Thus, I cannot stress enough the point that man is a fundamental

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factor in breast cancer. No awareness or early detection program, no matter how meticulously conceived, could ever work without the husband, the father and the son being convinced of its validity. Even if women were totally convinced, success in involving the other component of the man-woman combination is of the utmost importance.

A woman told me that her mother had breast cancer, and her sister perished because of it, which means that she is at risk of contracting the disease too. She says that unlike many other women, she is completely aware that she must regularly perform mammograms. “Every time I ask my husband to take me to a hospital for the test, his answer would invariably be, ‘come on, woman, leave it to God. We only get what we had coming!’”

Another woman says that whenever she goes to hospital for a checkup, her husband gets furious, simply because most hospitals don’t have female technicians and X-ray specialists. They end up going home without ever having the test. A third woman tells me that her husband hardly takes her to the doctor when she gets sick. As for periodic checks, he thinks they are unnecessary frivolities.

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So, as you can see, men in a male-dominated society like ours need to know that these checkups are vital and could mean the difference between life and death, between total healing and terminal suffering. They need to know that by simply having early checkups could help raise chances for total healing to 97 percent. But the most important thing that men need also to know is that these checkups and early treatment of cancer is much less costly than late treatment – let alone the fact that the patient’s suffering is priceless.

That’s why when the respected Professor Zuhair Al-Sibai, head of the Health Society, a pioneer society that is concerned with the public’s health, asked me to devise a program to combat breast cancer, I included in it a chapter about men’s awareness. I suggested creating a society for the husbands and relatives of cancer patients. Those individuals have had intimate experience of their suffering, and I believe that religious preachers who know the importance and sensitivity of these issues should be enlisted to guide them. After all, we live in a country governed by a vast religious institution, and matters of health are no exception. A man of religion leads

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by example, and his words are law to Saudi men. Men of God such as the respected Shaikh Salman Al-Oudeh and others can have considerable influenceon men in our country with regard to issues such as the legitimacy of treatment and when medical checkups are necessary, and whether a woman can go to a male breast cancer specialist when there are no female counterparts available.The role of men is very important, even in fighting false convictionsabout non-medical treatments and other things. Thus, we need man’s support, and even in the media we need men as writers and journalists. I wish that we begin with publishing these messages to our sons, for they are the husbands and fathers of tomorrow, and they are the ones who can contribute to changing the landscape of this disease. They are the ones who can participate in awareness campaigns on early checkups. They are the ones who can tell their peers that early medical checkups are not a decadent luxury, but an actual religious rite, and letting female family members perform these tests means being with their beloved wives, sisters and daughters for longer. Man is our partner in the long journey to eradicate breast cancer for a cancer-free world.

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The scariest moments of my conditionJust knowing that you have cancer should be terrifying enough. But God’s graces were great. I wasn’t terrifiedwhenIfirstfelt thelumpinmybreast.But I was bound to feel terrified in other moments.On the second day of my diagnosis, they did X-rays as part of a complete checkup and to determine what stage my condition was in. I took the results on the phone, and they told me that unfortunately, the cancer has spread to most of my bones. Just like in the movies, I dropped the receiver and just sat there, stunned. To discover the lump on Friday and get a mammogram diagnosis on Saturday, I could handle that, thank God. But for things to escalate to me being told that I am in the final stage of myaffliction… just like that, inside of 48 hours, for meto discover that I had cancer and that it was in its fourth and final phase… that was just too muchfor me to handle. I called my colleague, Dr. Mona Basaleem, one of very few breast consultants in the country, and asked her about my condition. She said that in my case, surgery would be useless. The method of treatment would have to change, she said, but she couldn’t be sure over the phone.

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These are moments of our lives that we never expect to have to experience. But we do. At that moment, I was profounfly horrified. I rushed to my physicianwithout even taking an appointment. On the way there, I was feeling my body all over and asking myself: How can I possibly be in the terminal stage of the disease and not feel anything?

My physician and I did some extensive testing, and I breathed a sigh of relief as it turned out that the previous results weren’t accurate.

That was the first moment of fear I had in thisexperience. As a physician, I’ve seen patients go through rigorous testing. Now, as a patient, I’ve seen their suffering from their side and know the daily turmoil our patients have to go through with us. This is why it is vital to always take a second opinion in serious cases.

The second time I got really scared was the day I sent my results to MD ANDERSON BREAST CANCER CENTER in the United States for consultancy. They found that there was a (area of calcification) in the other breast, and they thought it might mean another lump in there. They asked me to do some

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more tests. I was mesmerized to the computer screen when I read their email. This is just too much for me to handle. At that moment I felt guilty for being weak and scared and shed a tear. I called out to God, asking Him if these were more messages of love. If they were, I hope He would help me through, for I have been plighted and He is infinitely merciful.

The hits just kept on coming, and God’s tests kept rolling. Times passed by slowly between each test and the next, until my results came back showing there was no other lump.

This was my journey before the operation, one which I tell you now in a few minutes, but one that felt like a lifetime – a lifetime of fear. We are only human, and it is human to be afraid and weak, and equally human to be patient and enduring. That is why I ask those around me to pray for me to be strong, and pray for me and you to be among those whom a Muslim cleric once described, according to a message from one of my readers: “He whom God made for heaven shall endure all kind of predicament.”

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Wanna have children?A friend of mine who had cancer told me that one of her biggest concerns was what will happen to her in the future. “Will I get married? Will I have children?”

Another friend of mine, also a physician, said that when she and her fiancé learned that she hadcancer, they moved up their wedding so they can have more time together. A third one said that when her physician told her about how slim her chances for having children, she cried more because of that than she did because of her cancer.This is what a woman – a mother – is like, everywhere, always. The cancer patient is at risk of losing her fertility and her ability to bear children because of many reasons, most critical of which is chemotherapy. Chemotherapy affects healthy cells just as it does cancerous ones. It also destroys the ovaries’ store of cells. In some cases, radiation may damage the ovaries. In others, the ovaries and the womb may have to be surgically removed in later stages.

Years ago, we didn’t have the level of technology we do now. Cancer treatment was a priority, while

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pregnancy and birth were trivial issues rarely discussed or even thought about. As treatment methods got more refined, and the better chancesof recovery that ensued, a patient who was lucky enough to recover naturally wanted to have children, and began asking when she could get pregnant – or what the chances for her pregnancy are. Truth is, these are very important questions that every patient should discuss with her physician, not after the treatment or recovery, but even before, so as to findout what can be done. Earlier studies show that 90 percent of women who underwent cancer treatment became sterile, and 50 percent of those had the issue of pregnancy and birth discussed with.

Hence, you should be straightforward and ask your doctor the questions that should be asked. You should ask whether – and how – the illness and the treatment will affect your fertility rates, what alternatives you have, and if infertility occurs, what alternative treatments there are.

In fact, some modern methods are available in some advanced treatment centers, while others are still being tested and experimented with. The available methods are fairly limited. For example, eggs can

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be drawn out and frozen. This method can be used when there is an abundance of eggs which can be used years later. However, the rates of success are low. In another method, eggs can be drawn and fertilized, and the embryos can be used later if the woman decides to have another baby. In a third method, the ovary, or part of its tissue, can be stored and then reused.

These methods are all still being tested, but they are nevertheless great new technologies that provide modern ways to give hope to cancer patients, especially young women. Dr. Ihsan Abdul-Jabbar said in an interview with Al-Riyadh newspaper (Monday, July 31, 2006) that egg freezing is a relatively new technology in which the eggs, and even sperm, are frozen. This can be helpful to men with cancer, as well as women with cancer who are still single. In theory, the eggs can be saved to be used later.

This is why we as patients should discuss all these things with our physicians. It has become a necessity for physicians to keep up with the latest developments in modern medicine so they can provide answers and ways of treatment that give

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hope, especially in light of new information that we didn’t know before. For example, we now know that that some kinds of tumors in breast cancer are considered positive receptors of estrogen. Based on that, after the end of surgery and chemotherapy, the woman is given certain drugs that block the hormone’s effects on the tumor. However, pregnancy is impossible with such drugs, because they cause the deformation of fetuses. The administration of ovary stimulants is also prohibited. That said, there are new kinds of medication that can benefit breastcancer patients.

And so it goes. These new technologies have reopened the doors of hope. However, there are moral and religious considerations to be taken on the part of the patient. As an adult, consenting Muslim, she has the responsibility – as does her physician – to be careful about what is allowed and what is not. These new methods also require treatment centers to take precautions to prevent the mixing of genes. Most importantly, they should be careful to take eggs and embryos from a woman and put them back in the womb of the same woman, without involving a donor.

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All this puts upon us doctors a great responsibility. We are required to study the religious aspects to know exactly what we can utilize to give hope to women and give them a baby’s smile, and to let them know that for every disease, God has provided a cure. Much more importantly, we should all have faith that God decides to whom to give boys and girls. Greatest of all, however, is being truly content, knowing that God has greater rewards in store for us.


tumors.


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Got cancer? Spread the word!After I first found out about my condition, when Ipublished the first article in this series, my beloveduncle was most worried about such a bold move in a society that has always tended to keep things under wraps. So he suggested we show that first article toa friend of his, renowned writer Mohammed Salah Alddin, in order to get a second opinion and start off on the right foot.Fast forward to an interview with Arab Woman magazine, one of many with the media. The editor asked me a bizarre question: “As a well-known physician, don’t you think that publicizing your story amounts to self-defamation, or do you think otherwise?”

I told him this was exactly the kind of message I wanted to send across to people around me: that defamation is a term that should be used to describe something we want to keep hush-hush. Disease is not a crime or a shame. It is a test from God, and faith is to believe in fate and accept it. What’s more important is that I’m a doctor, and spreading awareness is part of my responsibility to society, and these articles are my messages to them.

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What we actually need to do is to break the barriers of silence, especially when dealing with our own illnesses. The truth is, though, that such silence exists in other societies as well. I once read an article in a magazine by the name of MAMM, which covers cancer in women, in which women expressed different reasons why they want to keep their illness a secret. Some of them were afraid to lose their jobs, others were worried about being abused by people around them who equated illness to death, while still others simply didn’t want to be seen as weak, and others worry from the side effects of chemotherapy, and so on and so forth.

As a matter of fact, perhaps the best thing that we get from making our condition public – and which is particularly important to me – is the sheer amount of prayers we get. Perhaps a prayer behind your back can do what nothing else can. The kind of interaction I got from people made me feel I was beginning to achieve what I had set out to do. One young man sent me an email saying that he never ever thought he would one day be discussing such things as breast cancer with his mother and sisters – or to even mention the word cancer in their house.

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But it was my articles that prompted him to ask his family to pray for me and perform mammograms. They even pointed out my articles to everyone they knew.

I was in my clinic one Wednesday, and a young woman knocked on my door and left me flowersand a number of letters from her and other young women. One of them wrote: “There are young women among us who learned from your articles a lot of things that our schools, universities, and mothers, never could teach us. We write to you today to tell you that we learned a lesson from you that preachers could never instill in our minds: how to be obedient to God and accept our fate.”

Another wrote: “Please remain strong to give more. We need you, and our society needs you.”

A third wrote: “Your words made me cry, not because I feel sorry for you, but because I feel sorry for this generation’s minds. We took interest in things you’ve put on our table for us to discuss.”

A fourth letter said: “If words were a sculpture, you would’ve seen a lot of sculptures of you, because you were the heroine who triumphed against reality.

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One more letter says: “I learned from you more than just being careful to perform periodic checkups and early detection of tumors. I learned how to be firmwhen the first blow hits. You are not alone. Everyonewho has read your articles prays for you.”

Because of all of this, I say if you experience a plight from God, thank him and spread the word to raise awareness among people. I am only one woman, but together we are a force to be reckoned with. Together, we should relay what we know to our society. Our reward will be the prayers they say for us, and their reward will be the happiness they experience through the deeply moving messages they send to me. There correspondence makes me happy at a time when I need all the happiness I can get. For that, may God grant them the best of his rewards.

Thursday, August 17, 2006

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Celebrities and breast cancerThere are women who have become landmarks in the history of breast cancer.

History will always remember the courage of Shirley Temple, who contracted breast cancer in 1972. She was the first woman to break the silence and speakpublicly about her affliction. Shirley celebrated her78th birthday on April 23, 2006.Another woman who had to suffer from breast cancer was US First Lady Betty Ford, who got breast cancer in 1974, two months after her husband Gerald became president.

Another US First Lady with breast cancer was Nancy Reagan, who was diagnosed with breast cancer in October of 1987. She now plays a significant role infunding research, especially stem cell research.

At the forefront of women in the history of breast cancer is Nancy Brinker. This woman’s story is one of promise and loyalty. Her sister, Susan Komen, contracted breast cancer at an early age, and died at the age of 36 in 1980.“After Susan’s death, I felt there was a promise I had to keep, and this is how

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the Susan G. Komen Breast Cancer Foundation, the largest organization of its kind, was born,” said Nancy. “The Foundation is concerned with breast cancer research, as well as awareness and early diagnosis.”

Nancy herself fell victim to breast cancer in 1984, thus joining the list of celebrities who turned their illness into awareness campaigns to let the bells of alarm toll.These campaigns have changed the course of history. After some 80 percent of cases reached advanced stages before they were diagnosed, now about as many cases are diagnosed early, multiplying chances of full recovery.

As far as we in the Kingdom are concerned, though, the picture is equally grim: eighty percent of cases in Saudi Arabia are diagnosed only after they had reached advanced stages, which vastly undermines chances of full recovery. Despite years of research and billions spent, we still lose loved ones, mothers, sisters and daughters. Medicine is still unable to find a cure for breast cancer – all the more reasonto intensify research efforts. This illness is limitless. Thus, research is our only hope for fighting thisenemy. When we see the support extended by the

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celebrities and billionaires of western world, and how science institutions enlist them for support, and compare all that with the situation in our contemporary Muslim society, we are faced with one question: how far are the Muslim world’s rich and famous from these human tragedies? Where does all their money, their zakat and their charities go? If Muslim money were channeled towards medical and scientific research, we would have contributedto great strides in science, and we would have helped alleviate the suffering of women everywhere. Breast cancer is a problem common to women all over the world, and few homes will be spared the agony of having a patient in their midst, even the rich and famous.

Perhaps we should start now to reorganize our charities and gear them towards funding treatment of patients and supporting scientific research in aworld that has shrunk into a global village, where women’s problems are all about the same right: the right to be healthy.

May God reward you for your good deeds.

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Yes, your highness, we have a problem!An article by Abdullah Abu Al-Samah titled “Well said, Prince” caught my eye. He was commenting on what Prince Turki Bin Nasser, President of the Meteorology and Environmental Protection Commission, the authority responsible for the Kingdom’s environment protection and combating pollution, said.

Abu Al-Samah was impressed how the Prince’s comments were all about combating pollution. I’ll take this opportunity to add some very important information that few people know about the dangers of environmental pollution. There is a real environmental disaster in the Gulf, which threatens the lives of people. Statistics indicate a rise in cancer rates after the first Gulf war – which causes us toquestion what we hear about the implications of the usage of depleted uranium weapons in the war, and the effects of all the oil fields that burned up.

Information from the National Register of Cancer Tumors, issued by the Ministry of Health, indicate that the Eastern Province is the leading area in the Kingdom in the rates of cancer, especially breast

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cancer. They show an annual increase of 22 percent in afflictions among women in the area, followed bythe Riyadh area at 19.9 percent, and the Makkah Region at 16.4 percent, compared to only 9 percent in the Northern Region.

Medical sources point that the annual average of cancer afflictions is generally on the rise. Medicalcircles attribute the rise to “environmental pollution left behind by the Gulf war, as well as the region’s industrial activity.” According to information I found on the internet, after the second Gulf war, there were significant increases in the rates ofleukemia, bladder cancer and (womb cancer), which calls for a speedy search for solutions to combat the permeation of this illness, which directly threatens the Saudi society, especially that the rates of afflictionare accelerating every year. In fact, I’m seeing more and more conditions in younger people, especially breast cancer among young women, which is a clear sign that something, somewhere, is wrong. I don’t recall ever seeing or hearing about such cases so frequently in the recent past.

So, is there pollution? Is there a real hazard?

I believe I’ve already said enough. The facts are

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painful, and they are still a reality. Hence, it’s no surprise that the Prince is so concerned. The concept of environment has developed into an exact science, information is readily available, and the threat is known and common. This means that there is a grave need to take this issue as seriously as it deserves. The media must be enlisted to clarify the meaning of environment, the dangers of pollution, and the need for more studies that will help drive away pollution. There is also a need for early cancer detection. There are too many households in which there is at least one cancer patient, most of whom we don’t know about.

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Free treatment, Mr. Minister of Health!We all know that cancer greatly impacts the lives of the individual and his or her family. What we don’t know, however, and what I never knew until the day I myself became a cancer patient, is the enormity of the financial burden the patient has to bear.

This patient, Mr. Minister, may be the wife of a simple employee, the daughter of a low-income man, or she may be divorced, a widow, or the bread earner of a family, or anything else.

To build this discussion on facts, I’ll offer to the readers and the Minister of Health some simple arithmetic: a quick number crunch of chemotherapy – the cost of which is as its symptoms.

Let’s take a dose of (Taxo) for an example. The canister alone costs around SR6,000. Then again, there is the cost of checking into a hospital to take the therapy, and a typical patient needs six to eight cycles of chemotherapy. Then there is surgical therapy, which costs some SR10,000 per operation, and radiotherapy costs another 10,000 or so. This is

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apart from all those checks and analyses.

After all of this, the patient thinks that’s the end of it. But cancer treatment is a painful business, only made worse by the fact that it takes a long time. After all of that come periodical monitoring and checkups. She’ll have to take drugs for five years. Acan of (Tamoxifin) of (Femara), for instance, costsSR500 a month.

However, if the patient suffers the king of tumor I have, which carries receptors called (Her-2), she will need a dose of (Herseptin) every third week for a year. Every single dose costs SR10,000 to SR12,000.

Doing the math, that’s hundreds of thousands of riyals to be paid in a fairly short period of time, and the wheel keeps dragging on into oblivion. However, if God is willing to compound the predicament and reward the patient for her patience, and the illness resurges – and we all know that it just might – then that’s another round of pain and financial strain.

Mr. Minister, dear readers, I know I’ve caused you a lot of stress with my simple arithmetic. But it’s very important for everyone connected with a

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cancer patient. A simple employee, or even someone with reasonable income, will not be able to afford such a great massive financial burden, because thechores of life are already great. To add such a great strain on the budget of a family is pure torture.

Free therapy is only available to a select few. The majority of people do not have access to the services of university and government hospitals. As for charities, they make a great effort, and hence need the support of all of us with whatever we can contribute, no matter how small. But they simply cannot cover all of this financial burden.

Mr. Minister, in advanced countries, which consider human beings to be their greatest assets, women have made great moves that forced the Congress to amend government spending or to make decisions and recommendations in favor of breast cancer patients. They forced Congress to provide budgeting for early detection, research, and free therapy. In many Arab countries, cancer therapy is provided for free. In our country, where Sharia rules, the human being is dignified and health is consideredas a responsibility. So, in light of the huge budget the government has allocated to health services, I convey this message to you, and I hope that Your

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Excellency will look into the matter of free therapy, and providing it to citizens and expatriates alike. If we can’t help humans with cancer, what else are we going to do?

cancer patient. A simple employee, or even someone with reasonable income, will not be able to afford such a great massive financial burden, because thechores of life are already great. To add such a great strain on the budget of a family is pure torture.

Free therapy is only available to a select few. The majority of people do not have access to the services of university and government hospitals. As for charities, they make a great effort, and hence need the support of all of us with whatever we can contribute, no matter how small. But they simply cannot cover all of this financial burden.

Mr. Minister, in advanced countries, which consider human beings to be their greatest assets, women have made great moves that forced the Congress to amend government spending or to make decisions and recommendations in favor of breast cancer patients. They forced Congress to provide budgeting for early detection, research, and free therapy. In many Arab countries, cancer therapy is provided

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for free. In our country, where Sharia rules, the human being is dignified and health is consideredas a responsibility. So, in light of the huge budget the government has allocated to health services, I convey this message to you, and I hope that Your Excellency will look into the matter of free therapy, and providing it to citizens and expatriates alike. If we can’t help humans with cancer, what else are we going to do?

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