Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Instagram
  • Listen to CMAJ podcasts
Humanities

Cancer in a time of Ebola

Kevin Pottie
CMAJ July 12, 2016 188 (10) 759-760; DOI: https://doi.org/10.1503/cmaj.151363
Kevin Pottie
Department of Family Medicine, Bruyère Research Institute, University of Ottawa, Ottawa, Ont.
MD MClSc
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Responses
  • Metrics
  • PDF
Loading

Yes, you have breast cancer. The tests clearly show it.

Your chart indicates that after your practitioner discovered the lump, a mammogram and then an ultrasound-guided core biopsy suggested an invasive ductal carcinoma, and surgery was recommended. As best as I can tell, you stopped there.

You are still a young woman, from my perspective. You have a beautiful daughter starting school and older children starting families. I want you to remain healthy. I have heard that your surgeon, radiologist and oncologist have given up on you. Or you have given up on them. You and I, we have a history of fighting illness together. Our routine has been that I play the advisor and you fight for what you believe in.

Ebola has begun to spread in Guinea, Sierra Leone and the Ivory Coast. As fear and panic take hold, people hide in their homes. Médecins Sans Frontières declares an Ebola epidemic and leads an emergency public health response. Within months, thousands of people fall ill with fevers, weakness, muscle pains and headaches. More than half of those admitted to hospital with Ebola will die over the coming months. Western doctors, traditional healers and sorcerers alike desperately seek answers. Trust is in short supply for hotas, strangers that come from away. In the crisis, rural people head home to cope, to the countryside. Most West Africans believe death occurs when an outside source weakens one’s life force.

You decide to treat your curse, the breast lump, your way. You return to your place of birth in upper West Africa. You enter the territory affected by the Ebola outbreak, undeterred. Not a city, but a rural savannah full of colourful fields, rolling hills, green trees and charcoal burners’ huts. Western-style hospital care remains a luxury in these parts. You visit your mother. You seek consultation with your healer. Both are happy to see you after so many years. Your witch doctor, a sowei elder, spends time getting to know you again. In his home he examines your breast inquisitively and later offers you a cutting and cleansing ceremony. The surface of your skin is cut, your blood is let and neat rows of scars are left as flame-shaped tattoos to guard your breast.

Figure
Image courtesy of Henrik5000/IStock

You come back to Canada. We sit in my clinic. Over several visits, over several months, I do my best to understand, to learn more about you, your beliefs about disease and your family in West Africa. You tell me about your mother, the plot of land that you are keen to inherit and your long-standing dream to move back to West Africa. You tell me how land is linked to family, and family is linked to traditions. I attempt to ask about the impact of Ebola on your family, but your eyes drop and your head shakes. So, sometimes we sit in silence. Later, you begin talking about how fast your daughter is growing up, and your smile is back and we laugh. You are never afraid to laugh.

I decide to ask you again to see the Canadian surgeon. I explain again how treatable this form of cancer could be, a kind that we can remove and maybe even cure. You listen silently with respect, but then violently shake your head and your body moves with conviction. You do not want anyone to do invasive surgery on your breast. You strongly believe that surgery will weaken you and that the sickness will spread. Bad spirits will get in. Doctor, you say, I will die. In your eyes, I sense fear of impending death.

Back in West Africa, people continue to die of Ebola. Fisticuffs break out between mourning souls and hospital authorities. People ignore the threat of fines and imprisonment, finding it near impossible to give up their traditions. The closest family members shave and then wash the corpses with mud for a week-long ritual of drumming, chanting and dancing that gives strength to a transitioning life force. The ritual also serves to free family members from the corpse’s jealous spirit so they may go on to live and to marry again. We know about these beliefs and the heavy toll for family loyalty, say the African anthropologists, but it is very hard to change customs, even in a time of Ebola.

I reflect on your life trajectory, your struggles during the long civil war and your determination to continue to remain self-reliant. In difficult circumstances, you have held tight to your beliefs, but you have never stopped coming back. Although I continue to believe surgery for your invasive breast cancer is well worth consideration, I respect your choice at this moment in time. I will not take away your autonomy, and you will continue to come for appointments. And under the auspices of these appointments, physical exams and a continuing relationship, I will learn from you and study the origins of your choice to forgo surgery. Within this arrangement, we will continue to work together and I trust there will be opportunities to help.

Footnotes

  • This article has been peer reviewed.

  • This is a true story. The patient has given consent for this story to be told.

PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 188 (10)
CMAJ
Vol. 188, Issue 10
12 Jul 2016
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Cancer in a time of Ebola
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Cancer in a time of Ebola
Kevin Pottie
CMAJ Jul 2016, 188 (10) 759-760; DOI: 10.1503/cmaj.151363

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Cancer in a time of Ebola
Kevin Pottie
CMAJ Jul 2016, 188 (10) 759-760; DOI: 10.1503/cmaj.151363
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Footnotes
  • Figures & Tables
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Ten million and counting
  • My three-point turn toward personalizing good death in old age
  • Delirium: perspectives of a patient’s wife and daughter
Show more Humanities

Similar Articles

Collections

  • Topics
    • Cancer: breast
    • Patient education
    • Patient's perspective
    • Shared decision-making (doctor-patient)

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: [email protected]

CMA Civility, Accessibility, Privacy

 

Powered by HighWire