Breast Cancer in Georgia

Wednesday 6th June 2012

I like the music teacher at my school.  One day she grabbed me and took me to the music room where they had a battered old piano and played and sang “Santa Lucia” to me.  She told me she taught herself to play by ear and can’t read music and she sounded like a pub singer, the ones that I used to go to with my mum and dad in the late 70s.  I’d given her 4 pairs of my trousers that were too big for me and she was always joking that she liked my tops (they weren’t black for starters!).  Well I thought she was joking but it probably was a direct request.  Anyhow she came over to me on Monday flapping around with her blouse saying something I couldn’t understand, and I thought she was talking about wanting my clothes.  Then she lifted up her top to show me her bra and when I still looked puzzled she took my hand and gestured for me to touch her left breast.  It was rock hard and I was thinking is that an implant?  Can’t be; and then I fell in.  She was pointing to the notice board and then back to her breast and I realised she was telling me that she had breast cancer. There was a notice about a presentation to be held the next day of Breast Cancer Prevention by the cancer Prevention unit in Tbilisi.  I didn’t know what to say.

The notice board in our staff room at Kaspi school #1

Four months ago I was introduced to a Fulbright scholar, Mahnaz, by another Fulbright Scholar, Del, who has started to come to church.  She was in Georgia, working with the government to write health policies regarding cancer prevention, diagnosis, treatment and after care.  She explained to me that in the USA 1 in 8 women were diagnosed with breast cancer but 93% of those women went on to have full and complete lives.  But in Georgia a diagnosis of breast cancer was in fact a death sentence and that this was entirely preventable.  She told me how Georgian women will not go and see their doctor if they found a lump or other concern with their breasts.  They take the attitude that they feel ok and don’t want to worry their family; they don’t want to put a financial strain on their family; they are worried that their husbands will leave them for another woman.  As a result, a diagnosis is made too late and it is too late to do anything about it.  Ironically, the family end up spending as much money on care at the late stage as they would have in the early stage.  Breast cancer is a taboo subject and women don’t like to discuss it; they keep their problems to themselves.  Mahnaz went on to say that in Georgia, after surgery, there is no after care, the women just go home.  There is no physiotherapy, no breast reconstruction, no psychological care or social support.

As part of her paid work as a Fulbright Scholar she is also involved in not-for-profit work and her focus was about educating women in Georgia about prevention and the need for early diagnosis and to help set up survivors support groups.  I asked if I could help.  Breast reconstruction was out of the financial reach of the vast majority of women and the lack of prosthesis available meant that breast cancer survivors had nothing to replace their missing breast that was the right shape and texture.  As a result, women didn’t go out and preferred to stay in indoors as they felt embarrassed about their shape.  She asked me if I would look into setting up a survivors group where women could get together to support each other and knit prosthesis for themselves and other women.  She told me about websites that offered knitting patterns and said the International Women’s Association were trying to provide materials for this to happen.

I did ask my teachers at school if they knew people who may be interested in a group but they said that Georgian women didn’t do that kind of thing and they liked to be private.  Without being able to speak Georgian, there wasn’t a lot I could do so instead I focussed on trying to organise health talks for the students which would include breast cancer prevention.  I was directed to several sources who could be of help but with only 4 months before I left Georgia there wasn’t enough time.  Instead we looked at inviting the Cancer Prevention Unit from Tbilisi to make a presentation at all 4 schools in Kaspi aimed at year 12, 11 and 10 girls and their mothers.  There is a TLG volunteer teacher in all the schools in Kaspi and we planned to work together to make this happen.

I had to produce a “Project Proposal form” and send this to TLG which set out what the presentation was about and the steps involved in completing the project.  I was getting a bit frustrated at this time as it seemed like a simple request to me and I think I put “Save Lives” as the final step in this project.  We just wanted to hold a presentation at 3 in the afternoon straight after school for female students and their mothers.  Why couldn’t the school director just say “Yes”? I spoke to my teachers, who spoke to the school director who spoke to the Education Resource Centre (ERC) who said “No”.  We then decided to look for alternative venue in Kaspi to hold the talk and while we were researching this I got in back in touch with TLG and asked if they could help.  The trouble is I just couldn’t see why they would not see it as a fantastic idea as the Director and teachers did?  What reason did they give?  “None”.  TLG came back to me and said that we could go ahead if we got permission from the Ministry of Education.  So I had to write a letter in English which had to be translated to Georgian and sent to the Ministry of Education.  This process in itself took over a week as I didn’t realise I actually had to produce a formal letter from myself making a request to the Director.  Time was ticking on and it was only 2 weeks before the talk was scheduled to take place.  How long would it take to get permission from the Ministry of Education?  No-one knew.

Because of the delays there was only time to schedule presentations at 2 schools and so we arranged them for the last possible dates, Tuesday 5th June and Monday 11th June.  I emailed TLG again to ask them to check what was happening and when I still hadn’t heard anything by Monday 3rd I let Mahnaz know that we were not going to be able to go ahead and put our hopes in the presentation at school number 3 for the following week.  However, at 10:40 the director came into the staffroom and told us that we had the go-ahead.  I could only hope that we would be able to let people know that it was happening in time.

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We had a full house! We had filled a classroom with around 10 teachers and 20 year 10 students who heard about the things they couldn’t do to prevent breast cancer (genetics) and the things they could do to prevent cancer (healthy lifestyle – eating well and exercising, having children at a young age, breastfeeding, not using abortion as a contraceptive), how and when to examine their breasts and what to check for, the importance of making an early diagnosis, screening, and what happens if surgery is needed.  It was all in Georgian and I didn’t understand a word of it but everyone looked interested.  You have to remember that this kind of event doesn’t happen in Georgia.  It’s not like the UK where personal health is part of the curriculum.

Year 10 students

Teachers

From left: maka (co-teacher),Mahnaz (Fulbirght Scholar), Tiko (Cancer  Team)
 Soso (Doctor Cancer team) Me, Maria (co-teacher) holding the board
to show how to recognise problems

Leaflets were left and placed in the staff room so that those who weren’t there could get the information and there were many positive comments were made.

Today in staff room, the music teacher came and sat next to me on the settee with a leaflet in her hand.  We just sat there together, she didn’t say anything; but sometimes there is nothing to be said.