In the past, when we needed radiation for  patients, we sent them to the University of Ibadan in Nigeria. This site is about 350 miles from Aba, where the Nigerian Christian Hospital is located. Unfortunately, the radiation treatments were too costly, so we have switched to the Ahmadu Bello University Teaching hospital in Zaria, Northern Nigeria. This is a 500 mile trek from Aba that takes 21 hours - in a bus which is not air-conditioned. The trip, room, board and radiation are quite costly-about $625.  Overall, radiation is a formidable undertaking. Many patients never make it to treatment, but just go home and die. 

It is important to remember that most of the patients have never been out of their village. The average monthly income of a patient that comes to the Nigerian Christian Hospital is only $100. So a bill for $625 is about 6 months income! We obviously can't save every patient, but we do feel an obligation to the individual patient who we have already treated with chemotherapy and surgery.

Peau d'orange skin
We recently sent our first patient to Zaria. I met this lady while on a mission trip to Eku, Nigeria, which is in Delta State-an 8 hour drive from Aba (this drive was quite interesting as we were stopped by the police, who then left us in the hands of bandits who wanted a "small fee" to let us proceed). 

This is a  pretreatment picture-note the  peau d’orange (orange peel skin) which is the edematous thickening and pitting of breast skin. The  striking orange peel appearance stems from lymphatic edema around deepened hair follicles. Peau d'orange is a sign of advanced breast cancer.

We treated this lady with neoadjuvant chemotherapy and the tumor shrunk considerably We then performed a modified radical mastectomy. To our dismay, she developed a local recurrence so we sent her for radiation. Fortunately, she has a very supportive sister and a small amount of money. She is still in Zaria receiving radiation.

Advanced breast cancer is common in Nigeria. Either through denial, lack of education, fear, or all of these-many Nigerian women (and occasionally men) present in the late stages of breast cancer. The tumor erodes through the skin and rots. Sometimes the patients come for consultation and ask for a pill to make it go away! Often there is nothing we can do. We try chemotherapy, radiation, and surgery but many succumb to the disease. For many, death is a release since they suffer so much with their disease.

 “All existing things are really one. We regard those that are beautiful and rare as valuable, and those that are ugly as foul and rotten.  The foul and rotten may come to be transformed into what is rare and valuable, and the rare and valuable into what is foul and rotten”  Zhuangzi