By Nyasha B. Dube
“For me, cancer meant death,” says Pelagia Chibaya (49) as she fixes her red morning gown and reaches for her maize meal porridge bowl which is on the table.
She sits comfortably on the sofa in her newly refurbished home and after a few minutes, the scent of burning food fills the living room. It is the leftover porridge she had forgotten on the stove which was on.
“These are some of the after effects of chemo. I also experience hot flashes and poor eyesight” she says as she rushes to take off the pot from the stove. She comes back and sits down, ready to tell her story.
Pelagia hails from Chivi, in Masvingo province but currently stays in the small mining town of Zvishavane in the Midlands province.
Her journey with breast cancer began in 2017 when she noticed a painless lump in her right breast, which would be removed four years later after a turbulent journey of denial, desperation and dread.
“Life as I knew it changed,” says the former cross boarder trader and mother of four.
When she discovered the lump, Pelagia says she ignored it largely because of the misconceptions surrounding cancer in Zimbabwe. In 2018, a friend advised her to seek clinical care after examining the lump which had grown bigger, and she visited Zvishavane district hospital where she was screened.
“The doctor told me that it could be a cancerous lump and referred me to United Bulawayo Hospitals (UBH). My world started spinning, I cried as I walked out of that examination room. I went home and shared the news with my husband who was very supportive, but part of me was still in denial. We went to the hospital and got a long list of the processes I was supposed to go through so they could confirm it really was cancer. The total amount was around USD$800 and by then my husband was not formally employed. We only had something like USD$30. It would simply not work,” said Pelagia.
Women in Zimbabwe remain vulnerable to health challenges, and their situation is worsened by lack of meaningful government long-term investment in the health care sector. For the past 15 years there has been a decline in the amount allocated to the health sector in the annual national budgets. According to available data on the country’s National Health Financing policy, government funding allocated to the health sector falls short of the international benchmark of 15% pegged as per the Abuja Declaration. In 2022, 10.6% was allocated to health and in 2023 the budget slightly increased to 11.2%.However, in the 2024 annual budget, a lowly 10.5% was allocated to the health ministry.
The under allocation of funds to the health sector weighs heavily on women diagnosed with breast and cervical cancers. Cervical cancer ranks as the first most frequent cancer among Zimbabwean women aged between 15 and 44 with a 30.2% prevalence, followed by breast cancer which accounts for 12.4% of the cancer cases according to the Zimbabwe National Cancer Registry. Zimbabwe, with a population of over 15 million, 52% of whom are women, has only two public health institutions that offer radiotherapy treatment in the country, which are Mpilohospital in Bulawayo and Parirenyatwa Group of Hospitals in the county’s capital, Harare (ZimFact:2023).
This speaks to centralization of cancer treatment services, where very few have direct access to such essential facilities. The radiotherapy machines at both hospitals have also been down for years now, and patients have to be booked on a waiting list basis, hence putting their health at risk, given the prolonged waiting periods and deteriorating health conditions. Poor equipment of local hospitals coupled with the exorbitant cost of treatment of between USD$150 and USD$1 000 per session – which is way beyond the reach of an average Zimbabwean woman – stand as a stumbling block.
“I was not really feeling any physical pain so we returned home and did not act for months until I told my young sister who is in South Africa and she suggested that I go there. I went to South Africa where they did a biopsy, X-ray, scan and mammogram all for free. When the results came back the doctor sat me down and broke the news to me, I had breast cancer and had to start treatment which included six chemotherapy cycles, an operation to remove my breast and radiotherapy. This would take months. I started thinking about my children, the youngest one was eight years old by then. I told the doctor I would not be able to do it and he referred me to the hospitals back home,” said Pelagia.
She added, “I came back home, ridden by fear and denial. I became so prayerful, I really hoped I could pray the cancer away but that did not work. I opted for the traditional route and tested almost every medicine there is, some of it being smeared on the breast, still that did not work, instead the lump burst and became a very sore wound. My health deteriorated because of the wound.”
More women have found themselves seeking the traditional route to escape from the exorbitant costs of cancer treatment, as asserted by Naturopath Tinashe Manzvii of Laxen Naturals.
“Herbal medicine has played a complex role in cancer care and I have seen more women use herbal medicine as an alternative or complementary therapy in response to the high costs of conventional cancer treatment. While some herbal remedies may alleviate the symptoms, others may however exacerbate side effects or even hinder conventional treatment efficacy,” Manzviisaid.
For Pelagia, the traditional alternative did not yield productive results, leaving her with no option but to go the conventional route.
“In 2021, I finally accepted that I had breast cancer and went to the hospital. I started my chemotherapy sessions in June 2021. These cost over USD$200 per session, plus transport and other costs. My endless visits to the oncologist were expensive and some of the medication prescribed would cost over USD$400. To date I haven’t done radiotherapy because no hospital has those machines here in Zimbabwe, the ones at public hospitals broke down.”
Many women in Pelagia’s predicament struggle to access proper cancer screening and treatment services due to high costs.
“I noticed a lump on my breast last year but I could not access hospital treatment. At the local clinic they referred me to the district hospital but I had no money for transport or screening. I even avoided going there because being diagnosed will mean more money which I could not afford. I do not know what will happen next,” said 65 year old Egnetha Sibanda from Mazvihwavillage in ward 14, Zvishavane.
A health official from Zvishavane District Hospital, who spoke on condition of anonymity says it is important for women to practice Breast Self-Examination (BSE) to promote early detection given the poor state of cancer equipment in the country.
Sibonisiwe Murambwi (35) also narrated her ordeal seeking cervical cancer screening services.
“All I knew is that cervical cancer kills, and after I noticed some signs and symptoms I wanted to do a pap smear at the local district hospital. I went there several times but could not be assisted. On some days I would be told that the machines are dead, on some days there would be no power. There would always be excuses,” Sibonisiwe said.
Sabrina Kundai Chambara, a women’s economic rights advocate with Women for Economic and Social Empowerment (WESE) says addressing the disparities in access to cancer care for Zimbabwean women requires a multifaceted approach.
“A combination of policy interventions, community based initiatives and educative programs are needed. Women also need to be economically empowered to reduce the financial burden and improve health outcomes,” Sabrina said.
The Ministry of Health and Child Care launched the 2014 to 2018 National Cancer Prevention and Control Strategy whose vision was to establish a “cancer free Zimbabwe” and increase awareness on all cancer related issues, however to date cancer treatment remains centralized and beyond access for many women. The strategy as updated in 2022, with support from World Health Organization (WHO) to now stretch from 2022 to 2026.
Whilst Pelagia opted for the private care route after the care she received at public hospitals did not yield much fruit, very few women can afford that alternative.
“I am a survivor. I survived the ruthless side effects of chemotherapy, losing hair and all. At one point the cancer started spreading to my spinal code but it was contained. I may be taking medication for life but I believe I am lucky that I conquered the battle. I watched my peers dying and even now in our support group we receive news of death all the time. Having cancer is not an easy experience,” said Pelagia as she was attending to her three weeks old chicks since she has started a poultry project.
“My only hope is to see the day when women can access cancer treatment for free,” Pelagia said.
Initiatives like the National Cancer Control Programme, the government Human Pappillomavirus vaccination rollout and organizations like Cancer Association of Zimbabwe have played a role in mitigating the cancer burden as well as providing platforms for information sharing, support groups and social support for cancer patients.