In medieval Bengali literature (12th to 18th century), it
was common poetic diction to describe and eulogize the beauty of
the heroine’s every part of her body, beginning from the head
to her toes. It was a popular fancy of the poets to draw the
similarity of the breast to a golden cup. In the modern period, the
concept of beauty has been changed. Poets now do not fancy with
the beauty of the body of his beloved but the beauty of her face
and personality. It is also a social taboo in uttering ‘stan’
a
word in Bengali, for breast. In colloquial language, this word
is not used. In place of this very word ‘stan’, womenfolk now
use Bengali euphemistic words like ‘dudh’-meaning milk or
‘buk’ meaning chest. Like the word ‘stan’ or breast,
cancer is also a prohibited word.
It is a known fact that,
cancer is the most fatal disease
in this world and breast cancer is termed as the ‘Greatest
Killer of Women’, between 25 and 50. According to WHO’s 1985
report, about five million people die of cancer every year and
it is apprehended, after twenty five years this number may rise up to
10 million. About 30 percent of cancer suffering women are
sufferers of breast cancer and 20% of them die of this deadly disease.
In Bangladesh, we
do not know exactly, how many women
are developing breast cancer or are dying of this. Here birth and death records are not properly done.
Death certificates are generally issued by the hospitals clinics
or private physicians,
who record causes of the death or
names of the diseases. In cases of dying of cancer or breast cancer, just ‘cancer’ is written,
breast cancer is
never mentioned. For that reason, it is difficult to know the actual number of women who died of breast
cancer. It is estimated that, about 17% of the women
suffering form cancer are breast cancer sufferers. One in
thousand in Bangladesh is developing cancer in the breast and
half of them expire after long suffering.
About 79% of the total population
in Bangladesh live in
rural area. But it is observed that, risk-factors for women’s
breast cancer in rural areas are lower than those of urban area.
The reasons are early marriage, early maternity, consumption
of low-fat diet and common habit of breast-feeding. In rural
areas, society does not approve late-marriage. The main age of females at
marriage in Bangladesh is 19.9. When the parents are
unable to get their daughters married, they sometimes
suppress the breast of their daughters with wrapped clothes.
Family Planning is not accepted in villages,
early-maternity is encouraged and celebrated. Economic condition
and austerity also bounds them in consuming low-fat or non-fat
diet. So the village-women are less prone to the risk-factors of
breast cancer.
Compared to the women in rural areas, the urban women
have high-risk factors to breast cancer. In urban area, early
marriage is very much discouraged. Child-birth is delayed by
late-marriage, and also due to the promotion of Family Planning.
The tradition of breast-feeding is also in the declining
position. Baby foods are easily and sufficiently available in
the city markets, which encourages the discontinuation of
breast-feeding. Both the husband and the wife believe that
breast-feeding is injurious to the beauty of a woman. Smoking
habit does not play any role in developing breast cancer among
Bangladesh women, as they are rarely habituated to smoking. The
only exceptions are the women-folk of tobacco-growing villages in
Northern Bangladesh, where rural or working class of women are
used to smoking-habit.
Women in Bangladesh, either in villages or in the cities,
are the worst breast cancer sufferer due to so many reasons,
like ignorance, shyness, social taboos and economic austerity.
Women in general, have heard about
cancer, but most
of them have not heard of breast cancer. When a lump or tumor develops in the breast, women are least concerned, as long as it
does not disturb or cause pain. They want to forget about it or
ignore the presence of the lump. It is a common belief that, a tumor
either subsides automatically or suppurates in due
course. When the lump or tumor causes pain or continues for a
long-time, they become alarmed.
In a society, where a wife eats the residue of the food,
after all members of her family have taken their meals, it is
quite natural for a women to be least-worried for her health.
But it is not so easy to tell somebody about the lump or
tumor in the breast. There is a proverbial saying in Bangla, ‘Buk phate to mukh fotena’ meaning
'women’s heart
shatters into pieces but her month is not opened.'
Women generally
do not want to show her body or breast
to anyone. They consider her body should always be covered.
Some among the Muslim community consider that any part of the
female body except the eyes, shown to people other than husband,
is a great sin. They feel ashamed of exposing their body to a
physician, either male or female. When they get the permission of the
husband, they agree to let the physician examine her. I know
of one case of a village girl whose husband was unwilling for
a long time to go to a male physician to show his wife. They are
not
only ashamed of exposing body, but also are afraid of
body-abuse. In Bangladesh, it is believed to be an
ethical duty
of a male physician to examine a female patient with the
presence of a female attendant or nurse. Even so, unfortunate
things happen.
Medical facilities in Bangladesh are very
meager. There
is no health insurance or free health service in Bangladesh.
Government
officers receive less that 200 taka or 6 Canadian dollar
per month as medical allowance. Health service is also confined
to limited sphere. There are 1397 government dispensaries mostly
in villages for free dispensing service. Government hospitals numbering about 645 are situated in different cities. Apart from
hospitals situated in Dhaka, most of the government hospitals provide no
cancer treatment. Only one or two hospitals in small
towns provide cancer consultancies. There
are about 44 T B clinics, but only one hospital for cancer treatment, which is known as ‘Cancer Institute and Research
Hospital. This cancer hospital, with the co-operation of the
Bangladesh Cancer Society, provides outdoor service for
mammography and other kinds of breast cancer detection. Number
of beds in the cancer hospital is only 50, for all kinds of cancer
patients, both male or female. Government hospital beds
are either free or paid ones where beds are not easily available.
People coming from the remote places throngs in the hospital-corridor. According to the Statistical Report (1996),
the number of persons per hospital bed are 3,229 and there are
4,866 persons per physician. There is only one mammogram in the
Cancer Hospital, but no mammogram machine is available in any
other government hospitals. President of the Bangladesh Cancer Society, in his 8th
Annual Conference speech gives a grin
picture of cancer treatment in Bangladesh. He feels sorry to see
that six Cobalt Machines are lying idle in government hospitals
for want of proper technicians.
For this reason, so many private
clinics or hospitals have been
established in different cities of Bangladesh. Some of the
private clinics offer mammography and other detection service.
Cost of investigation or treatment are too high to afford for a
person of normal means. For any kind of operation in a private clinic, one has to pay a high priced bill.
So, after physical inspection or palpation, if
cancer is
suspected, the patient and her family face problems concerning
treatment and its expenses. If they are residing in villages,
they must go to the city hospital. They become scared of hospital
expenses. Parents or husband with meager or of little
income, cannot cope with this unexpected expenditure.
Consequently, treatment is discarded half-way and operation, if
necessary, are avoided for fear of big expenses. An woman
suffering from this unfortunate disease consoles herself thinking it
as a course of God. She takes it granted that her days are gone.
She sometime leaves her habitual abode, her loving home, husband
and children for ever.
I
know of one lady, who was a breast cancer patient. Her
husband was almost bankrupt in the process of her treatment, in home
and abroad. Before she breathed her last, she uttered
‘Oh-God, Don’t give this disease to a poor family.’
Of late, in Bangladesh, women-abuse has become a frequent
happenings. Thousands of women and girls are smuggled out of the
country for trafficking purpose. Hundreds of wives, either are
killed or commit suicide for failure of paying dowry to the
husbands. Unmarried girls are becoming the victim of
violation, kidnapping or acid-throwing by girl-teasers, denied lovers, or sex-seekers.
But, very few of us know of another kind of
women-abuse.
This is abuse of breast cancer sufferers. They are not abused physically but are abused by mental or
psychological suppression. As soon as it is known that so-and-so has developed
cancer in her breast, the total attitude of
the family members changes. It becomes an hush-hush affair, as
if, breast cancer is a dangerous and infectious disease. Nobody
dares to touch her, talk to her with sympathy or console her.
Husband too begins to sleep in separate room. Life-long cordial
relation between husband and wife is shattered and
sometimes ends up into separation or divorce. Even her child is
not allowed in her lap for fear of infection. Nobody wants to
make matrimonial relationship or courtship with any member of
that family.
We known that,
government, human rights organizations,
different institutions and non-government organizations in
Bangladesh are trying to counter-act the social disease called
women-abuse. There exists one organization in
the capital city named ‘Bangladesh Cancer Society’ to fight against
this
cancer.
Apart form the establishment of different
cancer-centers
in different cities, they have chalked out an enthusiastic
program for the treatment and prevention of cancer, including breast
cancer. The Society in 1992 submitted a comprehensive
project proposal for cancer-control to the government of
Bangladesh the fate of which is still uncertain. They are
publishing different pamphlets and periodical news-letters. The
most praise-worthy effort of the society is Cancer Inquiry
Sessions in different educational institutions. I
wish different organizations should come forward to combat
breast cancer in the same way.
Those who have died of
breast cancer in Bangladesh
include women of different classes and status like doctors,
professors, students, litterateurs, day-laborers, and house
wives. It includes educated and conscious persons
too. The reason behind this, is the ‘hush-hush’ attitude towards
breast cancer. We are sorry as we could not do anything for
them.
Possibly we can do
something for those who have developed breast cancer, hiding their face
behind the window-curtain in agony and shame. At least we can give them message of
hope that, there is treatment for their suffering. We can even
convince them that, all lumps in the breast are not malignant.
But we have many things to
do for the rest of the women
of the society, who know not of their future. We must motivate
the society to let the women of all ages try to know the
basic facts of breast cancer. Days of silence and social taboos
are gone. Let all of us know that breast cancer is not an
infectious disease and it can be easily prevented. One must know what
a breast cancer is; how it develops; how to detect it and how to
do the necessary treatments.
Mass-communication
media can play vital roles in this
sphere. We have seen, the role of the media in
propagating tuberculosis treatment, Family Planning,
environmental and population problem, public health etc.
successfully. In some Bangla fictions and television plays, we
have seen heroines suffering form an un-named disease rejects
her lover and retires in lone-sufferings. This pessimistic
attitude must be replaced with optimistic messages.
It must be stressed on this
point that, one who does not
fight with odds, ignorance and prejudices should be
condemned for self-abuse.
This
paper is written by
Dr.
Razia Sultana,
Professor
Department of
Bangla,
University of Dhaka
She
was invited to present this paper at the ‘World Conference
on Breast Cancer’ held recently at Kingston, Ontario,
Canada.
