She has spent time crawling through shadows to truly appreciate what it is to stand in the sun now. Monica Muthini, 58 years, has survived two types of cancers over a span of 20 years with the most recent one detected last year and aptly treated. This single mother of two, and now a doting grandmother, says she is twice lucky to have survived breast and cervical cancer and now spends her free time spreading the gospel on the treatment and management of cancer. Her first cancer, of the cervix, was diagnosed in 1993, when her eldest son was in Form One, in a boarding school while the youngest was in Standard Four. Her children having grown anchored on her, Monica was at cross-roads how to break the news to them. Monica says the diagnosis threw her into a sea of worry but she braved it and broke the blue news initially to her mother and later to her brothers and sisters who vowed to help her through it all even if some of them thought that it was a death sentence.“During the 1990’s, we didn’t discuss cancer in public due to the myths. Its mention evoked fears abounding but I declared I would emerge a survivor to see my grandchildren, than be a victim ,” she remembers the chilling news of the first diagnosis. I had two weeks to raise the money for the surgery besides dealing with the emotions of having a fearful disease, says Mildred, who at the time worked as a civil servant and a part-time chef. Killing cancer Her doctor Prof S B O Ojwang’ deemed it fit to remove her uterus, a procedure known as hysterectomy. This eliminated the need for other forms of treatment like radiotherapy of chemotherapy. After talking to her family, she went through the procedure. Radiotherapy involves the use of high-energy radiation whereas chemotherapy is the use of drugs administered by IV solution, by pill, or by an injection to kill cancer cells anywhere in the body.After the treatment, she was back to work and, to date, has defied the odds to see her children through secondary school and tertiary institutions. However, two decades later in April last year, she experienced what she thought was an innocent pain under her right breast and opted to self-medicate with painkillers, assuming it was a normal pain from her daily chores. “When the pain began shifting and became uncomfortable, I decided to visit my doctor who performed a mammogram, which interestingly showed that the right breast was okay but the left one had an abnormality,” she says remembering that due to cost of the test, she had initially requested that a scan of the problematic right breast only to be informed by the doctor that it was standard procedure to examine both breasts. A mammogram is a computer-aided detection taken by gently compressing the breast tissue between two flat surfaces and taking an x-ray providing information about calcifications, masses and tumours that may be present in the breast. She is glad that both were checked. When the diagnosis was out, her head dropped, tears welled in her eyes, her knees bent and her feet went feeble. Cancer a second time, she shuddered, thinking again of her family. Her sons were now grown and she was a grandmother to three-year-old Maxwell Faraji.“I had Stage One breast cancer with a tumour smaller than two centimetres,” she remembers the diagnosis that she is glad was caught early. She sought second and third opinions from doctors in other hospitals and upon the realisation that the cancer was in her body and spreading, she realised she needed to be strong for her sons whom she chose to inform after she had a clear treatment plan in order to answer their questions head-on.“After the initial shock, I informed the doctor that I wanted to begin treatment immediately to prevent further spread and one and a half weeks later, a lump was removed and treatment for chemotherapy began,” she remembers.The treatment involved the removal of the lump and the lymph nodes in the underarm area known as lumpectomy and lymphadenectomy respectively and 25 sessions of radiotherapy. “I had the radiotherapy sessions every day and one session down was a day closer to recovery,” she shares her fighting spirit tip.The side-effects of the surgery were not far from her hospital door and when they came, it began with feelings of nausea that later graduated to lack of appetite not to mention that her long silky hair began to thin. Later, she would find a handful of her hair on her pillow every morning.“Combing my hair was a frustrating experience because it came off as if it had been loosely held on my scalp,” she says adding that she learnt to deal with the side effects through leaning on her social capital who informed her that all would be well. A year after the treatment, Monica is today on a preventive pill, for the next five years, to keep the original breast cancer from recurring and its development in the other non-diseased breast.For the cervical cancer treatment phase in 1993, she spent Sh95,000 for cancer treatment and management at a private hospital compared to about Sh650,000 for the breast cancer treatment in April last year.“These unforgiving costs make it unaffordable for most Kenyans especially because our public health facilities are ill-equipped yet the number of cancer patients grow every day,” says Monica whose bills have been paid through a combined effort of her employer’s health insurance cover and top-ups from family, colleagues and friends. Balanced diet Monica also points out that a fitting treatment regime, having supportive network and attitude and simple things, such as eating a well-balanced diet can have a positive impact on your recovery. Kenya Cancer Association Vice-chair Mr David Makumi, corroborates that with the rising cases of breast cancer in the country, the quantity and quality of treatment and management available is still wanting, and efforts need to be stepped up given that breast cancer is the most prevalent form of cancer among women in Kenya. And with one in four of every women cancers being that of the breast, Makumi calls for more stringent and frequent awareness throughout the year to catch it while still early. For decades now, the call to early breast cancer screening has become a hymnal, with women ignoring calls for self-examinations and screenings. This dampens the hopes of better treatment outcomes in a country where 12 women are diagnosed with breast cancer every day. Why should you, as a young woman in Kenya, be tested earlier than your counterparts across the seas? “Kenyan women get breast cancer earlier and at a much younger age, with a peak at 35-45 year (pre-menopausal) compared to women in Europe and North America where women get it post menopause peaking from mid-50s through to their 70s,” Makumi warns. Mr Makumi dispels myths that hospitals must have expensive machines to succeed in cancer control. He points out that there are many missed opportunities in our healthcare facilities because they only address a patient’s symptoms instead of taking a wholesome approach with treatment. “Every encounter with a health care professional - from dispensary to teaching and referral hospitals - should have a cancer education and screening component,” he points out. That October is hyped as the month to create awareness on breast cancer, Makumi says it should be replicated to other months in the year due to the aggressive nature of the disease.“Breast cancer month comes and goes, yet cancer does not sleep. All organisations working in breast cancer should spread out their activities and programmes all year round so Kenyans do not have to wait for October to think about breast cancer,” he said. Cancer ambassadors hope the draft law that calls for the setting up of the National Cancer Institute will be passed as it will help drive a focused and coordinated national response not only to breast cancer but all other cancers as well.Makumi calls for the expansion of the breast awareness campaigns to both men and women in peri-urban and rural areas.“Sadly, a lot of education, screening and awareness events target urban centres yet those in rural areas are equally affected,” says Makumi, adding that he envisions counties with established cancer control programmes; with robust screening and early detection activities. As these measures are put in place, Monica says sharing the message on surviving cancer remains her endeavour and contribution, especially among women given that women are the cornerstone of the family and the country.