DR. RAZIA SULTANA
PROFESSOR,
DHAKA UNIVERSITY
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. modern period, the
concept of beauty has been changed. Poets now don’t 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. I place of this very word ‘Stan’, womenfolk now
use Bengali euphemistic words like ‘Dudi’-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
upto 10 million. About 30 percent of Cancer suffering women are
sufferers of Breast-Cancer and 20% of Cancer suffering
women die of this deadly disease.
In Bangladesh, we don’t know exactly, how many women
are development Breast-Cancer or are dying of this. In
Bangladesh, birth and death records are not properly recorded.
Death certificates are generally issued by the Hospitals.
Clinics or private physicians, where causes of the death or
names of the diseases are recorded. 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 died f
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.
In Bangladesh, about 79% of the total population live in
rural area. But, it is observed that, risk-factor for women’s
Breast-Cancer in rural areas is lower than those of urban area.
The reasons are- early marriage and early maternity, consumption
of low-fat died and common habit of breast-feeding. In rural
areas, society does not approve late-marriage. The mean age at
marriage by female in Bangladesh is 19.9. When the parents are
unable to get marriage to their daughters, they some time
suppress the breast of their daughters with wrapped clothes. As
family-planning is not universally 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 dis-continuation of
breast-feeding. Both the husband and the wife believe the
breast-feeding is injurious to the beauty of a woman. Smoking
habit does not play andy role in developing Breast-Cancer among
Bangladesh women, as they are not habituated to smoking. The
only exception are the women-falk of tobaco-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 the Cancer, but most
of them have not heard of Breast-Cancer. When a lump or tumour
develops in the breast, women are least concerned, as long as it
does not disturb or causes pain. They want to forget about is or
ignore the presence of the lump. It is a common belief that, a
tumour either subsides automatically or suppurates in due
course. When the lump or tumour 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,
desease or ailments.
But it is not so easy to tell somebody about the lump or
tumour in the breast. There is a proverbial saying in Bengali
that, ‘Buk phate to mukh fotena’ meaning “women’s heart
shatters into pieces but her month is not opened.”
Women generally don’t want to show her body or breast
to any one. They consider her body should always be covered.
Some among the Muslim community consider that any part of the
female body except the eye, shown to people, other than husband,
is a great sin. They feel ashamed of exposing their body to a
physician, male or female. When they get the permission of the
husband, they agree to let the physician examine her. We known
of one case of a village-girl, whose husband was un-willing for
a long time, to go to a male-physician to show his wife’s not
only are ashamed of exposing body, but also are afraid of
body-abuse. Though, 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- attendent or nurse, even so, unfortunate
things happen.
Medical facilities in Bangladesh are very meagre. There
is no Health insurance or Free health service, in Bangladesh.
Govt. 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 facilities. one or two hospitals in small
towns provide Cancer consultancies only. In Bangladesh, 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 out-door 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, either male or female. Government Hospital beds
are either free or paid-one. But 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 Govt. Hospital. 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 COBULT MACHINES are lying idly in Government Hospital
for want of proper technicians.
For this reason, so many private Clinic or Hospitals have been
established in different cities of Bangladesh. Some of the
private Clinics offer Mamography and other detection service.
Cost of investingation 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 faces 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 meagre or little
income, connot 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 this unfortunate disease consoles herself thinking it
as a course of God. She takes it granted the her days are gone.
She sometime leaves her habitual abode, her loving home, husband
and children to ever.
In know of one lady, who was a Breast-Cancer patient. Her
husband was almost bankcrupt in the process of her treatment,
inhome 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
husband. Unmarried girls are becoming the victim of
violation, kidnapping or acid-throwing by girl-teasers, by
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 of 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 change. 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 to 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 relation-ship or courtship with any member of
that family.
We known that, Government, Human Rights Association,
different Institution and Non-Government Organisations in
Bangladesh are typing to counter-act the Social disease called
Women-abouse. Unfortunately, there exists one Organisation in
the capital city to fight against the Cancer, named
‘BANGLADESH CANCER SOCIETY’.
Apart form the establishment of different Cancer-centre
in different cities, they have chalked out an enthusiastic
programme for the treatment and prevention of Cancer, including
the 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-letter. The
most praise-worthy effort of the society is
Cancer-inquiry-session in different educational Institutions. I
wish different organisations should come forward to combat the
Breast-Cancer in the same way.
Those who have died of Breast-Cancer in Bangladesh,
include women of different class and status, like Doctors,
Professors. Students, Litterateurs, day-labourers, and house
wives. Unfortunately it includes educated and conscience persons
too. The reason behind this, kis the ‘hush-hush’ attitude
to-words the Breast-Cancer. We are sorry, as we could not do
anything for them.
Those who have developed Breast-Cancer, hiding their face
behind the window-curtain in agony and shame, possibly we can do
something for them. 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 should try to know the
basic facts of Breast-Cancer. Days of silence and social taboos
have gone. Let all of us know that Breast-Cancer is not an
infectious disease and it can be easily prevented. One must
know, what is a Breast-Cancer ? How it developes ? How do detect
it ? How do the necessary treatment ?
Mass communication-media can play vital role in this
sphere. In Bangladesh, we have seen, the role of the media in
propagating Tuberclosis treatment, Family-planning,
Environmental and pulation problem, public health etc.
successfully. In some Bengali fiction and television plays, we
have seen heroines suffering form an un-named disease rejects
her lover and she retires in lone-sufferings. This pessimistic
attitude must be replaced by optimistic message, where the
heroine fights with all odds, to combat Breast-Cancer.
In must be stressed on this point, that one who does not
fight with the odds, ignorance, prejudice, she should be
condemned for SELF-ABUSE.
Dr. Razia Sultana, Professor Dhaka University was invited
to present this paper at the ‘world conference on Breast
Cancer’ held recently at Kingston, Ontario, Canada. This paper
was read at the conference by some-one on behalf of Dr. Sultana
on 14 July 1997 as she could not go to Canada.
