Africa and Cancer | Taboos in Cancer Care: What matters to patients By Dr. Omar Abdihamid (Kenya)

"Weaving the cultural beliefs about Cancer as a "God-forsaken" disease in many cultures to the success of modern cancer therapeutics is a critical definition of complementary culturally based cancer care" Author: Dr. Omar Abdihamid

In the play Hamlet, William Shakespeare wrote, "Diseases desperate grown, by desperate measure are relieved, or not at all." June Goodfiled also quipped, "Cancer begins and ends with people. In the midst of scientific abstraction, it is sometimes possible to forget this one basic fact…Doctors treat diseases, but they also treat patients, and this precondition of their professional existence sometimes pulls them into two directions at once."

Millennia's old cultures and taboos across the globe continue to shape humans' present-day lives across the globe. It is a badge of honor, blessing, curse, or identity for many. Many of these taboos and practices continued to evolve and dissipate over the years, but what is more important is which ones remain to the present day and how it affects all spheres of our lives. I bring up this medieval yet poignantly modern and important topic of taboos and cultural practices because while we can easily think of them as "peculiar" and rush to patronize and "discard them," some remain critically and exclusively important to patient identity, a badge of cultural or religious honor and belief- a rapprochement. Cancer, colloquially known as the big C, is an older disease as the taboo itself and is as modern as the many present-day taboos. As an oncologist practicing in Africa, the cradle of humankind and possibly the only continent with the highest level of taboos practices and beliefs to this date, this topic hit home differently. 

"Now it is cancer's turn to be disease that doesn't knock before it enters," wrote Susan Sontag. In its very own etymology as a disease, Cancer is highly heterogeneous and a complex topic for my patients. From the various tumor types to the treatment types, to the treatment facilities, to cancer patients, to the different social determinants of health, and the insights and beliefs about Cancer, this disease remains a global scourge. Like many other unique or not so unique daily life practices, taboos also spill into the corridors of hospitals or cancer wards and clinics, to be precise.

Cancer is by far the only disease in the history of mankind that is highly aligned to negative taboo beliefs and connotations. From the Greek mythology and Latin word "crab" referring to Cancer, Greek physicians Hippocrates and Galen noted the similarity of the sea animal crab to some tumors with swollen veins, to the vivid descriptions of medieval times as "a curse from God" to the sorcery and bewitchment connotation, the cancer disease has been described globally in every passing millennium, including the modern times. But what is more important to modern cancer care is the patient's insight into their disease. In other words, how much does the patient know about their cancer diagnosis, what caused it, what is their belief on the outcome of such disease, do they believe in modern science and novel therapies, or will they rather resort to traditional healers and herbals or seek spiritual intervention.

In many instances, usually stemming from patients' education level, income bracket, age, and cultural background, the answers to the aforementioned questions are heterogeneous. Patients in rural Africa might not wholistically believe their cancer diagnosis as a "curse from God" or as an "outcast." Still, at some point, mainly due to circumstantial health inequities and disparities compounded by social-economic gaps and financial toxicity, they will resort to traditional ways of treating Cancer. These include but are not limited to; exenteration of the tumor, consumption of oral or topical herbs, physical burning of the tumor in the hope of shrinking, spiritual healing through the background faith and many more. 

Appreciating the cultural nuances and sociodemographic differences among cancer patients is the first step in empowering patients. Educating patients on the harms and ineffectiveness of the kept beliefs of outdated traditional home-based treatment strategies while engaging them as decision partners is the second critical step in improving treatment compliance. Weaving the cultural beliefs about Cancer as a "God-forsaken" disease in many cultures to the success of modern cancer therapeutics is a critical definition of complementary culturally based cancer care.

About the Author

Dr. Omar Abdihamid is a Clinical Oncologist. He is passionate about Global Oncology and cancer care in low- and middle-income countries, particularly cancer awareness and patient education. His main areas of interest are Gastrointestinal cancers, Breast Cancer, Lung, Head and neck and Genitourinary Cancers. Dr. Omar has a keen interest in cancer research and has published multiple SCI publications in peer-reviewed journals.  He is also an editor and a reviewer for several cancer journals.

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