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Dr. Miriam Mutebi, Consultant Breast Surgical Oncologist and Assistant Professor in the Department of Surgery at Aga Khan University Hospital, and Clinical Epidemiologist and Health Systems Researcher. [Courtesy]

Sunday Magazine
Nothing good comes easy; that’s one of the best pieces of advice I’ve ever received. But it is also critical to find your “why”.

Nothing good comes easy; that’s one of the best pieces of advice I’ve ever received. But it is also critical to find your “why”.

The Japanese talk about the concept of ‘Ikigai’, and this involves finding the intersect between what gives you joy, a sense of purpose and meaning, and what can make a positive impact to those around you.

You can work hard, but if you don’t know why you’re doing it, it won’t make sense. I like to say I am in the hope business, and this may confound people, because for the longest time in our country, the narrative has been that cancer equals death.

We are spreading the message that cancer is not only treatable but if caught early and given the correct treatment, it is also curable and that patients can live long, meaningful lives after their cure.

SEE ALSO: How to stay safe as you seek care in hospitals

Key component of my ‘why

It is not about giving people unrealistic hope, but giving them hope within the context of what their diagnosis is and what the expectations are in their management. That is a critical part of my “why”.

During my surgical residency, I noticed something. We’d learnt in school that breast cancer was a disease of the sixth and seventh decade, meaning it might affect you in your sixties and beyond, but the patients walking in were in their 30s and 40s.

We also learnt in school that some of the traditional risk factors included never having children or breastfeeding. Again, our patients were young, had children, and all had breastfed.

Despite all these traditionally protective factors, they were still being diagnosed with cancer. I thought to myself, someone needs to figure out what is going on with! That drew me to breast surgery.

SEE ALSO: Agony for cancer patients as caregivers stay away

Where I found my passion

Also, find your passion. Mine is making a positive impact in women’s lives. We have deliberately made the breast clinic at Aga Khan University Hospital a safe space.

I like to say it’s the place where I get the most hugs and tears, because women come in in tears, and leave smiling. When they come in with a concern, we explain to them that a considerable number of breast concerns and lumps are not a breast cancer.

Indeed, nine out of ten breast lumps are not a cancer. We then we work closely with them to ensure that they understand and continue to improve their breast health and awareness and make sure they leave empowered.

But it is not enough to tell them they are fine and they can go. The concern, for most of them, is not necessarily about cancer but the downstream effects – what a potential diagnosis would mean to their children, their families....

SEE ALSO: Cocktail of trouble: Why Kenya has highest breast cancer risk in Africa

Unless you address those fears, it is not enough to tell them they’re fine.

I might be the only female breast cancer surgeon in Kenya, and I am grateful for the privilege to directly impact care in my region.

I am happy to note that there is an interest in breast surgery and that there are a few more in training, so we will hopefully have an increase in numbers over the next few years.

We have about 15 female surgeons in Kenya, and similarly low numbers are seen in different countries across sub-Saharan Africa. Even when we are encouraging more women in surgery, it is not just for numbers’ sake.

Women have a unique role to play in the socio-cultural context, especially in Africa.

SEE ALSO: I had two choices: Kill my son, or my cancer

For instance, colleagues have shared where an older woman might walk into a hospital with vaginal bleeding and feel uncomfortable talking to a younger male doctor and leave.

Some women feel uncomfortable having their breasts examined by male specialists.

For us, the point is not just how to increase the number of women in surgical specialities, but also to support them and give them the skills they need so they can become advocates for healthcare improvement and change within their varying healthcare ecosystems.

I keep a gratitude journal

Evenings are my favourite part of the day. I get a chance to reflect and recharge through journaling.

SEE ALSO: I found my ‘why’ fighting breast cancer

I maintain a gratitude journal. I have learnt from my patients to live in the moment, engage with life fully and practice daily gratitude.

Journaling helps put everything in perspective: I look at how many of the day’s goals I have achieved, not with the intention of beating myself up for what I haven’t, but to be grateful and celebrate little triumphs or steps that I have achieved.

 I also like to read but usually leave my reading for the end of the day.

I usually to have several books going. I’m currently reading Educated by Tara Westover, Better by Atul Gawande, and Quiet: The Power of Introverts by Susan Cain.

I love the classics, and some of the books I constantly re-read include Chronicle of a Death Foretold by Gabriel Garcia Marquez, which I recommend for its compact excellence; The importance of being Earnest by Oscar Wilde, for its incisive wit; and Pride and Prejudice by Jane Austen, which is a brilliant social commentary disguised as a ‘boy meets girl’ kind of story.

The measure of a great book is when it keeps me up turning the pages late at night – and that for me was my latest re-read of Chronicle of a Death Foretold.

How I recharge

Outside work, I love theatre…no pun intended and dabble in creative writing, with, I must say, a somewhat questionable prose and poetry output though.

I think there used to be a dichotomy between the arts and the sciences, but embracing the two I find helps me a better clinician.

I find that engaging with these processes gives me greater insights into the nuances of socialisation, which ultimately helps to enhance my empathy.

It is important to recharge, refill and also recognise when you are getting exhausted and when you need to take time to rest and recalibrate.

As a clinician, it is critical for me to always give my best to the people I serve, but one cannot give from an empty cup.

-Dr Mutebi is a consultant breast surgical oncologist and assistant professor in the Department of Surgery at Aga Khan University Hospital. She is also the  vice president of East Africa of the African Organisation for Research and Training in Cancer, is on the executive committee of the Kenya Society of Haematology and Oncology, co-founder of the Pan African Women’s Association of Surgeons and is part of the Kenya Association of Women Surgeons.


Breast Cancer Aga Khan University Hospital Dr. Miriam Mutebi

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