Meet the woman fighting the disease and taboos in Sudan's only breast cancer clinic

When Dr Hania Morsi Fadl left her native Sudan for the UK in 1974 to become one of the first people to train as a radiologist, she was unwittingly starting a revolutionary career. Decades later she is at the forefront of the field, and running the only breast cancer clinic in Sudan and the Horn of Africa.

As equipment developed and basic analogue x-rays gave way to CT scans and ultrasound, Dr Fadl’s career grew with the advances. When she decided to hone her expertise, her memories of the devastation that breast cancer caused women in Sudan drew her to specialise in mammography.

Dr Fadl worked in the field in London for 20 years, and with the help of the Mo Ibrahim Foundation, her ex-husband's organisation, she opened the Khartoum Breast Cancer Care Centre in 2010 in a country where cancer has risen from the tenth to the second most common cause of death. In a population of over 37million people, cancer kills 5 per cent of people each year.

“I had all this knowledge and experience, and from my visits to family in Sudan I had seen the problem of breast cancer,” said Dr Fadl, explaining that accessing cancer treatment is very expensive in Sudan, and the life expectancy of men is 61 and 65 for women.

"One of my relatives, a young lady who had kids, died of the disease in her 40s, and a lot of other friends, too."

Since it opened, the state-of-the-art centre has seen over 15,000 women and diagnosed 12,000 cancer cases, including some men. As a non-profit facility, tests and treatments are given there at affordable prices, subsidised, and are sometimes free, depending on the patient. So, while a bilateral digital mammography costs over £200 in London, most patients are charged around £30 at the centre.

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And as the centre is the only one available to women in the Horn of Africa, it is vital that all of its services are under one roof. More than 80 per cent of the Sudanese population live in rural areas or are normadic, which makes disease control difficult.

“Imagine [if you are poor] you go in one place and have you x-ray to be diagnosed and then the hospital is in a different place. That makes the communications between the team who is treating you difficult.

“So we do the assessment and we decide what will be the best thing for the lady, and then after that we carry on with her treatment. It’s [centralised care is] exactly what I used to do in Charing Cross in London.”

However, Dr Fadl has also been faced with helping to educate women in a nation beset with conflict and poverty and with a conservative culture. Until recently, public health efforts were generally directed towards tropical and infectious diseases in Sudan.

"For developing countries especially, with our customs and traditions, and even more so in the countryside, cancer is a taboo and it is seen as a death sentence."

"I realised there is really urgent need to help, to do something."

"One woman came in last February and we diagnosed her [with cancer ] but said she can be treated. We kept calling her [to come back] but she wouldn’t answer the phone. She came back in July. We asked her ‘where did you go?’ She said her son and daughter were in their final year at school and they were going to university. She stayed until they finished their exams and then she came for treatment. And of course in 6 months the disease had advanced."

Following World Health Organisation (WHO) recommendations that nations where healthcare is sparse should at least help women to become more aware of their bodies, Dr Fadl said that training and awareness-raising projects by the centre and others mean women increasingly visit her with early-stage breast cancer, rather than developed forms which are harder to treat.

Dr Fadl hopes that as rates of breast cancer rise worldwide, that awareness-raising campaigns, such as those in the UK which encourage women to check their breasts, will become commonplace in Sudan.

"The recommendation of the WHO is to make ladies breast aware. Tell them how to breast self-examine. Your breast is part of your body, you shouldn't be ashamed of it.

"We do training and give lectures, we go to schools and universities. Now we get ladies with 2cm cancer and less which is a really marked improvement."

Women whose treatment is succesful are also vital in helping to battle the disease, she added.

"When they [women] come here [to the centre] they usually bring their mum or a relative, and we try to talk to them as well and tell them 'when you go tell your neighbour and your relatives about us'."

"The survivors are ambassadors, it gives a message and people see it with their own eyes. Breast cancer is not a killer. It is not a death sentence.”

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Asked if any cases in particular have affected her, Dr Fadl fondly recalls the case of a 41-year-old woman who was sixth-months pregnant when she was diagnosed with cancer.

“We diagnosed her with breast cancer so at 6 months you can’t terminate. So, we gave her chemotherapy.

"She had a lovely girl. After that she continued with us and we gave her surgery. The daughter is now three, and we [hospital staff] were invited to celebrate her birthday. In a way she is really our youngest survivor. It is so fulfilling.”