United by Unique: Stories of Resilience, Drawbacks, and Progress
We spoke with patients, frontline workers, and advocates in women’s cancers to learn about the challenges in providing access to quality surgical care in resource-limited settings.
In the series Voices in Global Surgery, we take a look behind the scenes of global surgical care.
By Yuval Cohen, Nefti Bempong-Ahun, Julia Curran, and Mélanie Samson
February 4th marks World Cancer Day, a moment when communities come together to share experiences, education, and stories in the journey of improving cancer care for people everywhere. The 2025-2027 theme is United by Unique, an initiative to highlight the unique stories, challenges, and perspectives of people with lived experiences with cancer.
We highlight four personal testimonies
As part of our Voices in Global Surgery series, we spoke with patients, frontline workers, and advocates in women’s cancers to learn more about the challenges in providing access to quality surgical care as part of multidisciplinary treatment for cancer in resource-limited settings.
We highlight four personal testimonies of patients who survived their own cancer diagnoses, of advocates who dedicate themselves to address gaps in care, and of those who wear both hats.
Mary Wong-Hemrajani shared her story with the GSF team.
Patient group engagement for more equity in Hong Kong
Mary Wong-Hemrajani is the Chairwoman of the Global Chinese Breast Cancer Organisations Alliance (GCBCOA) and a breast cancer survivor. She works to bridge the gap in care for women with breast cancer to improve their outcomes and patient experiences.
Mary shared with the GSF team the critical role surgery plays for a positive breast cancer prognosis. “From a patient point-of-view, if we can get surgery to rid the tumour from our body, it’s a relief,” said Mary. “But unfortunately, in many places, getting surgery can take a long time. In public hospitals in Hong Kong, it can be a two-month waiting time. During that time, there is a strong burden of worry on the patient.”
From a patient point-of-view, if we can get surgery to rid the tumour from our body, it’s a relief
— Mary Wong-Hemrajani
“I was worried that the tumour would grow very fast. I didn’t know if, during these six weeks, the tumour would worsen. There is nothing you can do except wait – the pressure is significant,” Mary added, reflecting on her own experience as a breast cancer patient.
Mary recalled that the wait time for surgery used to be shorter. “Surgery would be available within 4 to 6 weeks, now it is 6 to 8 weeks. This is due to a lack of medical staff and surgeons in the public sector. The private sector is quicker, but most cannot afford it.” Timely treatment is critical in cancer care and additional wait time to undergo surgery can make the difference between a patient treated at stage II or stage III, for example, with the resulting implications on the prognosis.
To accompany women through the patient navigation process, Mary leads a patient support group called the Global Chinese Breast Cancer Organisations Alliance (GCBCOA). “Ninety percent of the women we support are from a low-income background. They cannot afford to go to the private sector for a diagnosis – even though having one would speed up the process of getting surgery in the public sector,” she added. Through the GCBCOA, she attempts to negotiate with private clinics to provide reduced fees in some of these cases.
Pink Medical, a new initiative established by the GCBCOA, encourages private medical practitioners to volunteer their time for low-income patients waiting to receive their consultation and diagnosis. Mary emphasised that prioritising surgery means prioritising diagnosis: “If a private doctor can give a diagnosis or recommendation letter, this could shorten the wait time for urgent cases while they are stalled in the public system.”
Moving further along the continuum of cancer care, similar inequities exist for reconstructive surgery. “Access to reconstruction is free in the public sector. However, it must be done as a separate surgery due to a lack of specialised medical professionals. Women may wait as long as a year for reconstruction after the original cancer surgery,” Mary added. “In the private sector, on the other hand, you can do the tumour removal and the reconstruction at the same time.”
The scar doesn’t define us. It doesn’t mean we are lesser people.
— Mary Wong-Hemrajani
“It takes a lot of courage to go on the surgery table a second time. Some women decide not to proceed because of this,” she said. Mary feels passionate about accompanying women through this process and incorporates psychological support into her initiative’s programming. “In our supportive care for women, we try to help them accept their bodies with the scar. The scar doesn’t define us. It doesn’t mean we are lesser than other people.”
In a system that is divided along public and private sector lines, champions like Mary and the GCBCOA advocate for equity for all women with breast cancer in Hong Kong.
Dr. Anisa Mburu shared her story with the GSF team.
A gynecological oncologist’s perspective from Kenya
Dr. Anisa Mburu is a gynaecologic oncologist and surgeon in Kenya, working at the Aga Khan Hospital in Mombasa. In this function, she witnesses first-hand the immense local challenges faced in surgical care: “We are only two gynaecologic oncologists in the region, serving a population of five million.”
We are only two gynaecologic oncologists in the region, serving a population of five million.
— Dr. Anisa Mburu
Surgical capacity is essential to care for women with cancer. “We know that for most cancers that affect women, the primary line of treatment is surgery. That's the most important element to ensure a better prognosis.” Surgical diagnosis also allows for a more targeted approach in treatment, and palliative surgery can improve quality of life for women with cancer.
However, access to safe and timely surgery remains a challenge. “In most hospitals here, we are just starting to build the surgical system,” Dr. Mburu added. “Most of the equipment is for general surgery, so if surgeons need something specific, like uterine clamps, they often won’t have it.”
GSF’s approach
With our award-winning learning hub we are making surgical training available in all corners of the world.
In addition to a shortage in equipment, Dr. Mburu also noted a shortage in qualified surgical staff. Given this, she prioritises a teams-based approach to training. “When it comes to the healthcare workers themselves, I have had to start training the nurses from scratch, as they are not used to assisting with specialised surgeries. The risk to the patient is higher when the team is not coordinated.”
Moreover, bringing together different healthcare sectors towards the common goal of reducing burden for the patient can be an innovative solution. “I joined the National Colposcopy Programme, where we teach primary healthcare workers to perform colposcopies (cervix exams), and screen and treat pre-cervical cancer cases,” noted Dr. Mburu. “With the key Kenyan referral hospitals and Ministry of Health, we also host a series of webinars on gynaecologic oncology, drawing in over 1,000 attendees at a time. The goal is to empower primary health care workers to be able to make early diagnosis and timely referrals, so we can provide better care for the patients.”
The goal is to empower primary health care workers to be able to make early diagnosis and timely referrals, so we can provide better care for the patients.
— Dr. Anisa Mburu
Finally, Dr. Mburu emphasised the importance of partnerships to improve outcomes for women with cancer. “We have so many foundations doing small initiatives and we all have the same target, but we are not working together, so the reach is small. If we worked together more, we could do great things.”
Shanty shared her story with the GSF team.
Working to overcome treatment delays in Indonesia
When Shanty from Indonesia presented at her doctor for vaginal bleeding and pain, she was diagnosed with a fibroid (a common non-cancerous tumour that develops in the uterus and sometimes in the cervix). During her surgery to remove the fibroid, doctors confirmed that it was in fact stage 1B cervical cancer. Alongside Aryanthi Baramuli Putri, chairperson of the Indonesian Cancer Information and Support Centre Association (CISC), Shanty shared her story with the GSF team.
“I was correctly diagnosed in March but only had my surgery to remove my tumour in August,” Shanty shared. Treatment delays like the one experienced by Shanty are extremely common in Indonesia which has direct implications on patient outcomes. One study from the second largest hospital in the country revealed that over half began their treatment more than 12 months after the start of symptoms [1]. Furthermore, over 70% of women with cervical cancer in Indonesia are diagnosed in late stages, lessening the effectiveness of treatment and making it all the more imperative they are treated as soon as possible [2].
Over 70% of women with cervical cancer in Indonesia are diagnosed in late stages, lessening the effectiveness of treatment
We are ramping up our programming
Donating is quick and easy.
In addition to delays stemming from the health system, women sometimes delay seeking medical attention themselves when symptoms arise. For some women, like Shanty, this is due to a lack of information around what the warning signs are for cervical, ovarian, or breast cancer. “I first noticed symptoms in December but only went to seek medical care in February,” she shared. “All women should be aware of their own health. They should go to check-ups, pap smears, and HPV DNA testing... We should be more aware of what is happening to our bodies.”
Additionally, there is a strong cultural preference for alternative medicines, often delaying treatment. A study carried out at Cipto Mangunkusumo Hospital in Indonesia found that preference for alternative medicines had a significant effect on the delay in seeking treatment, including surgery [3]. “Luckily, at the counsel of close friends, Shanty went directly to oncologists and gynaecologists, rather than herbal medicine,” noted Aryanthi.
We should be more aware of what is happening to our bodies.
— Shanty, CISC Indonesia
Through the Indonesian Cancer Information and Support Centre Association (CISC), Aryanthi works alongside the community and the Indonesian government to advocate for and support people with cancer. The organisation prioritises education, awareness-building, and research to improve quality of care for patients.
Through patient navigation services and psychological support, patients like Shanty can feel better supported emotionally and physically while going through the often-complicated process of cancer treatment.
[1] Tjokroprawiro BA, Novitasari K, Saraswati W, Yuliati I, Ulhaq RA, Sulistya HA. The challenging journey of cervical cancer diagnosis and treatment at the second largest hospital in Indonesia. Gynecol Oncol Rep. 2024 Jan 18;51:101325. doi: 10.1016/j.gore.2024.101325. PMID: 38314320; PMCID: PMC10837473.
[2] National Cervical Cancer Elimination Plan for Indonesia, 2023-2030. https://www.iccp-portal.org/system/files/plans/National%20Cervical%20Cancer%20Elimination%20Plan%20for%20Indonesia%202023-2030_compressed.pdf
[3] Gondhowiardjo, Soehartati, et al. "Treatment delay of cancer patients in Indonesia: A reflection from a national referral hospital." Medical Journal of Indonesia 30.2 (2021): 129-37.
Sally Agallo Kwenda shared her story with the GSF team.
Empowering others to share their stories: a survivor’s perspective in Kenya
Sally Agallo Kwenda is a survivor of cervical, colon, and rectal cancer, and a fierce advocate and counsellor for people living with HIV/AIDS as she is herself HIV+. Working with the NCD Alliance in Kenya, she is a vocal advocate on the global stage for people living with cancer, focusing on policy commitments to cervical cancer and other NCD control.
“I wouldn’t be alive without access to safe and timely surgery,” shared Sally Agallo Kwenda, a survivor of cervical cancer. When Sally was diagnosed with stage II cervical cancer, she needed surgery as soon as possible. Fortunately, she had strong support from her employer and good insurance coverage, which allowed her to have multiple surgeries over the course of several years to combat the spread of her cervical cancer.
I wouldn’t be alive without access to safe and timely surgery.
— Sally Agallo Kwenda, Kenya
The road was difficult, however. In Kenya, there are 2.35 surgeons per 100,000 population, one-tenth of the target outlined in the Lancet Commission on Global Surgery.[1] “It was traumatising,” she shared. “There are very few cancer specialists and surgical professionals. They don’t have enough resources, and they are overwhelmed. Most of them have limited time and you are lucky if you can see them, even for a very short time.”
Surgeons’ lack of time due to an overwhelming number of cases can also contribute to concern and hesitation on the patients’ side. “A lack of information and clear communication of that information by the surgeon can make people fearful. If the surgeon can share the information in a clear way, that is key,” Sally shared, noting that limited time for doctor-patient consultation made this a particularly challenging task.
Sally advocates for better collaboration between the government and the medical council towards the goals of better equipping facilities and training more surgical personnel. “Even if you have access to surgery – it may be far away and not accessible. Facilities that have the equipment and staff may be over 600 kilometres away, in Nairobi or Eldoret,” Sally noted.
Time spent fundraising can allow the cancer to spread.
— Sally Agallo Kwenda, Kenya
High transportation costs, lost income from missing work, and the cost of surgery and post-operative care can put those with insufficient funds or without adequate insurance coverage at an extreme disadvantage. “If you do not have insurance, there is a huge financial gap that needs to be filled…and time spent fundraising can allow the cancer to spread.”
Sally also highlights the need to destigmatise cancer diagnosis for women in Kenya, leveraging community healthcare workers, household-level interventions, storytelling and sharing survival statistics. “A cancer diagnosis is often seen as a death sentence,” she shared. “The first time I heard the word ‘cancer’, I saw my grave.”
Speak and share your stories.
— Sally Agallo Kwenda, Kenya
“But survivors need to be given a voice. Nine women die of cervical cancer every day (in Kenya), but many women are not given data on how many people survived,” said Sally. Deconstructing the fear around diagnosis may bring people to seek and receive care earlier. “Time is critical…once the cancer is advanced, then surgery is not an option. Safe and timely surgery is key for human health.”
“Many people survive, and patients need to know this. Speak and share your stories.”
[1] Shirley H, Wamai R. A Narrative Review of Kenya's Surgical Capacity Using the Lancet Commission on Global Surgery's Indicator Framework. Glob Health Sci Pract. 2022 Feb 28;10(1):e2100500. doi: 10.9745/GHSP-D-21-00500. PMID: 35294388; PMCID: PMC8885340.
This is the second article in our series
Voices in Global Surgery
With the global momentum towards the meaningful engagement of people with lived experience, it becomes even more important to bring out these voices in conversations around global surgery. People with lived experience provide a unique expertise that is irreplaceable in understanding and filling the gaps in quality surgical care for all who need it. In this series, we will continue to dive deeper into the key barriers, gaps, and opportunities for progress towards surgical care for all, identified by those most affected.
We are ramping up our programming and need your help. Donating is quick and easy.