Cancer

"I never met anyone with cancer before," said Shakib. "Children in Afghanistan do not get cancer."

We were on our way home from a Leukemia and Lymphoma Society (LLS) potluck - following an 8.5 mile run. The event was an opportunity for our marathon team to meet our “honored teammates” - blood cancer patients in various stages of treatment - giving those without such ties a direct connection to the cause.

Jon and I have known far too many people with cancer. Some have won the battle. Some are still fighting. Others have lost their lives to cancer including Jon's sister Wendy. 

But this was Shakib's first encounter with cancer patients. He got to meet 8-year-old Tyler Cordova who has been in treatment for Non-Hodgkin Lymphoma since 2007 and hear his mother speak of the many breakthroughs and set backs that the family has weathered. The mother of Alessandra Sanchez spoke of her teenage daughter's courage as she faces a relapse of Hodgkin's disease and prepares for an impending bone marrow transplant. 70-year-old Roger Klinkhart spoke of living with chronic CLL, a form of leukemia. Roger, who has been through a research study and 2 clinical trials, acknowledged that without the funds raised by people like us, these studies would not be possible.

A pair of physicians from City of Hope - Dr. Ravi Bhatia and his wife Dr. Smita Bhatia spoke of their research efforts. A pediatric oncologist, Smitra’s particular area of interest is long term cancer survivorship. Ravi conducts bone marrow transplants and stem cell and leukemia research. 

A representative was on hand to register people for the Bone Marrow Registry. This effort is critical to blood cancer treatments. While millions of people are registered to donate marrow, matches are not easily made. What a gift it would be to be able to extend someone’s life by donating blood stem cells or marrow! Recovery is quick and the discomfort is short-lived. 

And of course Shakib got to meet our dear friend and Mission Captain Virginia Garner, a chronic myelogenous leukemia patient who - thanks to a clinical trial funded by LLS - has been effectively treating her disease with a drug called Gleevec for 11 years. While CLL is not curable, hundreds of thousands of people now live with chronic CLL thanks to Gleevec. While Virginia has herself run dozens of marathons, half-marathons, and other races, personally raising hundreds of thousands of dollars for LLS, and mentors newly diagnosed leukemia patients on a regular basis, perhaps her greatest gift has been in championing thousands of marathoners in our community over the last 10 years. We all know that if Virginia can do it, we can do it.

So there we were on our way home from this inspiring afternoon, and Shakib told us what he knew about cancer. "I never met anyone with cancer before," said Shakib. "Children in Afghanistan do not get cancer." He also believes that only people with great sorrow in their lives develop the disease. He was especially insistent that Afghani children do not get cancer: “I have lived in Afghanistan. I would know.”

Shakib and I will have to have a conversation about his personal test for reality. Meanwhile, we did explain that this business of cancer being caused by sorrow is a superstition. But you have to be careful of taking away people’s superstitions. He thought he was protected from harm. Now he wanted to know how people got cancer. Our explanations further shook his confidence in his immunity, and his insistence that Afghani children do not get cancer grew stronger.

Ultimately, I know that the truth shall set you free. So I did a little research. 

Dr. Nadera Hayat Borhani was one of the few doctors able to treat women under the Taliban rule.  She is now the Afghan Deputy Minister of Public Health. Dr. Borhani says: 

“Nobody in Afghanistan has access to health facilities for cancer. It’s the same situation for the children, the men, the women, the elderly -- nobody has access. Thirty years ago we had a centre for radiotherapy and a centre for diagnosis. But unfortunately during the war everything was destroyed...the infrastructure, the equipment, everything....So nearly we are starting at zero again.

“When the doctor sees some sign or symptom that a patient has cancer – the option is to send the patient to Iran, or to go to Pakistan, or to India, as their economic situation allows. But Afghanistan has a low economic situation, and most of the people are very poor, so most of them don’t go….

“We need a cancer registry in Afghanistan to see the numbers and different types of cancers in the country. Sadly in Afghanistan we do not know this. We need this information to make our policy. We have some data from the pediatric hospital in Kabul. They now have about 75 children with leukemia. But the real number I think is much greater, because the doctors send cancer patients to the foreign countries for treatment, or home to die.”

This is a country of 26 million. Life expectancy at birth is 42-43 years. 26% of the nation’s children do not make it to age 5, giving Afghanistan the highest infant mortality rate in the world. Maternal health is a national crisis. As for cancer rates, nobody knows. (Source: World Health Organization) 

I explained all of this to Shakib and suggested that perhaps he might study to be a physician. When one is 17, seven years of college can be daunting, but who knows where his interests and kind heart will lead him?

The great thing about life with Shakib is not that he has all the answers about Afghanistan, but rather that he gives rise to great questions.

“I was born in June. I was born under cancer. Do you know what is this?” he asked. 

“Yes. The word cancer has more than one meaning. In this case, Cancer refers to a giant crab. Do you know what a crab is?” Jon and I make claws with our hands. No pass. “Well, Cancer is the name of a constellation of stars that look like a giant crab.” Still no pass. 

[Note to self: Take Shakib to the Griffith Park Observatory and the Long Beach Aquarium.]

“Is there an immunization against cancer?” Shakib wanted to know. 

“No, not yet, but they are working on it. That is why we run marathons and raise money for research.”

Inshallah – God willing – we will have one soon.