With no radiation services in Donegal, women are choosing mastectomies rather than lumpectomies to avoid leaving their children for five to six weeks. Anne Dempsey reports.
While a cancer diagnosis is always difficult, travelling hundreds of miles for treatment increases the stress. In April 2005, Donegal Action Cancer Care (DACC) was formed to campaign for improved oncology services for Donegal where cancer services are under threat.
In 2001 the breast surgeon at Letterkenny General Hospital retired, with temporary replacements since. Now the hospital medical board has announced the phasing out of breast services from June 1st.
The DACC met the Taoiseach, Bertie Ahern, last week to highlight its grave concerns, and has now organised an Awareness Rally in Letterkenny for May 14th.
"The Taoiseach says he wants to put us out of business by resolving our breast services," says Noelle Duddy, DACC's spokeswoman.
Duddy (45) lives with her husband and three boys in Inishowen. In October 2004, she went to her GP with a breast lump, then waited eight weeks for a breast clinic appointment in Letterkenny, and waited again till early January 2005 for the result.
"It was bad news, and, at that moment, my life shot forward and I looked down a tunnel to my death. It took time to withdraw from that and claim it back. The good news was that the lesion was small and the surgeon felt he could conserve the breast with a wide excision lumpectomy followed by radiotherapy."
The day before surgery in Letterkenny, Noelle said goodbye to her husband and saw him walk away down the hospital ward. "One of the loneliest moments in it all, knowing he was not going to be able to get back that evening and seeing that happening with patients when families live at a distance."
Surgery was successful, the scar discreet. Daily radiation was scheduled at St Luke's Hospital, Dublin for five weeks. Because the Donegal Oncology Bus which travels to Dublin each week didn't suit the Duddy schedule, this meant her leaving home each Monday at 6am, flying from Derry City Airport and arriving back on Friday night.
Air fare is subsidised by the Health Services Executive which covers accommodation and hospital meals.
"Being away from home like that was traumatic. My husband was wonderful, family and friends were the rearguard action and the boys mucked in.
"But away all week, you are out of the equation, deprived of your role. Sometimes, through nobody's fault, I felt like a guest in my own house. It was very hard.
"The treatment took only 10 minutes but dictated the day and, as it progressed, I became more tired. I remember sitting on the steps of the National Museum and feeling I could sleep then and there. A call or a post card from home was always emotional because it highlighted your loneliness and isolation. It was as if you had to take time out of your own life."
A radiation service in Letterkenny would have made all the difference. The DACC surveyed 100 patients in Donegal and discovered that not only were families distressed and financially stretched but some made medical decisions based on distance.
"Mothers told us of choosing a mastectomy, losing their breast rather than a lumpectomy followed by radiation because they could not leave young children for five or six weeks. Patients needing palliative radiation [ which gives pain relief] are not getting it because they couldn't travel the distance or be away from home for so long."
The future development of radiation oncology services as outlined in the Hollywood Report (2003) proposes retaining services in Dublin, Cork and Galway while opening a satellite radiation service in Waterford and Limerick.
"There is nothing proposed north of a line drawn between Galway and Dublin. We now outline how in five easy steps the Government can indeed put us out of business," says Duddy.
These involve appointing a permanent breast surgeon at Letterkenny; opening a satellite radiation unit in the northwest; reducing the mammogram backlog; funding patients who must travel for treatment; and providing 70 public beds at Letterkenny. "We accept that patients with certain cancers must travel for specialist treatment. However, we believe treatments for common cancers should be treated locally.
"Some 10,402 women from Donegal await Breastcheck. Approximately 1 per cent of screenings reveal breast cancer, which means that 50 Donegal women a year currently lose out from an early diagnosis. Instead the cancer is being allowed develop needing aggressive intervention, and, in some cases, leading to premature death. We are being punished because of where we live.
"We all pay taxes. Donegal citizens currently pay an extra, hidden travelling tax, and the DACC is asking the Government to urgently designate funding to assist patients and families who have to travel for treatment. It's an unequal situation. Can you imagine, for instance, patients living in Dublin, Cork or Galway being expected to have to live in Donegal for five-seven weeks of radiation? Well, this is what many of us are doing in reverse. Given the services planned for the rest of the country, surely, we deserve no less?"
- The rally takes place on Sunday next, May 14th. Its starting point is the Town Park, by Letterkenny General Hospital at 2pm. The rally will walk to Market Square where there will be speakers to address the crowd.
- The Ireland Health Foundation, a registered charity, offers funding to help patients travel more comfortably, augment income which has been reduced to loss and funds some cancer research. It operates with as little bureaucracy as possible and welcomes approaches from the public. Contact the Ireland Health Foundation, 51 Anglesea Road Dublin 4/5 Athy Road, Carlow, Co Carlow.