Why expats battling breast cancer choose to stay abroad

Sharon did not want to go home for treatment for breast cancer and become a burden on her children. (Issa Alkindy)
Updated 31 October 2018
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Why expats battling breast cancer choose to stay abroad

  • Workers from the Philippines choose to stay in the UAE, despite being far from family, because the treatment is better and they can continue to earn a living
  • One Abu Dhabi doctor said 98 percent of his expat patients who have breast cancer choose to stay

DUBAI: Dazed and completely daunted, Sharon listened to the muffled words of the doctor informing her that she had Stage 3 breast cancer. “Why only now?” the doctor asked repeatedly, as images of her two young boys flashed before her.
It did not seem possible. With no family history of breast cancer or habits that would place her at risk of developing the disease, she had believed her health was fine. Then one afternoon, while she was in the cafeteria at the university where she worked, a pain shot from her armpit to her breast. Terrified, Sharon booked into a clinic for a consultation.
During the 10-day wait for the results of her tests to come back, the pain got worse by the day. Then came the diagnosis: Advanced stage breast cancer that might have already invaded lymph nodes and muscles beyond the tumor site.
Sharon, a single mother from the Philippines, had moved to the UAE in 2006 to teach at a university in Sharjah, leaving her children to be cared for by others who could provide them with a better life, in common with many others from her country who have chosen to support their families through working abroad.
Yet the strain of being away from family becomes even more intense for those with a chronic illnesses who face hospital appointments alone, sitting in waiting rooms without a familiar hand to squeeze.
Even so, when faced with the difficult choice of staying in the Gulf or returning home for treatment, many expats choose to stay. Sharon was no exception.
Breast cancer, which has four stages, is one of the world’s most common cancers, and causes 15 percent of cancer-related deaths among women — the greatest number, with 627,000 deaths worldwide in 2018 alone. In the Middle East, through fear and embarrassment, doctors fear women are discovering they have cancer when it is at an advanced stage when risks are higher.
“Breast cancer is the number one form of cancer in the Middle East among women, and there’s been a stable increase of reported incidents in the region,” Dr. Mohanad Diab, head of oncology at NMC Hospital in Abu Dhabi, told Arab News.
A significant number of his breast cancer patients are expats, he added. More than 98 percent of them stay in the country for treatment.
Often these women stay because they think of themselves as the “breadwinners” with families depending on their earnings. For them, going home would mean the loss of a major source of household income.
Sharon said that she “didn’t want to be a burden” to her kids by returning to the Philippines with an illness that would costs thousands of dollars to treat: After all, her young children were relying on her income for a comfortable life and good education.
Another factor is the “generous” medical insurance available in the UAE, which Sharon was able to use for most of her treatment — from initial tests to a mastectomy.
Alma Linggay, a 39-year-old expat who discovered she had cancer last October, faced a similar predicament to Sharon. She was also working in the UAE and receiving treatment away from family in the Philippines. “I can’t stop working. I have a lovely daughter I need to provide for. I have to be strong for her.”
Linggay said that it was a “blessing” to be able to receive treatment in the UAE, adding that her insurance has covered most of her chemotherapy sessions. “I only pay Dh10 ($2.72) per session for my chemo,” Linggay said, adding she might have had to pay for treatment elsewhere.
So highly regarded is the UAE’s breast cancer treatment that doctors even recommend staying in the country to benefit from this.
“In the UAE, we have the most advanced technology in radiotherapy, and all kinds of chemotherapy around the world are available in this country,” Dr. Diab said.
In the majority of cases, breast cancer patients are encouraged to continue with their daily routine, he said. “Breast cancer treatment usually takes a long time, so we advise them to stay here to continue working,” Dr. Diab said, explaining that not working can add to emotional and mental pressures patients face.
“We always tell them how they can still work as usual, with only 20 to 25 percent of daily power compromised. Nonetheless, patients with breast cancer will still be able to fulfill all commitments in their jobs,” he said.
But not everyone can face going through treatment without having easy access to the support of their family and home.
Sharon recounts the stories of some who returned to their home countries, either immediately after diagnosis or after being cleared of cancer, only to end up with more complications.
“I know around four to five people who died after going back to the Philippines,” Sharon said, her eyes downcast.
Despite being miles away from her family, she did not feel totally cut off while she being treated in the UAE.
“My doctors and nurses are very supportive, as well as my employer, who was also among those who convinced me to stay in the UAE,” she said, adjusting her bright pink turban.
“It’s extremely important for breast cancer patients to have a support system throughout their treatments,” said Dr. Nazura Siddiqi, a specialist in obstetrics and gynecology at Bareen International Hospital, adding that besides the physical challenges of the disease, it is “mentally draining.”
Yet Sharon has reported rarely feeling alone as she struggled with the disease. Once, she found more than 50 envelopes, scattered across the floor of her university office — all filled with anonymous messages from her students keen to cheer her up and promising to support her.
University staff would club together to help out every time she found herself unable to pay some additional medical expenses.
Now Sharon has become an advocate of breast cancer awareness, conducting informative talks in schools to share her experience in dealing with cancer and encouraging women to have themselves tested as early as possible.
She also meets with people who have the same condition in social gatherings, usually hosted by the UAE-based cancer support group, Blessed.
On the day she was diagnosed with cancer it felt like a death sentence, Sharon said. Now she wants to share how the experience turned out.
“I’ve successfully beat cancer now,” she said. “I’m glad I stayed.”


Next generation of biotech food heading for grocery stores

Fred Gmitter, a geneticist at the University of Florida Citrus Research and Education Center, holds citrus seedlings that are used for gene editing research at the University of Florida in Lake Alfred, Fla., on Sept. 27, 2018. (AP)
Updated 15 November 2018
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Next generation of biotech food heading for grocery stores

  • Scientists even hope gene editing eventually could save species from being wiped out by devastating diseases like citrus greening

WASHINGTON: The next generation of biotech food is headed for the grocery aisles, and first up may be salad dressings or granola bars made with soybean oil genetically tweaked to be good for your heart.
By early next year, the first foods from plants or animals that had their DNA “edited” are expected to begin selling. It’s a different technology than today’s controversial “genetically modified” foods, more like faster breeding that promises to boost nutrition, spur crop growth, and make farm animals hardier and fruits and vegetables last longer.
The US National Academy of Sciences has declared gene editing one of the breakthroughs needed to improve food production so the world can feed billions more people amid a changing climate. Yet governments are wrestling with how to regulate this powerful new tool. And after years of confusion and rancor, will shoppers accept gene-edited foods or view them as GMOs in disguise?
“If the consumer sees the benefit, I think they’ll embrace the products and worry less about the technology,” said Dan Voytas, a University of Minnesota professor and chief science officer for Calyxt Inc., which edited soybeans to make the oil heart-healthy.
Researchers are pursuing more ambitious changes: Wheat with triple the usual fiber, or that’s low in gluten. Mushrooms that don’t brown, and better-producing tomatoes. Drought-tolerant corn, and rice that no longer absorbs soil pollution as it grows. Dairy cows that don’t need to undergo painful de-horning, and pigs immune to a dangerous virus that can sweep through herds.
Scientists even hope gene editing eventually could save species from being wiped out by devastating diseases like citrus greening, a so far unstoppable infection that’s destroying Florida’s famed oranges.
First they must find genes that could make a new generation of trees immune.
“If we can go in and edit the gene, change the DNA sequence ever so slightly by one or two letters, potentially we’d have a way to defeat this disease,” said Fred Gmitter, a geneticist at the University of Florida Citrus Research and Education Center, as he examined diseased trees in a grove near Fort Meade.
GENETICALLY MODIFIED OR EDITED, WHAT’S THE DIFFERENCE?
Farmers have long genetically manipulated crops and animals by selectively breeding to get offspring with certain traits. It’s time-consuming and can bring trade-offs. Modern tomatoes, for example, are larger than their pea-sized wild ancestor, but the generations of cross-breeding made them more fragile and altered their nutrients.
GMOs, or genetically modified organisms, are plants or animals that were mixed with another species’ DNA to introduce a specific trait — meaning they’re “transgenic.” Best known are corn and soybeans mixed with bacterial genes for built-in resistance to pests or weed killers.
Despite international scientific consensus that GMOs are safe to eat, some people remain wary and there is concern they could spur herbicide-resistant weeds.
Now gene-editing tools, with names like CRISPR and TALENs, promise to alter foods more precisely, and at less cost, without necessarily adding foreign DNA. Instead, they act like molecular scissors to alter the letters of an organism’s own genetic alphabet.
The technology can insert new DNA, but most products in development so far switch off a gene, according to University of Missouri professor Nicholas Kalaitzandonakes.
Those new Calyxt soybeans? Voytas’ team inactivated two genes so the beans produce oil with no heart-damaging trans fat and that shares the famed health profile of olive oil without its distinct taste.
The hornless calves? Most dairy Holsteins grow horns that are removed for the safety of farmers and other cows. Recombinetics Inc. swapped part of the gene that makes dairy cows grow horns with the DNA instructions from naturally hornless Angus beef cattle.
“Precision breeding,” is how animal geneticist Alison Van Eenennaam of the University of California, Davis, explains it. “This isn’t going to replace traditional breeding,” but make it easier to add one more trait.
RULES AREN’T CLEAR
The Agriculture Department says extra rules aren’t needed for “plants that could otherwise have been developed through traditional breeding,” clearing the way for development of about two dozen gene-edited crops so far.
In contrast, the Food and Drug Administration in 2017 proposed tighter, drug-like restrictions on gene-edited animals. It promises guidance sometime next year on exactly how it will proceed.
Because of trade, international regulations are “the most important factor in whether genome editing technologies are commercialized,” USDA’s Paul Spencer told a meeting of agriculture economists.
Europe’s highest court ruled last summer that existing European curbs on the sale of transgenic GMOs should apply to gene-edited foods, too.
But at the World Trade Organization this month, the US joined 12 nations including Australia, Canada, Argentina and Brazil in urging other countries to adopt internationally consistent, science-based rules for gene-edited agriculture.
ARE THESE FOODS SAFE?
The biggest concern is what are called off-target edits, unintended changes to DNA that could affect a crop’s nutritional value or an animal’s health, said Jennifer Kuzma of the Genetic Engineering and Society Center at North Carolina State University.
Scientists are looking for any signs of problems. Take the hornless calves munching in a UC-Davis field. One is female and once it begins producing milk, Van Eenennaam will test how similar that milk’s fat and protein composition is to milk from unaltered cows.
“We’re kind of being overly cautious,” she said, noting that if eating beef from naturally hornless Angus cattle is fine, milk from edited Holsteins should be, too.
But to Kuzma, companies will have to be up-front about how these new foods were made and the evidence that they’re healthy. She wants regulators to decide case-by-case which changes are no big deal, and which might need more scrutiny.
“Most gene-edited plants and animals are probably going to be just fine to eat. But you’re only going to do yourself a disservice in the long run if you hide behind the terminology,” Kuzma said.
AVOIDING A BACKLASH
Uncertainty about regulatory and consumer reaction is creating some strange bedfellows. An industry-backed group of food makers and farmers asked university researchers and consumer advocates to help craft guidelines for “responsible use” of gene editing in the food supply.
“Clearly this coalition is in existence because of some of the battle scars from the GMO debates, there’s no question about that,” said Greg Jaffe of the food-safety watchdog Center for Science in the Public Interest, who agreed to join the Center for Food Integrity’s guidelines group. “There’s clearly going to be questions raised about this technology.”
SUSTAINABILITY OR HYPE?
Gene-editing can’t do everything, cautioned Calyxt’s Voytas. There are limitations to how much foods could be changed. Sure, scientists made wheat containing less gluten, but it’s unlikely to ever be totally gluten-free for people who can’t digest that protein, for example — or to make, say, allergy-free peanuts.
Nor is it clear how easily companies will be able to edit different kinds of food, key to their profit.
Despite her concerns about adequate regulation, Kuzma expects about 20 gene-edited crops to hit the US market over five years — and she notes that scientists also are exploring changes to crops, like cassava, that are important in the poorest countries.
“We think it’s going to really revolutionize the industry,” she said.