Uganda Fights Stigma and Poverty to Take On Breast Cancer

KAMPALA, Uganda Mary Namata . her dress in an examining room at Mulago Hospital, revealing a breast taut and swollen with grape-size tumors that looked if they might burst through the skin. How have you had this? a doctor asked gently. Ms. Namata, 48, an elegant woman with stylishly braided hair and a flowing, traditional Ugandan .., looked away, shamefaced. . a year, she murmured. The ., she admitted later, was closer to four years. Such enormous tumors, rare in developed countries, are here. Women in Uganda, trapped . stigma, poverty and misinformation, often do not see help for breast cancer it is too late. For Ms. Namata, though, there was .. hope that the cancer had not yet spread beyond the breast, her doctors said. Treatment could prolong her life, maybe cure her if it started soon. But . she be treated in time? Women in Africa often face perilous delays . treatment as a result of scarce resources, incompetence and corruption. Would Ms. Namata wind up . so many women here, with disease so far gone that doctors can offer nothing .. surgery to remove rotting flesh, morphine for pain and antibacterial powder to . the smell of festering tumors that break through the skin? Cancer has long been neglected in developing countries, overshadowed by the struggle more acute threats like malaria and AIDS. But as nations the continent have made remarkable progress against infectious diseases once thought . daunting to tackle, more people are living long .. to develop cancer, and the disease is coming to the forefront. Given the strides poor countries have made against other health problems, they also be able to improve the treatment of cancer, public health experts increasingly say. Two years ., the United Nations began a global campaign against noncommunicable diseases cancer, diabetes, heart and lung disease noting that they hit the poor .. hard. Worldwide, at least 7.6 million people a year die .. cancer, and 70 percent of those deaths occur in poor and moderate-income countries, to the World Health Organization. Breast cancer takes a particularly harsh toll. It is the worlds common cancer in women and their leading cause of cancer death, with 1.6 million cases a year and .. than 450,000 deaths. Survival rates vary considerably from country to country and even .. countries. In the United States, about 20 percent of women .. have breast cancer die from it, compared . 40 to 60 percent in poorer countries. The differences depend heavily .. the status of women, their awareness of symptoms and the availability of timely care. At the same

, scientists deepening insights into the genetic basis of cancer have introduced a complicated new dimension .. the care of women globally. Uganda is . to improve the treatment of all types of cancer in ways that make sense in a place with limited resources. A new hospital and clinic, paid .. by the Ugandan government, have been added to the Uganda Cancer Institute in Kampala, they have not yet opened, for of equipment. A research center is . built. But women like Ms. Namata, with breast cancer . advanced that there is just a tiny window of time, if ., in which to save their lives, will be among the toughest challenges here. The terrible part about breast cancer is that if we just did what we already know how do in other places, we could make major shifts in survival, said Dr. Benjamin O. Anderson, who heads the Breast Health Global Initiative, based at the Fred Hutchinson Cancer Research Center in Seattle. There is a pressing need for action because breast cancer is escalating, the initiative , predicting that incidence and death rates in developing countries will increase .. more than 50 percent in the next 20 years. The breast cancer rate in Africa seems . be increasing, though cervical cancer kills more women in the sub-Saharan regions. It is not clear breast cancer is actually becoming more common, or is just being detected and reported .. often, but physicians consider it a looming threat. Compared with breast cancer patients in developed , those in Africa tend to be younger, and they are more to die, in large part because of late diagnosis and inadequate treatment. Doctors also suspect that more aggressive .. of tumors may be more common in young African women, as they appear to be in young black women in the United States, though there is not enough pathology data from Africa to know for .. Among women who die young (ages 15 to 49) from breast cancer, 72 are in developing countries, and many leave small children. The story of breast cancer here is a miserable ., said Dr. Fred Okuku, an oncologist at the Uganda Cancer Institute in Kampala, which treats about 200 women .. year for breast cancer. There is little information for the people .. need to be helped. Only a few know . to read and write. Many dont have TV or radio. There is no word for cancer in . Ugandan languages. A woman finds a lump in her breast, and cancer cross her mind. Its not in her vocabulary.

As Search Goes On for Queens Boy With Autism, Adults at His School Face Questions
Eleven days . a teenager with autism walked away from his school in Queens in the middle of the day, a senior police commander, Chief of Department Philip Banks III, said . Tuesday that an intensifying search .. failed to turn up even a trace of the student. As the effort to locate the boy, Avonte Oquendo, continued, a lawyer for the family and advocates for children with disabilities said they were .. troubled by a prior mystery: How did the 14-year-old get out of the school to begin ..?

The lawyer, David H. Perecman, said he exploring several apparent breakdowns in the moments . and after Avonte left the Riverview School on Oct. 4, his disappearance the streets of Long Island City captured in a portion of surveillance video footage. What happened here was clearly a .. of mistakes, said Mr. Perecman, who has filed a claim against the city .. behalf of the family. His mother was under the understanding that Avonte would be . constant supervision. He and others, advocates for special-education students, said they wanted more information on the actions of adults supervising Avonte, on how the boy .. past a school safety officer who was guarding a side door and .. it took school officials between 45 minutes and an hour to contact the police and the boys mother, Vanessa Fontaine. No student .. ever get away, said Maggie Moroff, the special-education policy coordinator at Advocates for Children of New York, a nonprofit legal group. Schools Chancellor Dennis M. Walcott has said the episode has prompted a review of protocols and procedures for .. emergencies. But a spokeswoman for the citys Education Department declined on Tuesday to .. specific questions about the matter, citing the continuing investigation. The city school system has been carrying significant reforms of special education that are intended to reverse a longstanding practice of segregating those students in own classrooms and schools. Several advocates hailed the effort, known mainstreaming. Still, many wondered whether the policies attending the effort, begun in earnest last year, were adversely affecting some children, particularly .. with the most severe needs. This is not a clear case of reform gone bad, said Jean Mizutani, an education team leader with Resources for Children with Special Needs, a nonprofit . But the policies of reform affect programming and development and the plans made . these students. Any child should be entitled to be in any school, but at the time if the school is not .. to support that child successfully, that child should not be there and that is the gap we . in now. The program Avonte is enrolled in serves only special-needs children but is housed in a building with typical students from two . schools, said Mr. Perecman, who questioned whether in the building was as familiar as necessary with the special-needs population.

Avonte, who has severe autism and is nonverbal, has an Individualized Education Plan, .. as an IEP, calling for him to be in a class .. one teacher and one paraprofessional for every six pupils. This was his first .. at Riverview, Mr. Perecman said. On Oct. 4, Avonte his home in Rego Park and boarded a special bus for Riverview, which is at 1-50 51st Avenue in Long Island City. That day, Avonte .. to lunch, Mr. Perecman said, and apparently, based on accounts up to now, was noticed missing by his teacher when class was . to begin again. He wandered off the line, he ran, said Mr. Perecman, who said the boys past educational plan noted how he . run in the hallways between classes and that a goal this year was to work that problem. Avonte encountered a security guard who later told the boys grandmother that she .. him a question and when he did not reply, she . him leave the building, Mr. Perecman said. The police said Avonte was last .. at 12:38 p.m., dressed in a gray striped shirt, black jeans and black sneakers. Ms. Fontaine . called at 1:40 p.m. and arrived at the school at 2:40 p.m., when school officials asked her to call out to her son over the schools public address system, Mr. Perecman said. The police were first notified sometime .. 1:35 p.m. and 1:45 p.m., Mr. Perecman said, which he called a preposterous delay. Because Avonte likes trains, fliers with his face have . plastered throughout the transit system. Subway riders are announcements that begin Police are seeking a missing child, Avonte Oquendo, 14. He suffers .. autism and cannot communicate verbally.