“Women often aren’t the primary decision maker for their own healthcare.”

Ophira is a medical oncologist at the Women’s College Research Institute in Canada. Her work focuses on women’s health equality and global cancer control. As the winner of a Grand Challenges Canada award, she and her team are using mobile phone technology to improve breast cancer diagnosis and care in Bangladesh.

Is global surgery for women just about obstetrics?

No, it’s about women’s health – which is about much more than just reproductive health.

Of course access to safe surgery is critically important for complicated births – we lose thousands of women unnecessarily in so many countries for lack of obstetric care. But what a colossal shame for their child to watch them die of breast or cervical cancer ten years later because basic surgical care was unavailable.

What is the reality for a woman with cancer in a low-resource country?

It cuts down women in the prime of their lives. Most of the world’s deaths from cervical cancer are in these countries, and breast cancer strikes at a much lower age – in Canada on average at 61, in India and Bangladesh it’s about 42, 44.

These operations aren’t difficult to teach. But despite all the attention we pay cancer in high-income countries, there is silence on the topic of high-quality – or even basic – surgical intervention for women in low-resource settings.

Is there a gender imbalance?

Gender inequality really plays a role, especially in rural Bangladesh where I work. Women often aren’t the primary decision maker for their own healthcare. Most of the cases we see at our clinic are very advanced (and of course there’s a lack of palliative care) primarily because women aren’t coming when surgery would have made a difference.

They see that their aunty, their mother doesn’t come back – instead they need to see that effective surgery can save their life.

So do women with cancer get no surgical treatment at all?

Sometimes it’s worse than that. A third of the women we interviewed for a study published in the International Journal of Breast Cancer had already had ‘surgery.’ That is to say they’d had a suspicious lump partly cut out, highly unsafe surgery with no pathology, no follow up.

So here they are again a year later with a fungating [necrotic] tumour. It’s a profoundly morbid situation that absolutely could have been prevented with proper surgical management.

What is the wider impact of lack of access to safe surgical care?

Beyond the obvious of women dying unnecessarily? Effectively, orphan children. Children younger than ten may not immediately die from malnutrition, but they’re ostracized, impoverished, less likely to complete school – imagine what happens to them later in life?

Limited access to surgery, inadequate or unsafe surgery, directly contributes to the cycle of poverty.