Patients' perspectives on late diagnosis of breast cancer in northern Tanzania: The role of traditional healers.
Authors: Bright Elizabeth F. , Abraham Mackenzie , Serventi Furaha , Cyril Perry M. , Kitali Brenda C. , Saria Vivian F. , Massenga Gileard G. , Rocque Gabrielle Betty , Mmbaga Blandina Theophil , Gutnik Lily 
Published: September 2022

116 Background: In Tanzania majority of women are diagnosed with advanced stage of breast cancer. Factors influencing delay in diagnosis resulting in advance stage have not being investigated in the region, particularly as it relates to rural and urban patients. This study aims to explore the experience of breast cancer diagnosis amongst rural and urban patients. Methods: Women diagnosed and confirmed with breast cancer in outpatients setting in a Cancer Care Centre were identified by clinic nurse and introduced to the study. Semi-structured interviews were conducted and transcribed verbatim. Thematic coding using a grounded theory approach was done by two independent researchers using NVivo 12 Mac. Results: Twenty patients (10 rural and 10 urban) participated in the interviews. The average age was 56; 5 (25%) were married, 11 (55%) had primary education, and 10 (50%) were not employed. The majority (70%) had stage IV breast cancer, 15% had stage III and 15% had stage II breast cancer. Seventeen respondents (85%) sought care from traditional healers prior to diagnosis and treatment at the cancer center. Women largely described this pattern of care due to family or community recommendations and pressures to first seek care with traditional healers, as noted by one woman “... neighbours who took me to the traditional healer they told me that, it is the same healer who treated the man who cured from cancer. During my visit to the healer the man who get cured used his medication also I use to see him attending to this traditional healer.’’. All the participants regretted this decision at time of interview due to ineffective and costly treatment which ultimately delayed their hospital presentation and ability to receive quality treatment. One women stated, “...t he medicine cost me one thousand and fifty thousand Tanzanian shillings [75$]. The traditional healer initially want a patient to pay one hundred thousand Tanzanian shillings [50$] then the rest of the money to be paid once a patient complete the dose. I paid only hundred thousand but when used and found there are no any good progress didn’t continue to take it...’’ Rural patients emphasized. ‘‘... no they cannot cure cancer. They just waste people’s time there, while the disease is growing. I am saying this because when I call the traditional healer and tell him that, I am feeling sicker, instead of telling me to go and see him for the change of treatment. Instead he tells me go to hospital it means they cannot cure cancer. They took our money, waste our time and when disease goes bad they tell you to go to the hospital. I don’t belief on them at all.’’. Conclusions: Traditional healers are a critical part of the cancer delivery system in Northern Tanzania yet may contribute to delays in cancer care. Culturally sensitive interventions targeting these providers are necessary to promote early detection, decrease delay in presentation, and improve timely access to care.