Battling Breast Cancer in Bosnia Means Changing the Narrative

No matter who are or where you live, learning you have breast cancer is a devastating diagnosis. Affecting people of every race, religion and gender, it results in more than 500,000 deaths every year.?? 

What comes before and after that diagnosis can make all the difference in your prognosis. And it is often where you live that determines what happens during those crucial moments. In many other parts of the world, resources for breast cancer screening and treatment can be inadequate and support services for women are just beginning to gain traction.?? 

One of those places is Bosnia-Herzegovina. Home to a population still haunted by the civil war of the 1990’s, breast cancer is the leading cause of death in women in this country. In fact, breast cancer-related mortality is 40% compared to about 11% in the U.S. I learned about these startling statistics as part of a recent visit to the Balkans and Central Europe with two other colleagues from NYU.? 

It was there in Sarajevo, the country’s capital that we met with Dr. Vanessa Beslagic, a radiologist at the University Clinical Center. Her imaging clinic has just one mammogram machine, 20 years old, and two 12-year-old ultrasounds. In the surrounding rural areas and smaller cities, there are even fewer resources. For the entire country, almost 2 million women have access to only 30 mammogram machines and there is no national breast cancer-screening program. Long waits of up to 7 months are not uncommon. According to Dr. Beslagic, physicians and gynecologists are not well educated about breast cancer and there aren’t enough radiologists trained in breast imaging.? 

Cultural and religious taboos also present barriers to women seeking help for breast cancer. Bosnia is a multiethnic society, its?home to Muslim, Serbian Orthodox, Catholic, and Jewish populations, and is?deeply traditional in family structures. Women in Bosnia often worry that a breast cancer diagnosis might alienate them from others and share a deeply held belief that a cancer diagnosis means certain death.??All of these factors delay diagnosis, treatment, and the chance to survive.? 

Since 2004, however, one woman has single-handedly changed the face of breast cancer advocacy:?Nela Hasic. With a bright smile and shock of blonde, close-cropper hair, this unassuming 55-year-old?has helped helm a movement to battle the disease. She is a member of the storied local Sephardi Jewish community and together with her two children were part of a legendary evacuation?of Muslims, Jews, and Christians?out of Sarajevo during the siege of the city in 1992.? 

Since 2004, one woman has single-handedly changed the face of breast cancer advocacy in Bosnia-Herzegovina:?Nela Hasic.

Nela was safely removed from the city by JDC. After years abroad, she returned to help rebuild lives and her city. Once she returned, she began working for a new initiative to fight breast cancer called the Women’s Health Empowerment Program, or WHEP, established by JDC in 1995. In the 24 years that has passed, WHEP has set up support groups and hotlines for the newly diagnosed and breast cancer survivors.?

WHEP has provided free mammogram checkups and PAP tests, even traveling to smaller cities and rural areas with mobile units. It sponsored workshops and facilitated collaborations with the government, NGOs, and the medical community. And its flagship event, the annual Sarajevo Race for the Cure, is one of the largest in this part of the world with more than 8,000 participants. This was made possible through a partnership with Susan G. Komen since 2005.? 

Along the way, this effort expanded further and needed to more fully represent the Bosnians engaged in this work. So Nela and her team, with the support of JDC, transitioned this program into their own independent NGO called THINK PINK.? 

In the last year alone, THINK PINK provided 1,500 post-surgery care packages to women diagnosed with breast cancer. More than 1,600 women received free mammographic screening throughout the country. And almost 1500 first-aid packages were distributed to women with breast cancer in hospitals and clinics. In 14 cities across the country, interfaith support groups are facilitated by trained leaders. Most recently, Nela Hasic was awarded a grant from JDC’s 2019 Tikkun in Action Program — which gives support to those who are inspired by Jewish values to create impactful projects serving vulnerable and underserved populations in their local communities – to help her continue to grow and help women across Bosnia. 

Among these women impacted by THINK PINK was Nedeljka, woman who developed breast cancer before she became pregnant. She was devastated by the diagnosis, underwent a mastectomy, and breast reconstruction. After recovering from chemo, she discovered yoga as a practice to heal her body and mind. Now she is a certified yoga instructor, runs her own studio, and teaches free classes at THINK PINK for women with breast cancer and survivors. 

And the word “survivor” is not lost on these women. Indeed the history of their country, of ongoing tensions along ethnic and religious lines, define almost everyone they know. With cancer, they became part of a much smaller group of survivors, but with many of the same characteristics: they had no say in the process and often little insight into how this happened. They survived often times by sheer luck and resilience — lucky to be in Sarajevo, lucky to get a good doctor, lucky to get through treatment.?

But, when asked about how they got through treatment, the physical and emotional side effects, they were incredulous. The response was “who asks?” However, in this safe space of THINK PINK, these amazing women come together as a community because at long last, there is someone to ask, and someone to listen.? 

What emerged in those conversations, which we took part in, was an unmatched persistence, resilience, and humor. They recounted similar stories of their initial diagnosis, often delayed or because their doctors frequently dismissed their symptoms. None of them were offered any psychosocial services or psychopharmacology by doctors to mitigate the expected anxiety or insomnia, simply because they did not have the expertise.? 

And yet, they chuckled about their experiences with the health care system, describing bumpy four-hour bus rides home after receiving chemotherapy. Asked how their illness impacted their intimate lives and marriages, they said little and rolled their eyes. In the end, they said, the doctors uniformly told them that “they would be fine,” and they seemed to accept this.?They never complained.? 

And in that – as well as their volunteerism and advocacy, their public fight against the disease and their involvement of family in that effort – they set an example for their peers and for countless women who may one day face this disease.? 

Nela, surveying the room, offered an insightful analysis of the impact of these women, and this work, on this still-healing land:? 

“Women don’t need to share national aspirations or religious beliefs. All that is needed to make this work a success is to acknowledge that cancer is a killer that doesn’t differentiate among ethnicities or religions. That may sound like a simple observation, but believe me, it’s not,” she says emphatically.? 

“We have shown that women can come together on behalf of a greater good to achieve health and well-being for ourselves and our daughters, granddaughters, and future generations.” 

Dr. Ruth Oratz, an oncologist at NYU Langone, is an avid photographer, traveler, and member of JDC’s Ambassadors.

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