Natasha Said­wan

Pro­duc­tion Ed­i­tor

natasha.said­wan@guardian.co.ttt

In the Caribbean, can­cer is the sec­ond lead­ing cause of death, ac­count­ing for about one fifth (IARC Caribbean Can­cer Reg­istry Hub). Here at home, it is al­so a lead­ing cause of ill­ness and death. Syn­ony­mous with pain and suf­fer­ing, bring­ing re­lief to pa­tients is one of the main rea­sons why ra­di­a­tion on­col­o­gist Dr Ane­sa Ahamad chose this as her call­ing and has ded­i­cat­ed decades to find­ing a cure or, at the very least, im­prov­ing the life ex­pectan­cy for can­cer pa­tients the world over.

Orig­i­nal­ly from Are­na, Freeport, Dr Ahamad is one of four chil­dren of Rooki­ah and Nazir (dec) and she has ex­ten­sive ex­pe­ri­ence in can­cer treat­ment, re­search, and ed­u­ca­tion. She be­gan her train­ing at the UWI, St Au­gus­tine cam­pus and con­sid­ers this to be the sol­id foun­da­tion for her con­tin­ued suc­cess. Her path has tak­en her as far as Christie Hos­pi­tal in Man­ches­ter, Eng­land, and the MD An­der­son Can­cer Cen­ter in Hous­ton to Key West and the Uni­ver­si­ty of Mi­a­mi. She is now at­tached to two clin­ics in Mi­a­mi, as a ra­di­a­tion on­col­o­gist and con­tin­ues her pas­sion at here at home.

Like so many, the dis­ease is a per­son­al one for Dr Ahamad as her grand­moth­er and two very close un­cles suc­cumbed to can­cer. But, ac­cord­ing to this ex­pert, this was not the on­ly rea­son for her choos­ing this spe­cial­i­sa­tion.

She re­calls: “In 1993, dur­ing my in­tern­ship on the ward, a pa­tient came in from Las Cuevas with swelling in his neck and he was gasp­ing for breath. It was be­lieved to be can­cer.

“Now, if some­body comes with a throat prob­lem you call the ENT spe­cial­ist, do a con­sul­ta­tion and fix it. If they had a bel­ly bow­el block­age is­sue, the gen­er­al sur­geon will come up and fix it. If you broke some bones, the or­tho­pe­dic sur­geon/spe­cial­ist would fit it. If you had can­cer in Port-of-Spain Gen­er­al Hos­pi­tal, in 1993, there was no one to call.”

This was the be­gin­ning for Dr Ahamad on a path that has led her to be­come an ex­pert in this field.

“I went to the li­brary as there was no one I could talk to about this.

“I found the biggest, fat­test book that said ‘on­col­o­gy’, found the au­thor and wrote him a let­ter ask­ing to vis­it his clin­ic in Lon­don.

“To my sur­prise, he in­vit­ed me there, maybe that was British po­lite­ness, but I saved up sev­er­al months’ salary and head­ed to the Ham­mer­smith Hos­pi­tal in Lon­don.”

She start­ed al­most im­me­di­ate­ly in the po­si­tion of spe­cial­ist reg­is­trar.

And that au­thor was Prof Karol Siko­ra, de­scribed in a sim­ple search as the world’s lead­ing au­thor­i­ty on on­col­o­gy.

With­in the first month of train­ing in Eng­land, Dr Ahamad knew this was where she was meant to be.

“Right away I thought of that man from Las Cuevas. I re­mem­ber his face, his tu­mour and the sound he made. It could have been a lym­phoma. If it were, one tiny, tiny dose of chemo would have shrunk it down, even a dose of steroids would have opened his air­way.

“If we knew it wasn’t cur­able, we could have of­fered him pal­lia­tive med­i­cine, and se­dat­ed him. He didn’t have to suf­fer.

“I chose on­col­o­gy be­cause I know there had to be a bet­ter way to help pa­tients with can­cer.”

Im­me­di­ate­ly af­ter came po­si­tions at North Mid­dle­sex Hos­pi­tal, Christie Hos­pi­tal in Man­ches­ter, and res­i­den­cy at the Roy­al Col­lege of Ra­di­ol­o­gists, cul­mi­nat­ing in a fel­low­ship at MD An­der­son, Hous­ton.

Af­ter a suc­cess­ful run, Dr Ahamad re­turned to her home­land in 2006 with the sole pur­pose of giv­ing back and im­prov­ing the lives of can­cer pa­tients lo­cal­ly, work­ing for both the gov­ern­ment and pri­vate sec­tor.

“The des­per­a­tion of pa­tients in my own com­mu­ni­ty, my own peo­ple; the feel­ing and un­der­stand­ing quite quick­ly in my ca­reer that it didn’t need to be so, that it could be bet­ter, re­mained my div­ing force.”

Dur­ing that five-year con­tract, Dr Ahamad was in­te­gral in the es­tab­lish­ment of a na­tion­al on­col­o­gy pro­gramme, the Na­tion­al On­col­o­gy Cen­tre and the cre­ation of out­pa­tient cen­tres.

But change didn’t come easy.

“While a lot was ac­com­plished at that time, it was on­ly one per cent of what I was ca­pa­ble of and what I would have want­ed to do.

“I faced de­lib­er­ate road­blocks, per­haps due to in­se­cu­ri­ties. This was not gen­der-re­lat­ed but ed­u­ca­tion. At that time, the doc­tors in charge were trained in the 80s us­ing less mod­ern ap­proach­es. They may have felt threat­ened by the changes and ideas that were be­ing in­tro­duced.”

But that one per cent to which Dr Ahamad re­ferred made a dif­fer­ence es­pe­cial­ly to the lives of pa­tients re­sid­ing in the rur­al ar­eas.

“At that time, every­one from far and wide came to St James for treat­ment, some were able to overnight by rel­a­tives, many trav­elled by bus or taxi and had to trav­el back af­ter a day of ra­di­a­tion or chemo treat­ment. The fo­cus at the time was the Na­tion­al On­col­o­gy Cen­tre at Mt Hope which was good but would not have solved the prob­lem that some pa­tients faced.”

For­tu­nate­ly, the per­son in charge at the Min­istry of Health agreed with Dr Ahamad and com­mu­ni­ty cen­tres were in­tro­duced.

“Es­tab­lish­ing cen­tres in San Fer­nan­do, San­gre Grande, and To­ba­go meant that these pa­tients had care that was more ac­ces­si­ble to them.”

This, too, did not come with­out ob­sta­cles.

“Bu­reau­cra­cy and un­will­ing­ness to ac­cept change and the work that came with it were some of the road­blocks faced but there were al­so many who em­braced that they could make a dif­fer­ence. San Fer­nan­do, for ex­am­ple, con­vert­ed an en­tire build­ing for can­cer treat­ment. Grande’s can­cer treat­ment fa­cil­i­ty was ex­pe­dit­ed quick­ly and it was so wel­comed that it quick­ly be­came over­sub­scribed and over­flow­ing with pa­tients.”

Dr Ahamad was al­so in­stru­men­tal in fill­ing a void in can­cer care by propos­ing to the gov­ern­ment of the day the im­por­tance of fund­ing doc­tors to spe­cialise in on­col­o­gy.

“This was or­gan­ised quick­ly and so now, un­like when I was an in­tern, when a pa­tient pre­sent­ed her­self with symp­toms, there were one of three spe­cial­ists to ad­vise what to do.”

Ground­break­ing treat­ment

Her work is di­verse and fo­cussed.

So far, Dr Ahamad she has pub­lished more than 140 works, de­liv­ered more than 130 pre­sen­ta­tions to both pro­fes­sion­als and com­mu­ni­ty groups na­tion­al­ly and in­ter­na­tion­al­ly, and host­ed more than 150 ra­dio and tele­vi­sion shows.

And it’s all about im­prov­ing care.

“Noth­ing is stop­ping me. If I want­ed to do a re­search project or new treat­ment pro­gramme, I have the sup­port to do it.”

She con­tin­ues to blaze the trail with can­cer re­search and treat­ment, pro­mot­ing the use of stereo­tac­tic ab­la­tive ra­dio­ther­a­py (SARB) with more-than-en­cour­ag­ing re­sults.

“A change in com­put­ing, en­gi­neer­ing and ad­vance­ment in can­cer re­search has now en­abled us to treat small tar­gets with­in the body with mega dos­es, even mov­ing tar­gets, and com­plete­ly ab­late those tu­mours. This is with­out surgery and with min­i­mal side ef­fects.

Ac­cord­ing to Dr Ahamad, the sig­nif­i­cance for can­cer pa­tients is that this ap­proach can po­ten­tial­ly elim­i­nate can­cer cells, with a cure rate of 50 per cent, mean­ing 50 per cent of pa­tients will be still alive in five years.

She pre­sent­ed a pa­per on the use of SARB at the Amer­i­can As­so­ci­a­tion of Ra­di­ol­o­gy in 2021 and 2022 with re­search based on tar­get­ting lung neu­roen­docrine tu­mors.

In 2023, she will be pre­sent­ing a pa­per on the ab­la­tion of tu­mors that spread to the adren­al gland.

“This tech­nique has ren­dered many pa­tients who were in­cur­able to cur­able, avoid­ing a life­time of chemother­a­py and im­prov­ing dra­mat­i­cal­ly the qual­i­ty of life. Af­ter treat­ing 100 pa­tients, ap­prox 97 per cent have their tu­mors com­plete­ly de­stroyed.

“Ground­break­ing!”

Since last year, SARB has been made avail­able right here with Trinidad be­ing the on­ly is­land in the Caribbean of­fer­ing this op­tion to can­cer pa­tients.

Ac­cord­ing to IARC da­ta, in 2020, there were an es­ti­mat­ed 3,919 new cas­es of can­cer record­ed in T&T with 2,239 deaths. Among men, the over­all age-stan­dard­ised can­cer in­ci­dence rate was ap­prox­i­mate­ly 160 per 100,000 and the most di­ag­nosed can­cers are prostate, lung, and colon, hema­to­log­ic and stom­ach. Among women, the over­all age-stan­dard­ised can­cer in­ci­dence rate was ap­prox­i­mate­ly 146 per 100,000 and the most di­ag­nosed can­cers among women are breast, cervix, uterus, hema­to­log­ic, and colon.

“Tar­get­ted treat­ment can im­prove the cure rate in this coun­try.”

On whether she would re­turn to T&T per­ma­nent­ly, Dr Ahamad has not ruled this out but recog­nised the ground now is more fer­tile with can­cer care.

“T&T has come a long way with pal­lia­tive care and gen­er­al im­prove­ment in con­scious­ness among physi­cians. We still don’t have all that we need for pain man­age­ment. It is not un­usu­al for the coun­try to run out of pain med­ica­tion. We still don’t have the pain patch­es, or enough long ac­tive pain med­ica­tion.

Work/life bal­ance

About life and bal­ance, Dr Ahamad per­son­i­fies the adage: choose a job you love and you’ll nev­er have to work a day in your life.

“I get to en­joy pa­tients and share part of their lives. I get to en­joy physics, bi­ol­o­gy, com­put­ing and en­gi­neer­ing, cre­at­ing and de­sign­ing. I am very lucky.”

She takes the ap­proach that Maya An­gelou got from her moth­er: do the best you can un­til you know bet­ter; then when you know bet­ter, do bet­ter.

“That helps you deal with what you think might have been a mis­take per­son­al­ly or pro­fes­sion­al­ly. My life has not been a lin­ear one from day one. My dad was a bus dri­ver and my mom, a home­mak­er. Whether I did my home­work or not, no one checked on it. But I did the work and the doors opened for me. My par­ents have been my great­est in­spi­ra­tion, so was my men­tor Dr Waveney Charles.

“I don’t re­gret my colour­ful path­way. It has al­lowed me to ex­pe­ri­ence on­col­o­gy in Eu­rope, in US at the No 1 can­cer cen­tre in the world. I have worked in the Caribbean and I have a prac­tice here.

“Love your life and don’t com­pare it to any­body else’s.”

Giv­en her busy sched­ule, Dr Ahamad shared her ap­proach to self care.

“It has to be de­lib­er­ate­ly thought about and planned be­cause it’s nev­er gonna hap­pen nat­u­ral­ly. Take care of your men­tal health. Have a lot of re­la­tion­ships, healthy re­la­tion­ships, good com­mu­ni­ties and friend­ships. So­cial­is­ing is hard es­pe­cial­ly when you are busy. You have to make the ef­fort and be tol­er­ant.

“Phys­i­cal health takes dis­ci­pline. Stay ac­tive. I rec­om­mend the Har­vard plate.

“I try to be mind­ful and ap­pre­cia­tive and my be­lief and faith in God helps with my over­all health and hap­pi­ness.”