Serah Yugh had undergone eight sessions of chemotherapy, 25 rounds of radiotherapy and a single mastectomy on her left breast before realizing one shocking fact: she did not have breast cancer as misdiagnosed by the doctor!
She wore a scarf, a smile, and brought a sheaf of papers out of her bag. Occasionally, her scarf fell off to show her plaited hair. But this is not how she was three years ago when her hair started falling off due to chemotherapy. Her doctor had warned her of what would happen to her hair, but the day she was taking a shower and applied soap to her head, she screamed as chunks of hair fell off her head. This was in 2017 after she underwent a mastectomy on her left breast. And this was also the beginning of a journey that would forever alter her life.
When Serah started losing weight while undergoing her National Youth Service Corps (NYSC) assignment in Ekiti State, she went to the hospital seeking a solution but found none. Tests were done but results didn’t point to anything.
TINY LUMP, BIG PROBLEM
While self-examining her breasts in 2017, she felt a tiny lump on her left breast. This bothered her so much that she first went to the Federal Medical Centre, Makurdi before going to the Benue State University Teaching Hospital at her sister’s suggestion. What was supposed to be a simple test developed into a three-year-long back and forth with the hospital.
It was such a tiny lump that — when a biopsy was performed at the Benue State University Teaching Hospital (BSUTH) — was described as “a single very tiny piece of greyish biopsy tissue that may be inadequate for process.” At the hospital, Serah told them she wanted to know the type of lump she had.
MISDIAGNOSIS, THEN INDUSTRIAL ACTION
The histopathology diagnosis of the first test was Atypical Epithelial Hyperplasia (an abnormal growth pattern that is associated with a small increase in breast cancer risk), which has been shown to be pre-cancerous but is not cancer. The second diagnosis was an Invasive Ductal Carcinoma which, according to the Johns Hopkins Medicine, represents 80 percent of all breast cancer diagnoses.
Just as Serah was awaiting the result of the third test, the hospital went on an industrial strike in September 2017 and by the time the strike was called off in January 2018, she had undergone five rounds of chemotherapy. Her doctor, Dr. Stephen Atokolo, had urged her to do a mastectomy to quickly stop the spread of what could be cancer. She did the surgery. When the third test result was out, the histopathology diagnosis was Fibroadenoma. Serah Yugh did not have cancer.
This misdiagnosis was however not what bothered her. Serah needed her immunohistochemistry test. The test was to be given before radiotherapy since it determined the next steps of treatment. This however didn’t happen and she started taking Tamoxifen.
Since 2017, she had been coming to BSUTH from Kaduna and Abuja, asking for her immunohistochemistry test from the Dean of the College of Health Sciences, Dr Joseph Ngbea. The test result was to enable the doctor at National Hospital decide on the treatment to give her.
Dr Ngbea told FIJ that he was not in charge of Serah’s case. And while Serah had paid for the test to his secretary at his request, each time she went, she was told the results were coming. The last time she waited to see him at his office, she recalls, he shouted at her.
At a meeting with Dr Raymond Vhriterhire, the former Head of Department of Histopathology, and Dr Joseph Ngbea — who was newly appointed as Commissioner for Health, Benue State, Serah was offered a breast reconstruction, and a job. She rejected both.
She was more interested in knowing the exact life-redefining error made by the doctors. She also wanted to know why they had not yet given her the immunohistochemistry test. She had asked them how she would cope with the side effects of the chemotherapy, radiotherapy and drugs she was taking. The offer came across to her as a ploy to silence her from asking questions — questions she had been asking since September 2017 when a mastectomy was performed on her.
A doctor who asked not to be named explained to FIJ that in matters of misdiagnosis as applicable to doctors, negligence is determined by a couple of factors. A doctor has a duty to a patient. Secondly, there is a dereliction (when a doctor deliberately fails to do what he or she is supposed to do). Thirdly, there is a damage due to the dereliction and that damage bears a direct link between the doctor’s negligence and the result (the damage).
After her chemotherapy, Serah returned to Kaduna. It is here that she found Kunak and Project PINK BLUE, two NGOs that gave her support. Project PINK BLUE, an organization engaged in cancer awareness, paid for her radiotherapy. But prior to then, Serah had to get an immunohistochemistry test that was supposed to further pin down the diagnosis of a cancer.
According to an oncologist, Dr Chinedu Arua, histology and immunohistochemistry tests are prerequisites for patients seeking breast cancer treatment.
“Those things have an implication in terms of the drugs we are going to use to treat the patient, and the outcome of the disease,” he said.
“It also has medical implication. Without the tests, a doctor won’t agree to treat the patient. What they’ll do is to take a second sample from that tissue and get a histology for that. This would help the doctor give the appropriate drugs to the patient and give a focal of what would be the likely outcome of the disease. Is the patient dealing with a disease that is curable, or one that they’ll just be managing? The immunohistochemistry test is very important! Without it, the patient might be given a wrong drug for a wrong disease.”
It was when Serah went to Abuja that her oncologist pointed out the discrepancies in the results she presented. She didn’t know the test results were different and therefore signified something deeper she might have been missing.
“All my plan was to finish chemotherapy and do radiotherapy so I could play my part and rest,” she told FIJ.
TURNING TO GOD
The National Hospital Abuja, the leading cancer centre in Nigeria, was where Serah underwent radiotherapy for six months. It was after radiotherapy that she returned to BSUTH to get her tissue block in order to do the immunohistochemistry test that was requested by oncologists at the National Hospital, Abuja. She had paid for the test in 2017 at the behest of Dr. Ngbea just after her mastectomy in September. But the test results never came.
“I lose weight when I am stressed,” Serah says.
With each date she remembers, she presents a supporting piece of evidence to support her claim. At other moments when she remembers her travails, she smiles and shakes her head. In those dark moments, she says, she turned to worshiping God. It was there she found strength and solace. It was also in her relationship with God that she found the strength to emulate the biblical Joseph and keep chasing for her immunohistochemistry test without giving up.
“I couldn’t do radiotherapy the particular time I was supposed to do because I was psychologically down and my weight drastically came down. They said they had to place me on bed watch. I was eating and sleeping, trying to gain weight.”
After her radiotherapy, her oncologist told her they wouldn’t proceed without the immunohistochemistry test. Since payment in 2017, and until 2019 when she underwent radiotherapy, she received no test results. She was without money and couldn’t go to Benue State to follow up on the test.
WHERE IS THE TISSUE BLOCK?
Dr. Ngbea’s secretary told her the tissue block had been sent to Labnetwork, a pathology and medical laboratory in Abuja. This was a wild goose chase. They didn’t have her records. She called Dr. Ngbea to inform him her tissue block had not been received. When it was eventually sent, the test wasn’t paid for.
Serah opted to do a tumour marker test as a second option. A tumour marker test looks for tumour markers in the blood or body tissues. When Serah eventually got the immunohistochemistry test from Labnetwork, the diagnosis read: “Breast tissue – no residual malignant tumour is seen!”
Up until December 2019, two years since her mastectomy, Serah still believed she had cancer. The doctors at Benue State University Teaching Hospital did not reach out to her to inform her of any misdiagnosis.
Still, despite the diagnosis from Labnetwork, Serah did not yet understand that the results showed she did not have cancer. According to her oncologist, her tumour marker test showed that she was clear of cancer. But the specimen which showed invasive ductal carcinoma was not what was sent to Labnetwork. What had happened to that specimen? Had it been disposed? Or had the doctors at BSUTH already known a mistake had been made and were covering it up? When Serah went back to get her tissue block she was told they could only find the first and third tissue blocks. The second tissue block said to contain cancer cells could not be found.
FINDING OUT SHE NEVER HAD CANCER
On March 2020, Serah wrote a letter to the Chief Medical Director of Benue State University Teaching Hospital demanding for her immunohistochemistry test, and her tissue block from the second test she did.
“I have made repeated verbal demands for my tissue block to the Departmentof Histopathology, but nothing has been done,” she wrote. “I need you to help take the necessary action to enable me get the tissue block, because the next line of my treatment and medication depends on it.”
When she received no response, Project PINK BLUE wrote to the Chief Medical Director, Dr. Terlumun Swende, in May 2020 to appeal for the tissue block. The hospital, through the Chief Medical Director, responded to Project PINK BLUE on July 2020.
“I am to inform you of our inability to grant your request for the release of the tissue block in respect of above patient,” the response read. “The patient may however wish to approach the current managing physician, as requests of this nature normally emanate from the managing physician.”
In August 2020, the Department of Histopathology of the National Hospital, Abuja sent a request to the Chief Medical Director for the tissue block, which Benue State University Teaching Hospital said contained cancer. No response was received.
Searching for her tissue block to be given to her became a full-time occupation for Serah. When she was directed to the Head of Department, he wasn’t available for more than three days. She later learned he had gone out on an official assignment.
They started setting meeting. Before I knew what was happening, the H.O.D (Dr. Raymond) called my uncle telling him that it was an error. I told him, I am the victim here. When you were telling me I had cancer, did you call my uncle?” Serah told FIJ, almost breaking down in tears.
“So why are you calling my uncle telling him that I don’t have cancer. I am the one with the problem don’t call my uncle. If I could handle the news that I have cancer, then I can handle ‘I don’t have cancer it was an error’. They said they have a method of doing things.”
It was in the meeting set up between Dr. Raymond and Serah’s uncle that Serah got to know she had been misdiagnosed and didn’t have cancer. This revelation made her demand to see the Chief Medical Director.
“You came to my department requesting for blocks for the test that you wanted to do, that you did sometime in the past… to enhance your treatment, which was difficult for us to actually achieve. I want to apologise on behalf of the department that we could not do that. I am very sorry that we could not give you the blocks,” the H.O.D started by saying in the meeting.
It was in the meeting that Dr. Raymond revealed that specimens were discarded in 2018 because the lab was filled up. Serah’s specimen was also discarded. Having read the three reports, Dr. Raymond didn’t think the test would be necessary.
Those three reports, the one that was at variance was the second one. When I looked at it, I now thought within me, if we decide to do immunohistochemistry it might not yield much,” Dr. Raymond said.
The surgeon relied on the diagnosis of the pathologist. The second report, which showed that Serah had cancer, had Dr. Ngbea as the consultant pathologist. FIJ got a copy of the report and on it someone signed for Dr. Ngbea. When we reached out to Dr Ngbea, he claimed the resident doctor responsible had left the hospital but that he had nothing to do with Serah’s case.
The Nigerian health system has come under criticism for how poor it is
FIJ obtained an audio recording where Dr Raymond and Dr Ngbea had a meeting with Serah. Dr Raymond said in the recording: “It is unfortunate that in the process of trying to offer help, sometimes error occur. What can we do to assist her pick the pieces of her life together because obviously she does not have cancer?”
He further said, “The diagnosis of cancer has disrupted her life for the past three years. . . The good news is that all those surgeries that she went through she survived it. None took her life. The question now is what is the way forward? How can we get her to pick pieces of her life. It might not completely bring back her joy but at least a little taste.”
It was in this meeting that they offered Serah a breast reconstruction and a job as efforts to show that she is not left to bear the burden alone. This however seemed to come at a time when Serah’s suffering and burden had more than weighed her down. At the meeting, Dr Raymond acknowledged a failure in the check and balance system of the hospital and a failure of the system.
“I don’t know what is going on. I am just in the middle of everything going on,” Serah said, confused. “First I thought it was immunohistochemistry result I was coming for. Then I discovered it was tissue block. Then the next thing is that I never had cancer.”
These meetings were long explanations into how mistakes were made by doctors. Serah questioned what they would do about the side effects of chemotherapy, radiotherapy and Tamoxifen? She recalled how weak her bones were and how inconsistent her periods became. She could not walk or travel for long distances and many times had to deal with headaches. As we talk, she tries to remember some of the questions I had just asked her minutes before. She tells FIJ she’s been dealing with memory loss.
At the meeting she asked that the Benue State University Teaching Hospital write a letter to her doctor at the National Hospital, Abuja, that they made an error and therefore she should stop treatment. No letter has been written. And while verbally the doctors have acknowledged they made an error, it’s not been documented officially.
“When they told me I had cancer it didn’t affect me this much,” she said. But it’s the battle of fighting the error that has taken more from me. When I think about it, eating becomes a problem.”
Serah lost her relationship, and her dream to pursue a Ph.D.
“I don’t want others to fall victim because I know it will not end just with me alone,” she said, explaining why she’s been fighting the misdiagnosis made on her. Even though she fears for her life and the repercussion her speaking up might bring to her, she wants an official apology from the Benue State University Teaching Hospital.
Runcie Chidiebe, the founder of Project PINK BLUE, told FIJ that getting justice for Serah is in three folds.
“Number one is the justice that has to be driven by the lady whose breast was cut off when there was no need for that. That’s justice for her as a person,” he says.
“The second part is for women across the country who have been through this, to speak out. This should be a very strong message to every medical practitioner to be very mindful of the licence they’ve got.
“The third part is if you think about the impact of this, she will live the rest of her life with one single breast when she never had cancer. This is a very strong reminder of what the system has subjected many to.”
Chidiebe lamented that there are millions of people who will still get cancer in Nigeria or elsewhere in Africa, but they must seek second opinion before undergoing surgery.
“You don’t just get first opinion, then allow your breast to be cut off. Multiple tests must be done,” he warns.
On what Serah might want at the end of all this, he explained that her most pressing targets are not pecuniary.
If Serah had wanted a job, she would have been working at the hospital long ago. If she wanted money, she would have gotten the N10million that was promised her several months ago,” he said.
“But she told me long ago she desperately wants this information to get out so that other people diagnosed with cancer can avoid the pitfall she’s into. And I think that is really confident of her. She needs to be supported and protected at all costs.”
Having worked in the space for seven years, this is not the first case of misdiagnosis Chidiebe has seen.
“We’ve seen a woman who was diagnosed triple negative, but they had given her someone else’s result and said she was hecto-positive,” he said.
“And they were treating her with a different cancer chemotherapy, one that she didn’t need. It’s happening in hospitals across this country — because of negligence. ”
For this reason, Chidiebe wants those culpable in the misguided removal of Serah’s breast to be prozecuted in a court of law.
“It’s so painful when people know the truth and they’re hiding it from you, making you look like a kid,” he laments. “The people who made this mistake should be prosecuted!”