The common adage ‘what doesn’t kill you makes you stronger’ is one way to describe 56-year-old Haston Charlotte’s life—being a survivor of the 1994 Genocide against the Tutsi, and thereafter, battling breast cancer.
The early days
Born in 1967, as a child, Charlotte was passionate about caring for people and hoped to do something related to that in the future.
After high school, she didn’t join university right away, however, she took an A2 level nursing course in Senior Six at Rwamagana Nursing School in 1988. At the time, she was also practicing nursing.
The country was short on midwives then, and so the Ministry of Health informed health workers, particularly nurses, to upgrade to midwifery while doing their own line of work.
Disaster strikes
Charlotte lived with her husband and two children in Nyamirambo, a Kigali suburb before the 1994 Genocide against the Tutsi spread out. On the morning of April 7, after having breakfast with her family, her husband stepped out of the house for what was supposed to be a brief moment.
Twenty minutes later, Charlotte wondered what was taking him so long to get back, which prompted her to go outside and check on him.
She found him dead, next to the sitting room entrance, with fresh wounds. It appeared he had been shot in the face (near the mouth) and in the neck.
"I was horrified and panicked, as I didn’t know what to do. I didn’t hear him scream or hear anyone enter our gate, up to now I am still curious about how my husband was killed,” she says.
Charlotte went out of the gate to ask for help but in vain. With the strength she could gather, she pulled her husband’s lifeless body into the house, where she cleaned him up, wrapped him in a bedsheet, and left him in the bedroom.
She called one of her neighbours who told her that they would bury the dead the following day. They dug holes near their homes and buried their loved ones on April 8. By that time, the killings were in full swing.
On April 9, Charlotte received a call from a colleague at the University Teaching Hospital of Kigali (CHUK) where she worked. She started packing as he said he would pick her up to go to the hospital and stay there.
She hurriedly got her two children ready to leave, her son was four and her daughter a year old.
When her colleague arrived, they got into the car and drove off fast. As they approached the hospital, they got to a roadblock where they were commanded to get out of the car and interrogated on their destination. They explained over and over that they were heading to work, and after a while, they were given way to continue to the hospital.
They took refuge at the hospital for a few weeks, though some people were found and killed—weirdly in the hospital’s mortuary and not in the open. Around May, grenades were thrown inside the hospital.
"People were running for their lives. I didn’t know which way to go. I recall seeing a colleague with his injured child who needed to be rushed to another hospital asking the hospital’s director for an ambulance which was given to him. I, therefore, knew I had to be smart and ask for one too,” she says.
Charlotte requested an ambulance that took her and her children to Rugunga, a place the International Committee of the Red Cross had created to give assistance to people. These were hostels that were transformed into a hospital for people wounded during the Genocide.
At first, she was denied access to the hospital, but she explained that she was a nurse and was there to offer assistance in treating patients. She was let into one of the wards that had many injured people, where she used some space for herself and the kids.
Her children were sick and dehydrated since they hadn’t taken water in a while. The hospital didn’t have enough water. They vomited. When she asked one of the nurses better suited to treat the illness to help, very little attention was given to her, which sadly resulted in her daughter’s death on April 11.
"I wasn’t skilled in the paediatric area, so I didn’t know the best treatment to give my child. I believe if I had gotten help earlier, she wouldn’t have died,” she says.
Charlotte’s daughter was buried in the hospital’s compound. After which she put her son on a drip, hoping to save him. Luckily, he got better with each day.
She stayed in the hospital until July, which had very few attacks during the Genocide, and that’s how she managed to survive.
When the Genocide was stopped, she tried to look for some of her relatives. Sadly, she lost many of them, including seven of her siblings and an aunt who would later help her through another tribulation in life.
She managed to trace and find her sister-in-law after the Genocide and stayed with her at her home in Kiyovu.
She has never received counselling regarding what she went through and remembers the horrific period mostly through other survivors sharing their stories.
"I didn’t actually know I had a problem until I started going to church and praying. It is then that I felt peace, and realised that I had been miserable all along,” she says.
She continued to find solace and healing in church sermons.
Disaster strikes...again
While working at King Faisal Hospital as a midwife in April 2014, going about her duties or assisting the gynaecologist with patients, one patient walked into the doctor’s office and requested a breast exam.
At this point, Charlotte realised that it had been quite some time since she had done a personal examination with her hands—something she used to do.
She remembered how they were urged way back in school to do their own breast examinations in order to detect breast cancer early, as that would make it easier to treat it.
"I couldn’t wait to get home to do the self-check. Unfortunately, on passing my hands gently around my breasts later, I felt a lump in my left breast, though it was small and not painful,” she says.
Fear kicked in, and Charlotte reached for her phone in a panic and called a doctor at the hospital to schedule an appointment the next day.
After discussing the odds in length, the gynaecologist advised her to see a radiologist and oncologist. "He was so kind to me, even when I met the doctors he recommended, they were expecting me as he had communicated with them,” she recalls, adding that she was required to take an echography — a medical examination of the internal structures of the body by means of ultrasound and undergo mammography.
The lump spotted raised suspicion of cancer, which prompted the doctors to suggest surgery to have it removed, and also perform a biopsy to remove a piece of tissue or cell sample from her body to be tested in a laboratory.
Charlotte went through a successful surgery at King Faisal Hospital where the lump and two-centimetre surrounding area were removed and taken to the National Reference Laboratory in Huye. She was hospitalised for three days.
"After the surgery, I was clothed in worry, fear, doubt, mistrust, and panic. I tried to pray but didn’t have the right words to say. Countless thoughts ran through my mind. I wondered if I would be cured if the results turned out positive. By then, there were few cases of cancer survivors in Rwanda,” Charlotte says.
To say she was nervous about the results would be stating it lightly. The doctors, however, raised her hopes; since the lump was out, she was most likely going to be okay and wasn’t going to lose her breast if it turned out to be cancer for sure.
Then the day she got her results, life dealt her another ‘blow’.
The battle
In three weeks, the results were in her hands. "I am sorry to break the sad news, but you have breast cancer,” Charlotte remembers the doctor's words, delivered in a serious yet calm tone.
"I froze and panicked at the same time. I was quiet for a moment,” she recalls. No one in her family had ever been diagnosed with the illness and thoughts of death lingered in her mind, once again. "How was I supposed to leave my son alone?” She thought to herself.
She didn’t know what lay ahead even when the doctors informed her of the next procedures. Everything was new to her.
As doctors discussed the results, they came to the conclusion of removing her breast to avert the cancer cells that could have perhaps spread to some other parts of the breast.
"I was thwarted because they had elevated my expectations, so I was certain I was remaining with my breast. I couldn’t envision having one breast. It broke my heart.”
The doctor advised Charlotte to bring her family for support. She decided to go with her aunt, the Genocide survivor earlier mentioned, who was enlightened in detail about the process of a mastectomy (a breast cancer surgery that removes the entire breast).
Though she had many questions stemming from her disappointment, doctors cautioned her that the decision was for her own good.
One month later, the surgery was done successfully and she started chemotherapy after the wound healed. It was a harsh treatment that she had to undergo once every three weeks for eight months.
The treatment and check-ups were costly but made easier by the health insurance she uses that covered 90 per cent of her bills.
Before starting treatment, the doctors checked her height and weight as the dose of chemotherapy is determined by one’s body mass index, among other important things, like standard blood tests, radiologic tests, and dental or podiatric exams to check for infections that could result in complications during treatment and a review of medications and foods. She was also required to sign an informed agreement granting permission for chemotherapy.
She was advised by the medics to consume foods that gave blood a boost, drink enough water, and reduce sugar intake.
Charlotte’s aunt ensured that she was in a clean place, ate a balanced diet, and got enough rest and some exercise. She would also invite people home, especially family, to support and encourage her to stay positive.
By then, chemotherapy had just been introduced in Rwanda, it weakened her, and she felt like it was crushing every cell in her body. Her veins darkened.
"Everything happened so fast. After starting treatment, I vomited a lot, felt exhausted, and I lost my hair,” the midwife says, adding that even though she was prepared for hair loss, she didn’t know it would happen so soon.
One morning, a week after starting chemotherapy, as she combed her hair, getting ready to go to work, huge chunks of it stayed in the comb. "It was worrying because even a mere touch of my hair pulled it out with ease. I freaked out but managed to call my workplace to request a day off. I wore a cap, and headed to town to purchase a wig.”
On returning home, she looked in the mirror and, her ‘head was a mess’. Some parts had hair, while others didn’t. She broke down in tears for the first time—she had bottled up the pain for so long. She then pulled out all her hair, till she was almost completely bald.
"I am a strong person, but I couldn’t recognise myself anymore,” she notes emotionally.
Going back to work the following day, a close colleague looked at her and cried as the changes had come fast.
Charlotte spent most of her alone time praying, though she felt unhappy and depressed.
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While lost in thought and wondering what was next for her, a workmate introduced her to Philippa Kibugu, a breast cancer survivor and the founder and CEO of Breast Cancer Initiative East Africa (BCIEA), at the end of 2014.
Kibugu gave her a breast prosthesis—designed to replace a missing part of the body or to make a part of the body work better.
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Wearing the cotton prosthesis, which she fixed inside her bra, worked perfectly as a replacement for her breast, and this boosted her confidence.
Before getting the prosthesis, Charlotte would fix a small piece of cloth in her bra, though it was tricky to maintain the breast shape or balance with the right breast.
"Meeting Kibugu was satisfying, she advised me and other cancer patients on how to live a normal life, that is, throw worry and stress outside the window and focus on hope, curbing stigma, and taking treatment seriously.
"We created a group where we discussed cancer, and comforted each other. We weren’t alone,” she says.
Whereas some cancer patients also deal with stigma, Charlotte didn’t. Having a supportive family and friends allowed her to recover, even when doubt tried to creep in.
Connecting with other patients enabled her to relate to others’ experiences about coping with the disease and its treatment.
"My support system offered me an opportunity to talk about and deal with my feelings, and also grapple with the side effects associated with treatment,” she says.
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Cancer free
After eight months of undergoing chemotherapy treatment, in May 2015, Charlotte was declared cancer free. However, doctors advised her to continue with check-ups every three months, then six, and later a year.
She goes after every six months for a review, albeit worriedly as she fears that even the slightest pain could be cancer.
Seeing her hair, eyebrows, and eyelashes grow back after chemotherapy was mesmerising, it was like a flower regaining its freshness. "I had missed going to the salon,” the Kagugu resident says.
Getting her health back was fulfilling. Everything is a gift, she says, noting that many times we take things for granted until we are tested. Being healthy is a treasure.
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In 2011, Charlotte joined the Rwanda School of Nursing and Midwifery, now the University of Rwanda, School of Nursing and Midwifery on a government scholarship, and pursued a diploma in midwifery for two years. She still works as a midwife at King Faisal Hospital.