Paula Hemphill, a minister's wife for more than 40 years, has long been in the forefront of cross-cultural missions among women. She and Sarah Auler, a pharmacist from Georgia, were invited to speak about breast cancer awareness to Pakistani oncology medical staffers in December 2010. Part of their presentation to doctors and nurses at the Ayub Medical Center in Abbotabad was about magic mouthwash. Auler shared the recipe with the Pakistani doctors, showing them how to mix the solution.
Hemphill -- a two-time breast cancer survivor -- was especially intent on talking with women undergoing treatment; an estimated 89 percent with the disease in Pakistan do not survive.
Pakistani women, like so many overseas, are faced with a barrage of health care challenges stemming from environment, lifestyle, social taboos, poor literacy and limited medical facilities. Culture is another of the factors that contribute to nearly 40,000 Pakistani women's deaths from breast cancer each year -- one of the highest incidences of the disease in Asia. Cultural norms make many women hesitant to discuss the disease with their husbands, much less male physicians.
Unfortunately, breast cancers in Pakistan often go undetected for so long that the majority of women are already in the third or fourth stages of the disease by the time they are diagnosed.
That's one reason Hemphill is passionate about teaching breast cancer awareness and the importance of an early diagnosis.
"I feel like God has allowed me to go through this journey twice now," Hemphill said. "I have the medical background that allows me to communicate accurately the things that have happened to me and the things that can happen to other women. I understand the drug treatments; I've done research online. But I also just feel like God has opened a door for me to talk to women about breast cancer awareness."
Hemphill's family was stunned in 2006 when they learned she had cancer, but as one of her three daughters, Kristina, put it, "She seemed so confident in the Lord and so full of faith that her outlook very much shaped the way that we responded to the news."
It began with excruciating pain in Hemphill's right breast. Her gynecologist prescribed an antibiotic, ordered a mammogram and an ultrasound. Both were negative. He recommended a wait-and-see approach, but Hemphill, then 56, insisted on seeing a surgeon who soon diagnosed her with breast cancer.
"If I'd waited three months like my told me to," she said, "and then come back, my prognosis could have been a lot different.
"Because I insisted on seeing a surgeon ... within six days, I had a mastectomy."
Chemotherapy left her exhausted. Radiation caused uncomfortable burns. She lost her hair, eyebrows and eyelashes. Hemphill's treatments finally ended in October 2007.
In June 2010, her oncologist spoke the words every cancer patient hopes to hear: "You will never have this cancer again."
But that November, shortly before her trip to Pakistan, she received bad news: another diagnosis of breast cancer -- this time, a different type.
The second diagnosis was even more shocking than the first. "Breast cancer and other cancers don't have any rhyme or reason," said Hemphill, noting that one in eight women in the United State will be diagnosed with the disease during her lifetime. "You can't ask the 'why' question. It's not a productive question. You have to ask 'What now?'"
Hemphill's "what now" is paying it forward to other cancer victims. Prior to her second cancer surgery, her oncologist agreed to let her make the trip to Pakistan. Her family also encouraged her to go.
"When I told I'd asked my husband's permission to come to Pakistan, that I'd just been diagnosed, they gave me a standing ovation. It made the story so much more poignant," Hemphill said. "Here I was, a breast cancer patient, pre-op, caring enough about Pakistani women that I came to Abbotabad."
Among the things she shared with the Pakistan medical staff were tips her friend and colleague -- and breast cancer survivor -- Julie Pierce had suggested.
Pierce advised Hemphill to make sure to suck on a Popsicle or put ice in her mouth during the chemo infusion to minimize mouth sores and to wear socks and gloves during radiation, which is usually administered in cold rooms.
Pierce also called periodically to check on her friend.
"The Bible says comfort others with the comfort you have received, and Julie did that for me," Hemphill, tearing up, recalled. "She told me what to expect with the chemo -- she told me some things to do that would make the treatments easier."
Lack of resources
Hemphill's cancer experience left her acutely aware of the lack of resources for early detection and breast cancer awareness for many women, even in the U.S.
"I think there is a very simple, story-based tool that we could develop to give to women in our churches," she said. "They could use it to then train other women and expose them to early diagnostic self-examinations and tools that would help encourage and empower those women to deal with their own bodies."
In Pakistan, Hemphill shared with the doctors how effective the magic mouthwash was during her first bout with breast cancer.
"One of the biggest adverse effects with chemotherapy is severe mouth ulcers," said Sheraz Ahmad, a doctor at the Ayub Medical Center. "The best therapy is a mouthwash having a lot of ingredients ... and its impact is magical to heal."
Ahmad sent Hemphill a message in the spring of 2012: "Today, the cancer support group members from the pharmacy department made the first batch of magic mouthwash ... the first ever in this area. I am so happy today."
Her husband Ken said she "spent a lot of time dealing with her issues on Facebook and talking with and encouraging our daughters in the midst of ." But Hemphill had no idea what an impact her willingness to share would have.
Upon seeing family photos and stories on her Facebook page, one Pakistani doctor told her: " dispelled my misconceptions about American families. We are told there is no more family life because of money and other American influences."
Hemphill leaned heavily on her family when she returned home from Pakistan in 2010. She knew the toll cancer treatments take, both physically and emotionally, as she prepared for another battle.
"I've had two times during all these treatments where I literally felt like I could die from the nausea and the fever," she said, "... when you are literally so weak you can't stand.
"My husband would have to pick me up and put me in the bed or take me to the bathroom. I could not walk."
Since both her cancers were fast-growing, Hemphill decided to have another mastectomy. "I've had two breast cancers," she told her surgeon, "I don't want to risk a third."
While many women struggle with body issues following mastectomies, Hemphill credits her husband with helping her through any insecurities.
Ken said he learned that one of the most important things he could do was to be a good listener for his wife -- something she, herself, put into practice in Pakistan. As breast cancer patients shared their stories, Hemphill listened and prayed for each one.
Her trip to Pakistan helped affirm God's plan for Hemphill to use cancer as an opportunity to share Christ intentionally.
"During the last two months I have sent several personal messages to Pakistani friends related to Jesus, eternal life and hope of heaven," she said. "Their worldview is so different and many are very serious Muslims.
"These doors are only open because I went and God made the connections," Hemphill continued. "Access is through social media and prayer. ... The need for training for Pakistani believers in reaching the majority peoples is urgent. Their reluctance to share because of persecution and blasphemy laws makes the presence of other believers necessary."
While Hemphill is "forever a breast cancer survivor," she continues to seek opportunities to share her cancer story.
"It's a natural entrée to talk about the Lord."
Yvonne Carrington is an International Mission Board writer/editor.
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