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Faith and Fortitude

A cancer survivor embarks on a spiritual journey to Poland and finds inspiration in a local cancer hospital. By Cynthia Ryan

Just weeks before I met Agnieszka Mitręga in August 2016 at Holy Cross Cancer Center in Kielce, Poland, the 41-year-old mother of six learned that her estrogen receptor-positive breast cancer, first diagnosed in the spring, had metastasized to her bones and lungs. I asked Mitręga, whose children range in age from 4 to 22, how she was coping with the news.  


​Agnieszka Mitręga says her metastatic breast cancer has not deterred her from looking after her family and the family's farm. | Photo by Cynthia Ryan
“I have no time to think about it,” says Mitręga, who lives in the town of Pińczów, about 25 miles south of Kielce. Between growing vegetables and rye, tending to the household, and caring for her husband and children on her family’s 32-acre farm, Mitręga admits that, though she worries about the future, she remains “very active” and has “no time to dream about lying around, resting.”

Mitręga assured me that she was “not feeling any pain,” and that her doctor believed “she was in a good place” following a mastectomy, six rounds of chemotherapy and one treatment of radiotherapy. I was in awe of her calm strength and her belief that she would get through her experience with cancer, even though the disease had spread to many parts of her body, including her spine, ribs and likely her pelvis.

“I am a believer in God,” Mitręga says. “I am Catholic.”

Spirituality and Survivorship
As I learned in conversations with others at Holy Cross Cancer Center, one of 16 regional public cancer centers in the country, Mitręga’s fortitude in the face of a frightening diagnosis and uncertainty about the future was a common theme among both cancer survivors and those who treat them in Poland.

I traveled to Poland in July 2016 to attend World Youth Day with my teenage daughter and other members of her church youth group from Birmingham, Alabama. Begun by Pope John Paul II in 1985, the international celebration of World Youth Day is a biennial event for Catholic young people from around the world. The 2016 celebration was in Pope John Paul II’s home country of Poland and culminated in an outdoor Mass celebrated by Pope Francis before an estimated 2 million people at Campus Misericordiae (the Field of Mercy) in Brzegi.

As a lifelong Catholic whose faith was tested by breast cancer diagnoses in 1993 and 2004, I met many Catholic believers in Poland. More than 94 percent of Polish citizens self-identify as Catholic. The country’s landscape reflects this with a multitude of religious sites, including the monastery containing the image of the Black Madonna at Częstochowa, a revered icon that survived damage to the church during World War II and is a favorite destination for pilgrims.

Following the World Youth Day events, I stayed in Poland to learn about cancer care and survivorship. With a population of more than 38.5 million people, Poland is located between Germany to the west and Belarus, Ukraine and the Baltic states to the east. Its eastern neighbors were once part of the former Soviet Union, and for much of the 20th century, Poland suffered at the hands of its more powerful neighbors. After occupation by Nazi Germany ended in 1945, Poland endured 45 years of communist rule. As I would learn, decades of communism and isolation from the West had a significant influence on Poland’s infrastructure—including the health care system.

Institutions devoted to caring for Poland’s people had to be reoriented once the country was no longer governed by the communists. Decades of government oppression had left too few trained physicians, so waiting times to get medical attention in the public health care system were lengthy. Treatments were frequently inaccessible. Poles were understandably distrustful of the government and other social institutions long controlled by the communists. While private health care facilities are available in Poland, most citizens can’t afford them.

My examination of the current state of cancer care in Poland began with a visit to the Polish Cancer Patient Coalition in Warsaw, the nation’s capital. On the third floor of a communist-era concrete building on Piękna Street, I sat with several members of the coalition, including the organization’s president, Szymon Chrostowski, and the office director, Beata Ambroziewicz, who served as our translator. Also present were Joanna Bogusz and Dorota Dudek-Godeau from Poland's National Institute of Public Health–National Institute of Hygiene, who would accompany me for three days as I conducted research.
  
My hosts explained that, as a result of long delays in diagnosis and treatment of Polish cancer patients, a new “waiting time and oncology treatment package,” called the oncological package, was signed into law in January 2015 by then-health minister Bartosz Arłukowicz. The plan authorizes general practitioners to evaluate patients for cancer and, if they show symptoms of the disease, issue a “green card” giving them access to the cancer care system. Patients issued a green card are guaranteed to be tested and diagnosed in eight weeks or less. Within two weeks of receiving a green card, patients see a cancer specialist for an initial diagnosis and are assured a second opinion within six weeks.

Visiting Holy Cross Cancer Center
In Kielce—a city of roughly 200,000 and the capital of Świętokrzyskie Voivodeship (Holy Cross Province) in the southeastern part of Poland—I visited Holy Cross Cancer Center, established 26 years ago to care for cancer patients and promote research in the region. The center is the only comprehensive cancer care facility in the province, boasting 368 hospital beds and treating about 22,700 patients in 2015. One of 16 cancer registries in the country is housed there—part of a national effort to keep accurate records of cancer incidence, survival and mortality. Holy Cross Cancer Center offers several specialty areas: clinical oncology, radiation and surgical services; a bone marrow transplant division; and departments devoted to brachytherapy and hyperthermia, urology, endocrinology, gynecology and palliative care, among others. 

12/30/2016
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