DAKAR, Senegal -- Christine's doctor felt a small lump in her left breast at a checkup in 2015, though she was flooded with relief when the technicians assured her they had detected nothing amiss.
Still in pain more than a year later, she pushed for another mammogram. The 44-year-old mother of four was then diagnosed with advanced breast cancer.
"It was the descent into hell," she said. "You ask, 'Why, why, why?' ... I was so angry. Because why in 2015 did they not see this, and why was it left for so long?"
The word "cancer" is rarely spoken in Senegal, synonymous with death in a country where many like Christine are only diagnosed in the later stages of disease and radiation therapy can be difficult to access.
Cancer has become an emerging public health problem in West Africa, and the lack of strong prevention, good screening and treatment often leaves outcomes grim. For that reason, Christine and most other patients don't share their diagnosis, and they ask not to be identified by their full names.
For now, radiation treatment is impossible for Senegal's population of 15 million people without leaving the country. The sole radiotherapy machine, donated in 1989, broke down last year. Senegal's government had promised two new machines by December, and they were delivered weeks ago, but patients must wait until they are functional.
In the meantime, their only option is to seek treatment in North Africa -- more than 1,000 miles (1,600 kilometers) away -- or even Europe.
"Wherever you go in Africa you have the same problem. Late diagnosis is a fact ... and you don't have the same treatment that you have in Europe or the United States or other developing countries," said Macoumba Gaye, head of the radiotherapy department of Dalal Jamm Hospital outside Dakar.
The need for radiation in West Africa is greater, too. While about 70 percent of patients might need radiation in developed countries, more than 80 percent require the treatment in Senegal because their cases are caught at more advanced stages, Gaye said.
The problem is only expected to worsen unless improvements are made. The number of cancer cases in Africa is projected to double between 2008 and 2030 because of an aging population, according to the International Agency for Research on Cancer.
The Senegalese Ministry of Health did not respond to several requests for an interview on the broken radiotherapy machine.
The country has been planning to set up a National Cancer Institute within five years, plus a registry to track cancer patients. There is also a program to have mammogram machines in all regions of Senegal by next year.
Gaye said they hope to have the two new machines up and running by September.
Until then, Senegal's government is paying for patients' travel to Morocco, said Gaye, who is on the committee that approves who can get such funding. He says some 70 patients have been sent to Morocco so far.
Treating stage 3 to 4 cancer costs at least $5,000-$10,000, he said, while preventative planning such as a pap smear costs only $20.
It's unclear how many people have had to forego the important treatment, but Gaye said it's likely in the hundreds.
Christine's husband had insurance that allowed her to undergo radiation treatment in Casablanca after her tumor was successfully removed by surgery in Senegal in November.
She was fortunate to have a daughter who already lived there, but still had to attend 30 treatment sessions by herself. Christine said she and other West Africans didn't feel entirely welcome in Morocco, adding to the burden of being sick and trying to hide their illness.
"Treatment there was frustrating because they were indifferent to me," she said. "But when the Moroccan patients came in they got kisses, greetings and were treated with kindness."
Wearing a wig, a bright purple dress and a bra with inserts, she said she hopes to start a consultation service for others who have to fight cancer, helping them find such bras and wigs.
She especially credited Dr. Abdoul Aziz Kasse, her Senegalese surgeon, with helping to save her life.
Kasse has been at the forefront of Senegal's cancer care for decades and has been pushing for improved treatment options and government planning to focus on prevention.
Kasse has saved lives with mobile screening units as well, saying that screening can reduce cancer rates by some 30 percent. He now hopes to continue helping others like Christine by opening a new private clinic in Senegal's capital that would expand treatment options.
Once opened, it will offer advanced technology at a lower cost than treatment in Morocco. He and his French partners hope that their business model can be replicated with satellite facilities in Burkina Faso, Ghana, Benin, Ivory Coast and Rwanda.
Burkina Faso has no radiotherapy machine but expects one by next year, said Paulin Somba, head of non-communicable and chronic diseases at Burkina Faso's health ministry. The government has suspended since 2015 sending its citizens to other countries for medical evacuation because of the costs -- the lowest coming in at about 1.5 million CFA, or $2,500, he said. Because of that, the death rate is at 50 percent, he said, adding that surgery and chemotherapy are available.
Mali and Mauritania do have radiotherapy machines, Gaye said.
In East Africa, Uganda has faced the same challenge as Senegal, with its only radiotherapy machine breaking down in April 2016.
A new machine is being shipped and services will be restored "by the beginning of August," said Christine Namulindwa, a spokeswoman for the Uganda Cancer institute. For now, patients who require radiotherapy are referred to a hospital in Kenya's capital, Nairobi, she said.
In Senegal, patients like Christine who have had successful recoveries still worry the cancer could return. Their silence means few know of the hardships many must overcome after such a devastating diagnosis.
"Most people will simply tell me I am going to die," she said. "I don't need their pity."
International on 07/16/2017