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Battle against death by geography

ANN McGowan believes it is death by geography. And for her, the planned removal of cancer facilities north of the line from Dublin to Galway is a deeply personal insult -- a regional form of apartheid which will mostly affect women like her.

She is a cancer survivor who had to fight every step of the way to have her disease treated and she is still bitter and angry about the 12 lost weeks after she found a lump in her breast which she knew in her heart was malignant.

Faced with further delays to see a specialist, she turned to the airwaves, giving up her anonymity about this most personal trauma to angrily denounce on Liveline what had happened to her.

That evening, she received a phone call from a health administrator with an appointment for her. They had found cancer. She went through surgery, chemotherapy in Sligo, as well as five weeks of radiotherapy in St Luke's Hospital in Dublin, over 140 miles from her home.

Ann will be on anti-cancer medication for the rest of her life, and wonders, if she had been seen immediately after she found the lump, whether the disease might not have spread to three of her glands. The fearful spectre of the disease returning still casts a shadow.

There is also some sense of guilt. She wonders whether the fuss she made on radio, which got her bumped up the waiting list, meant that some other woman was put further back in the queue.

"But when you are fighting for your life, you will do anything," she says.

Ann was one of 3,500 people who endured freezing weather to take part in a silent vigil outside Sligo General Hospital against the planned removal of cancer facilities from Sligo.

There were no speeches. The campaigners feel this Government isn't listening, the Minister for Health is turning an obdurately deaf ear and the Health Service Executive is bull-headed in its refusal to countenance any tinkering with its grand plan for cancer "centres of excellence".

Instead, at the end of the vigil, in a spontaneous outpouring of solidarity, the campaigners sang Amazing Grace and We Shall Overcome.

Nobody is arguing that centres of excellence are a bad idea. Concentrating the experts and all the cancer treatments in one place is acknowledged as the best way to improve treatment of this most insidious of diseases.

But under the current plan, Dublin will have four centres of excellence with others in Waterford, Cork, Limerick and Galway while the country north of the line between Galway and Dublin faces the prospect of being so far from specialist cancer care that people living there feel their civil rights have been ignored.

Oncologist John Crown says the concept of centralising cancer care is absolutely correct, but he is passionate that the northern half of the country needs its own centre.

"You cannot have every little hospital treating breast cancer. The treatment will be inferior. People will have to travel a bit to get treatment. The problem here is that the current plan is more of an acknowledgement of big hospital and medical school politics and less about the quality that comes with central- isation. Why else would they have four centres in Dublin?

"There is another part of international standards which they are ignoring completely, and that is the concept of the comprehensive cancer centre. That is what every single international study says is the right way to treat cancer. All of the different cancers treated in all of the different ways under one roof. But that is not what we are going to have under this current plan," he says.

"What's going to happen in Dublin is that we are going to have four hospitals doing breast cancer, two hospitals doing bowel cancer and two hospitals doing prostate cancer, and the reason why they are doing it is because they won't grasp the nettle of having a small number of cancer centres in Dublin covering all cancers. That would mean they could have two or three comprehensive centres in Dublin and move one of them up to the north west."

Professor Crown says there was a way in which placing a centre of excellence in Sligo would make sound medical and economic sense.

"If they take the old North Western Health Board region -- Sligo, Donegal and Leitrim, which would have about 225,000 to 250,000 people -- that is plenty big enough of a catchment area for a cancer centre. Under the current plan, they have given Donegal a small cancer chemotherapy unit maintained with some surgery, instead of having a comprehensive service covering the whole region and all the different types of cancers and their treatments in Sligo or elsewhere in the north west. It just makes no sense.

"The way forward is for all the people of the north west to agitate not for Sligo, or even the north west in particular, but for the entire north of the country," he says.

Campaigners face an uphill battle. The new cancer czar Professor Tom Keane has already declared that the debate on where to locate the centres of excellence is over.

Local politicians such as Cllr Barry O'Neill from Ballyshannon have been joined by religious leaders, with the Bishop of Elphin, Dr Christy Jones, denouncing the planned removal of cancer services from Sligo General Hospital as a "grave injustice".

The new plan would mean that people in Sligo needing cancer care would have to travel to Galway, 86 miles away, for treatment. Those north of Sligo in north Leitrim and Donegal would face even longer journeys.

Senator Marc MacSharry says that when the cancer strategy was announced, everyone welcomed the plan. It wasn't clear at that time that there was going to be nothing in the north west region and there was going to be a winding down of facilities in Sligo.

He has called for the direct intervention of the Taoiseach in the matter because at this point it is clear that it will be a political decision.

"You cannot have the entire northern half of the country with effectively no service," he says.

The MacSharry family have been touched by cancer. Mr MacSharry's father, former EU Commissioner Ray MacSharry, made an emotional plea for the retention of services in Sligo while addressing mourners -- including the Taoiseach -- at his wife Elaine's funeral last January.

"While the concept of centres of excellence is the right approach, the practical, geographical and operational aspects of the strategy to be implemented by Professor Keane are ridiculous in the extreme and must be changed.

"All we want in the north west is to be treated fairly and provided with the level of care and service that we are entitled to have and enjoy in our area as much as those who live south of the Dublin-Galway line," Senator MacSharry says.

Ann McGowan says the decision discriminates against women.

"Breast cancer is predominantly a female disease and that is the first thing they have removed from Sligo. The Government is not listening. They are not even listening to the elected members of their own party. Bertie Ahern and Mary Harney appear to have dug in their heels and the attitude is 'we will do what want and that is it'," she says.

She is all too familiar with the arduous nature of chemotherapy treatment when she had to travel from her home in Donegal to Sligo.

"I had to get someone to leave me up to Sligo every time I went for treatment. I was so ill. I was so tired. I couldn't walk to the top of the stairs without a rest. Yet they expect people in the north west to travel down to Galway. At the very least, it's a four-hour round trip and that is not talking about the people who come from the north of Donegal," she adds.

She says that even now there are women with symptoms who are waiting three months for an appointment.

Ann McGowan says they want radiotherapy in Sligo.

"It is totally inhumane to tear people from their families for that amount of time. People have jobs, they have children, they have elderly parents to look after, farms to look after. Let's say a father has a job and the mother is sick. He can't just drop his job and go and spend weeks in Galway.

"I know women here in the north west who moved from the North during the Troubles and their extended families are in the North and they have chosen to have radical mastectomies rather than lumpectomies because they can't leave their children to undergo radiotherapy. They have no-one to look after their families," she explains.