Spoken from the Heart (68 page)

In the early 1960s, my grandmother found a lump in her breast. She never told Mother or Daddy or me. She simply found a surgeon, checked herself into the hospital, and had her breast removed. On our next visit to El Paso, after she was well and healed, Grammee matter-of-factly mentioned that she had had a breast tumor. The cancer never spread, and two decades later, when she was eighty-two, Grammee died in her backyard, watering her flowers, from what must have been a stroke or a heart attack. Papa found her body amid the flower beds.

My mother is also a breast cancer survivor. Her lump was discovered during a routine mammogram a few years after Daddy died. She had a mastectomy in Midland with her own doctor. I was with Mother when she was wheeled into surgery, and we said a tearful good-bye in case she did not wake up. Afterward, I spent several days at her house caring for her, but she refused to allow a home health aide to come help her once I left. She told me, "I don't need any more help."

But I knew all too well the ravages of breast cancer, which had killed my former Midland next-door neighbor and close friend, Cathie Blackaller. In Dallas I had volunteered with the Komen Foundation when it was in its infancy. In the United States we have benefited from years of advocacy for breast cancer treatment and prevention. There are still, though, many places where cancer remains a highly taboo topic and where it is difficult to mention the word "breast." One such region of the world was the Middle East, where many women live their lives shrouded behind abayas.

Health diplomacy is an important way for American women to reach out to other women around the world, and a key component of that health diplomacy was the U.S.-Middle East Partnership for Breast Cancer Awareness and Research, launched in 2006 by the U.S. government, the Susan G. Komen Breast Cancer Foundation, and the M. D. Anderson Cancer Center at the University of Texas. As this partnership took off, I became an advocate for women's health not just at home but overseas. In October 2007, I visited some of the countries hardest hit by breast cancer. In many Middle Eastern nations, breast cancer is the most commonly diagnosed cancer in women, and in some nations, such as the United Arab Emirates, it is the second leading cause of death.

I arrived after dusk in Abu Dhabi, one of the seven United Arab Emirates, and was hit by a wall of searing, humid heat when I stepped off the plane. Sheikha Lubna Khalid Al Qasimi, the UAE's minister for foreign trade, was waiting to greet me. Sheikha Lubna was educated in California and is a member of the ruling royal family; she is the first woman to hold a ministerial post. We walked into the enormous and thoroughly modern gilt and marble dignitaries' airport terminal for the ancient Arab custom of offering tea to an honored guest. Then my motorcade left, illuminated by the brilliant reflected light from the skyscrapers that soar above Abu Dhabi.

The next morning I awoke to the hum of giant cranes and the skeletons of massive buildings rising from what had less than a century ago been a desert home to nomadic fishermen and herders. In 2007
Fortune
magazine had declared it the richest city in the world. Yet its vast riches had done little to protect women from disease. In Abu Dhabi, breast cancer is the leading cause of death for women; only 36 percent of all women find their cancers when they are most treatable, in stage one or two. Many women do not want to be examined by a physician because they fear social ostracism if they are found to have breast cancer. Their husbands may leave them; their sons may turn their backs. Their daughters may be considered unmarriageable.

Away from the glint of the city's modern towers, I gathered with breast cancer survivors inside a large circular tent whose walls were draped in billowy pink fabric. The emirates were a largely Bedouin society before the discovery of oil, and this tent, which had been erected within the walls of a hospital, spoke to those ancient traditions. The women who came to this Pink Majlis, literally, in Arabic, "the pink place of sitting," were veiled and covered. A few had sewn pink ribbons on the black cloth of their abayas. In a voice barely above a whisper, one survivor told me of having been abandoned by her husband. Another spoke proudly of how, when her hair fell out from chemotherapy, her husband and her two sons shaved their heads in solidarity. I listened to these women and heard in their voices the common fear of all women, the fear of a disease that causes sickness, disfigurement, and death.

Before I left Abu Dhabi, I visited the seaside palace of Sheikha Fatima, the widow of the late ruler of the emirates. Her home was decorated in marble and gold, and every table fairly groaned with enormous platters of food, overflowing bowls of fruits, and trays of dates and nuts. Abundance is the sign of hospitality. Sheikha Lubna joined us, along with many of Sheikha Fatima's female relatives, and it was a striking confluence of the changes in women's lives, behind the veil, in just a few generations. While the young, veiled women talked about participating in Abu Dhabi's business and political life, Sheikha Fatima remained firmly rooted in traditional ways. She not only covered herself but she wore a leather face mask. Her husband, she told me, thought it was very provocative to see only the tiniest bit of her eyes.

The neighboring emirate city of Dubai is even hotter; it is the largest of the emirate states. Dubai had already begun a major initiative through the Chamber of Commerce and local businesses, including American-owned firms like FedEx, to create an education program about breast cancer. I marveled at the massive buildings, the man-made islands, and the second largest man-made marina in the world. The entire city, a modern wonder where towers twist and point to the sky, has been fashioned on top of a sandy outcropping.

The third Middle Eastern partnership was located in Saudi Arabia. In the newly opened King Fahd Medical Center, I spoke to reporters as a female doctor watched me from behind a dividing wall, her entire body covered except for a thin opening for her eyeglasses.

In the Saudi Kingdom, women contract breast cancer at far younger ages than in the United States, often a decade earlier. Over coffee in the city of Jeddah with breast cancer patients to "break the silence," I looked around and realized that every woman in the room was young, many two decades younger than I. Many were mothers with small children. One of the country's most outspoken cancer patients, and one of the first Saudi women to speak openly about her disease, is an obstetrician and gynecologist, Dr. Samia al-Amoudi. In 2007 she was forty-nine years old.

As we talked, a cancer survivor asked me what I thought of Saudi women. I told her the truth, that at first I had found it disconcerting to sit with women who were covered, that the covers seemed like barriers between us, closing them off from me, and that I had expected it would be difficult to talk to them, but I was wrong. It was surprisingly easy to talk about such an intimate subject as breast cancer. A woman held up a bit of her black abaya and said, "These covers may be black, but they're transparent," meaning that underneath we are all very much the same.

As our visit ended, two women gave me a black head scarf decorated with pink ribbons. Most of the women in the room were wearing them. As a sign of respect to them and to their disease, for a minute I placed the scarf over my head. The hastily snapped photo capturing the moment spawned a small uproar: by wearing the symbol of Saudi cancer survivors, I was thought to be endorsing veiling across the globe, as opposed to sitting with mothers and their daughters who were looking for hope when facing a disease that is, far too often, a death sentence.

From Saudi Arabia, I went on to Kuwait, where I met with a group of about twenty women leaders, including a lawyer, the first female government minister, and an assistant government undersecretary for tourism. I asked to meet with female leaders in nearly all of the countries I visited, but this meeting was special. Just a year before, in 2006, Kuwaiti women had won the right to vote. In pleading their case, the women's activist Roula al-Dashti had said, "Half a democracy is not a democracy." Twenty-seven women ran for office in the 2006 national elections, and while up to 58 percent of Kuwait's women voted for the first time, every female candidate lost.

Three of the women I met with had been among the candidates. We gathered in the home of a female Kuwaiti politician and member of the ruling family, Rasha Al-Sabah. We sat on thick, cushioned sofas around the edges of the room, and it was clear when they spoke that the women were deeply disappointed and hurt that other women had not turned out to elect them. Gently, I asked the women, What did you run on? What was your platform? And they looked surprised. It apparently had not occurred to them to run on issues, something we take for granted in our political campaigns. They had run simply on the fact that they were women. We forget when we look at other nations trying to democratize how much there is to be learned. I am reminded of the story of China when it began expanding its relations with the West at the close of the nineteenth century. Vast numbers of traders, emissaries, missionaries, and other visitors saw Chinese women hobbling on bound feet. Shamed, China began to abandon the practice; it was formally banned in 1912. Yet even now, there are old women whose feet are wrapped in rags.

I mentioned to the Kuwaiti women that George in his campaigns, starting with the one to become governor of Texas, had run on specific issues that were important to him. His goal was to explain what he would do if he were elected and how his plans differed from those of his opponent. In May of 2009, sixteen women ran for public office in Kuwait, and this time four of them were elected to the country's assembly.

After meeting with the Kuwaiti women, I had a chance to meet and thank some of our troops who were stationed in Kuwait, helping to support U.S. forces in Iraq.

I paid a call as well on the emir of Kuwait, and we sat in two very fancy chairs surrounded by members of his government and my staff, attempting to make small talk. When our supply of topics dwindled, I began to look for a way to gracefully excuse myself. Just then he stood up, and a door opened onto a beautiful and elegant tea party. Drinking from a dainty china cup and nibbling on delicacies, I walked about and spoke with the Kuwaitis in one of the most gracious parties I ever attended.

On this trip I returned to Amman, Jordan, where I announced a U.S.-Jordanian partnership at the King Hussein Cancer Center, named for King Abdullah's father, the late King Hussein, who had battled cancer for years. Indeed, with cancer, we do not know from where a breakthrough treatment will come or when. Perhaps it will be a doctor in Amman, or a study of Bedouin women in Abu Dhabi that helps us unlock some of the mystery of this disease.

On my previous visit, everyone in Jordan had told me to go to the ancient city of Petra. Before my plane took off for home, this time I did, walking through its intricate buildings carved deep in the sandstone, rather like the ancient Buddhas in Bamiyan, Afghanistan. Along one street I spotted a group of camels and their handlers, and I turned to our ambassador, David Hale; my chief of staff, Anita McBride; and my press secretary, Sally McDonough, and said, "Let's ride." On our camels, we meandered through the twisting, narrow gorge that surrounds the ancient city and its rose-colored walls. Much of the city has lain largely silent since the 300s, when an earthquake struck, but it is still possible to imagine the people who once made their homes amid this cavernous stone. As we rounded one final bend, almost like a hallway cut through the earth, we came upon a group of Americans. When they caught sight of me, they spontaneously raised their fingers to make the sign of "hook 'em horns" and began singing "The Eyes of Texas." It was a tour group from home.

The November 6 visit of Nicolas Sarkozy, the new president of France, to Washington was surrounded by high-level intrigue: would he or would he not be bringing his wife? In August the Sarkozy family had chosen to vacation on a New Hampshire lake. Cecilia Sarkozy, France's first lady, had mentioned this to me during the G8 Summit. I knew George and I would be in Maine visiting his parents, and I suggested that the Sarkozys and their son come to Kennebunkport. We planned a kid-friendly meal of hamburgers, hot dogs, and blueberry pie, but Cecilia stayed behind and Sarkozy came alone. Now, before we printed the invitations for the state dinner, the National Security Council was working with the French government to determine whether this visit would also be a solo one.

George and I like Nicolas Sarkozy very much. He is young and dynamic and blunt, and he has a great sense of humor and understanding of the frequent absurdity of political life. Sarkozy's father was a Hungarian immigrant, a refugee from World War II and the Communists. Over lunch Sarkozy told us that when he was young, his father said to him, "You must move to the United States." When Nicolas looked at him quizzically, his father had added, "I know that you want to be president, but a man named Sarkozy will never be president of France."

Sarkozy did come by himself. Shortly afterward, he and Cecilia divorced, and a few months later, he married the model and singer Carla Bruni. Single or married, the French president arrived in Washington with a very interesting entourage. Rather than the typical group of political people, his delegation included a chef, Guy Savoy, from one of Paris's top restaurants and the director of the Louvre Museum, Henri Loyrette, as well as a retinue of cabinet ministers.