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Fransisca: A Mother, A Fighter, Leaving a Legacy to Her Doctor Son

January 12, 2024 • By Meredith Compton

Community Blog

In the bustling heart of Jakarta, Dr. Kinan is more than just a dedicated physician; he's a living testament to his mother's unwavering spirit and resilience. Fransisca, a remarkable woman who bravely battled colorectal cancer, left behind not only her legacy but a profound influence on her son's life and career. Today, we delve into the inspiring story of Fransisca's cancer fight in the context of Indonesia, particularly in Jakarta, and how her legacy lives on through her son's commitment to delivering high-quality medical care and patient education.

1. What were the colorectal cancer symptoms your mother, Fransisca, displayed?
   The first symptom that my mom had been telling me about was acute diarrhea for 3 months continuously and her condition did not improve even after using Imodium (anti-diarrheal over the counter medicine). Following the diarrhea, mom complained about narrow stools and feeling never complete when trying to defecate. She also mentioned there was white mucus in her stools and continuous bleeding. After six months, she felt her anal sphincter did not function normally, so she had to use adult diapers at all times. She could not control the urge to defecate and every time she would urinate, it was always accompanied by unconscious bowel movements.


2. What were the challenges Bu Fransisca faced in the early stage of disease, during treatment and last treatment?
   Before the doctor diagnosed her with colorectal cancer, my mother was someone who regularly went to community health care centers (Puskesmas) for regular medical care check-ups. She had great trust in her community health center. When she told the doctor her complaints about her defecation problems, she received medication, Metronidazole (anti-biotics), which she used for six months. As her child, who is also a doctor, I pleaded for the community health care referral to more equipped hospital because the symptoms that appeared were already indicative of cancer. But the referral was not provided by the community health center with the reasoning that it could still be treated at the community health center. My mother was only given a referral when her hemoglobin (Hb) level reached 7.0. When her Hb was at 9.8 (as she showed fatigue), she was never referred to a hospital for a blood transfusion. She was very resilient and appeared spirited and optimistic about her care at the community health care, believing her recovery was at this Puskesmas’ hands. Due to unbearable pain, we took her to an internal medicine clinic, a private hospital, and after a colonoscopy she was diagnosed with colorectal cancer. There, she began to feel anxious and afraid, but we continued to encourage her. She underwent surgery, radiotherapy, and both basic and advanced chemotherapy. Over time, her enthusiasm waned, and she became more resigned and tired. As the second round of advanced chemotherapy approached, she seemed increasingly resigned and exhausted. A day before she fell into a coma and passed away, she held onto us, her family members, all night, as if by holding my hand, she was bidding farewell without words. However, her facial expression clearly conveyed a deep sense of longing, love, and farewell (if I had known it was her last embrace, I would never have let go until the end of her life). My mother went through her colorectal cancer journey full of life and with sincerity because she believed that God gives and God takes away.


3. What are your ups and down as her support system?
   Me and the whole family, as supporters of Fransica, felt encouraged when she wanted to eat, drink and had the motivation to attend medical appointments. Her determination to get better motivated us. We never showed signs of fatigue or boredom while accompanying and kept cheering her on. We fulfilled all her wishes, even when she didn't ask for them, as part of our palliative care for her. What brought us down was when our mother seemed exhausted, tired and lost hope. There were moments when our family was willing to accept that our mother might have to pass away. Seeing her struggle for a year with her condition deteriorating, our only hope was to "let go."


4. What do you think about screening CRC, how indonesia health care system dealing about CRC?
   In my experience, the colorectal cancer screening at one of the private hospitals in Jakarta was very well-organized, allowing us to understand our mother's condition and the extent of the cancer metastasis. The entire process was carried out smoothly, ensuring that my mother was mentally and physically prepared. This subsequently became the foundation for her strong desire to recover.
   
   Regarding Universal Health Coverage, or known as BPJS (Badan Penyelenggara Jaminan Sosial), I deeply regret the referral system in BPJS. My mother had a lot of faith in the services of her community health center but her referral kept getting delayed, but we believe it was all in God's hands, which is why we decided to use our personal funds for treatment at this private hospital (which is not cheap). Even though the symptoms clearly indicated colorectal cancer, the Community Health Center continued to prescribe Metronidazole, which had the side effect of causing my mother to feel nauseous and vomit and ultimately worsened her physical condition. After we received the diagnosis, we were finally referred to a national government hospital (a teaching hospital in Jakarta) and my mother had to undergo chemotherapy under the BPJS program. The national government hospital service was excellent, and my mother received great care right up until the end of her life.
   
   For me, at this point, I would not make it difficult to provide referrals for community health care for patients with indications of colorectal cancer or other conditions. I promise to myself, let my mother's case be a great lesson that no one should be denied to get their best care.


5. What are your ups and down as her support system?
   Me and the whole family, as supporters of Fransica, felt encouraged when she wanted to eat, drink and had the motivation to attend medical appointments. Her determination to get better motivated us. We never showed signs of fatigue or boredom while accompanying and kept cheering her on. We fulfilled all her wishes, even when she didn't ask for them, as part of our palliative care for her. What brought us down was when our mother seemed exhausted, tired and lost hope. There were moments when our family was willing to accept that our mother might have to pass away. Seeing her struggle for a year with her condition deteriorating, our only hope was to "let go."


6. What are your hope to tells other about your mom journey?
   My hope is that everyone become aware of any symptoms or complaints that arise, such as chronic diarrhea with bleeding or mucus, or bowel movements that make narrow stools. The earlier the detection and treatment, the better also. As a support system, we should be able to provide the best care until the end. I learned as part of my personal journey was sometimes concealing one's sadness (as a caregiver) can support the mental well-being of a loved one who is fighting a serious illness. Also, if one feels that universal health coverage services are inadequate, it's better to consider insurance or personal payments, so that the condition can be detected and treated early.

Fransisca’s message

"Be a person of value and help as many people as you can. God has blessed us abundantly, so it is only fitting that we give even more to others. Life is an opportunity; let it be a blessing to those around us."