Nonhlanhla Ramuhala – Coming out of hiding

After losing her nose due to skin cancer, Nonhlanhla Ramuhala has decided to come out of hiding and face the world. She shares how she got to this place of acceptance.

You can listen to this article below, or by using your favourite podcast player at pod.link/oncologybuddies

Nonhlanhla Ramuhala (53) stays in Meyerton, Gauteng. She is married with three children. 

In 2013, Nonhlanhla had encephalitis (inflammation of the active tissues of the brain caused by an infection) and after recovery, stopped working. She also always battled with rhinitis (inflammation of the mucous membrane inside the nose) and would visit her GP many times to treat it. 

In June 2021, she noticed a bump and what she thought to be a pimple on the right side of the bridge of her nose. The doctor prescribed antibiotics. By December, it was still present so she requested the GP to send her for a scan, which showed a sinus infection. In January 2022, it was now hard, bigger and looked like a cyst so more antibiotics were prescribed. 

Unfortunately, Nonhlanhla had a severe reaction (swelling of the face and itchiness) to the antibiotics so landed up in casualty, which was actually a blessing in disguise as it eventually led to the real diagnosis. But it did come with the doctor telling Nonhlanhla that she is being dramatic and dismissing her when she asked if it could be cancer. He continued administering antibiotics and then surgically removed it as there was no change, and it was sent for testing.

In March 2022, the result showed that it was indeed skin cancer (squamous cell carcinoma). The tumour was as big as a fingertip and had attached itself to the bridge of her nose. 

“I will never forget how cold the doctor was. The confirmation of my suspicion broke me. The one thing that I was afraid of was cancer,” Nonhlanhla says.

The rough journey starts

Nonhlanhla was referred to an ENT surgeon, plastic surgeon, and maxillofacial surgeon. “This ENT was gentle, confident and very encouraging; he explained things well, telling me that this cancer was a bulldog, but he prepared me for the road ahead,” she says.

In March 2022, the 14-hour surgery took place to remove the remaining cancer, and reconstruction. Cartilage from her rib and a skin graft from her forehead were used to reconstruct her nose. After eight days in hospital, with her eyes covered due to the incision, Nonhlanhla was discharged.

“It was traumatic to see my face after surgery. Now I viewed myself with an abnormality and wondered if I would ever be normal again. I was worried how my children were going to react, not them rejecting me but the worry and fear in them. I loved my nose, it was the one part of me that I adored. My beauty was from my nose and I felt like I was punished by God in a way. It was here that I asked my husband to be my shoulder to lean on as I could feel that I wasn’t as emotionally strong as I usually was.”

Nonhlanhla underwent two more surgeries to finish the reconstruction. 

“I would call myself a koala bear; making a joke out of my situation as it made me feel better.” 

Unfortunately, the wound on her head wouldn’t heal and kept oozing. It was eventually discovered that the wound dressings were expired. 

Tip of nose changes

A few months later, in July 2022, Nonhlanhla noticed the tip of her nose was changing. “It looked like a pimple and broke open. After a biopsy, it was confirmed to be the same cancer,” she says. 

A second surgery was planned; Nonhlanhla was informed that there is a chance of her losing her whole nose as they don’t know how far the cancer has spread, and reconstruction would only happen once she had seen an oncologist. It was also decided to scrub the wound on the forehead to help the healing process.

In August 2022, Nonhlanhla underwent the five-hour surgery. “I was told that the ENT surgeon was so distressed during the surgery as he couldn’t handle doing this to me as he had to keep cutting as he wasn’t getting clear margins and it was spreading under my eye. But we made an agreement that he will do what he has to in order for me to survive.” 

Chemotherapy and radiation

In September 2022, Nonhlanhla started one chemo weekly for seven weeks and 35 sessions of radiation concurrently. The side effects were headaches, weight and muscle loss, weakness, and a darker complexion. She encountered two scares with fevers but thankfully got to the hospital in time. I was put on nutritional supplements and other supplements which really helped. She still suffers with dry mouth today. 

“During this time, I would take selfies, but I wasn’t comfortable with myself. 

I was still bubbly with my doctors but when I was alone I could feel I had lost myself. I couldn’t sleep at night and I didn’t tell anyone. An aunt of mine suggested I go see a therapist,” she says. 

Once treatment finished, Nonhlanhla went for monthly check-ups. 

Family support

At first Nonhlanhla didn’t tell her family what was happening, it was only after losing her nose completely that she told them. “They planned a special gathering for my birthday and just loved me saying that I’m still the Nonhlanhla they love. The only person who cried when she saw me was my grandmother. They made me feel so accepted,” she says.

Sadly, Nonhlanhla’s daughter stopped her studies due to the stress of her mom’s diagnosis.

Coming out of hiding

Nonhlanhla explains, “On 22 August 2023, I woke up and realised it’s been a year since I’ve been in hiding, avoiding going out, and when I did, always wearing a big hat, dark sunglasses, and a face mask. I decided this has to stop, I’ve been in exile and punished myself for too long. I started writing my story, The journey was rough, and shared a poem I wrote with my family. This is when I also started changing my own bandages and cleaning my nose instead of going to the wound clinic. Instead of the big white bandage, I wanted something that wasn’t so noticeable so started using plasters.”

Nonhlanhla also started seeing a psychologist and pushed into her faith, getting strength from worship music and scriptures from the Bible. 

New growth under jaw

In November 2023, Nonhlanhla felt a lump on her jaw and had a biopsy. 

“I decided I didn’t want to know the results so avoided any calls I didn’t know and only phoned in January. It was the same cancer, it had spread.” 

Nonhlanhla underwent neck dissection surgery in January then had a further 13 chemotherapy cycles and 35 radiation sessions which she finished in August. The side effects were pins and needles, mouth thrush, and lymphoedema. A new benefit has been added to Nonhlanhla’s medical aid, where a doctor, sister, and social worker do monthly visits at her house. She continues to see the psychologist.

Nonhlanhla’s husband unfortunately developed depression due to the reoccurrence and has been put on leave from work. Nonhlanhla admits that she feels guilty for putting her family through so much.

The future plan

Once Nonhlanhla has been in the clear for six months, the plan is to get an artificial nose which is specifically made for her. 

“I will undergo an operation to get plates inserted in which the nose will hook on and the skin will grow over. But for now, I’m happy; my inner beauty keeps me going strong, confident, and I’m not afraid of cancer anymore.”