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40 million Kenyans, less than 40 cancer specialists

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 Patients in rural areas where screening is inadequate are wrongly diagnosed while others link witchcraft to their unending sicknesses

Early this year, when the government declared that people suffering from chronic ailments will enjoy a medical cover, the announcement caught the ear of Sarah Wangui, a cancer patient.

Through the help of well-wishers, Wangui immediately joined the National Hospital Insurance Fund (NHIF), the insurance provider whose members’ contribution is partly directed towards the cancer fund.

The single mother discovered she had breast cancer following a diagnosis last year. It was at an advanced stage and the only option was to remove the affected breast before being put on chemotherapy at Kenyatta National Hospital (KNH).

Being a member of NHIF, Wangui thought part of her financial burden had been lifted. According to her, she used to spend around Sh40,000 per session – money she struggled to raise because she is jobless.

As was routine, Wangui went to KNH for her chemotherapy in May. This time round, she was not carrying any money but the NHIF card.

Wangui was disappointed when it became apparent she could not access treatment using the card.

“They told me that only inpatients and civil servants qualified for the NHIF medical cover,” recalls the 36-year-old.

Feeling dejected, the Dandora resident walked to Texas Cancer Centre in Hurligham, Nairobi, where she received treatment after two weeks when NHIF finally gave the green light.

“I can say their treatment is better and a bit cheaper than KNH, where they prescribe expensive outpatient drugs,” says Wangui.

Thousands of cancer patients like Wangui continue to suffer due to poverty, high cost of treatment, unavailability of treatment, acute shortage of specialists and lack of adequately equipped medical centres.

On why KNH turned away some NHIF card holders, the corporate affairs and communications manager, Simon Ithai, was cagey in his explanation: “That question can be answered by NHIF itself because we depend on the guidelines they have given us as the insurance providers.”

Annually, about 30,000 new cancer cases are recorded with a corresponding mortality of around 28, 000 people each year, according to statistics from government and NGOs.

Cancer patients have no choice, but to contend with the sorry state of affairs. A majority of them try to seek treatment at KNH and Moi Teaching and Referral Hospital (MTRH) – two public hospitals where treatment is offered.

At KNH, patients recommended for radiotherapy are normally kept waiting for months. Wangui, for instance, had been booked for radiotherapy in 2018! That’s the year her daughter would be in Form Three.

If data by the Kenya Network of Cancer Organisations (KENCO) is a true reflection, the country has four radiation oncologists, six medical oncologists, four pediatric oncologists, five radiation therapy technologists, three oncology nurses and two medical physicists.

The fact that more people have become aware of the disease has led to an upsurge of people seeking screening, unlike in the past when cancer was falsely thought to be a disease for the rich.

Until when a vigorous awareness campaign was launched in 2012 through the Cancer Prevention Act, many people died of cancer due to poor or wrong diagnosis.

Last August, Peter Magu lost his wife of many years through cancer after spending lots of money and wasting time trying to detect the kind of ailment Caroline Wanjiru, 57, was suffering from since she got sick in March.

Doctors at two leading private hospitals in Nairobi initially thought it was ulcers.

“They then started telling me it was pancreatitis before it was discovered that my wife’s cancer was at stage four,” says the 64-year-old resident of Kangemi.

Many cancer patients in rural areas where screening is inadequate are wrongly diagnosed, while others link witchcraft to their unending sicknesses.

Stakeholders say that though awareness has led to an increase in the level of enlightenment, focus should now shift to developing infrastructure to meet patients’ demand.

“There are no machines in almost all the counties apart from those at KNH and MTRH, but the challenges at the two hospitals are high costs and long queues of patients waiting for radiotherapy,” says Boniface Mbuki, the director of Cancer Awareness Centre.

The Act was to promote public awareness about causes, consequences, means of prevention and control of the disease, besides extending to every person with cancer full protection of their human rights and civil liberties.

It led to the creation of the National Cancer Institute (NCI) of Kenya whose key function is to encourage and secure the establishment of hospitals, vocational treatment centres and other institutions for the welfare and treatment of persons with cancer in all counties.

Dr Alfred Karagu, the NCI chief executive officer, was non-committal on the progress of developing sufficient diagnostic control and curative facilities, while admitting there are challenges.

“There are a number of things that are taking place, whose details I won’t divulge since I am on leave,” he said.

According to William Wanjohi, the Secretary General of Hope and Courage International, the current healthcare system does not meet the demand of cancer patients. He cites KNH as the only public institution that offers radiotherapy services, but patients on scheduled appointments there wait for several months.

“At the moment, we do not have the necessary infrastructure to deal with the problem. For instance, the level of awareness is still inadequate and secondly, a hospital could have good equipment but no specialised doctor,” observed Wanjohi.

Though it is difficult to get accurate national data on cancer in Kenya, it ranks third as a cause of death after infectious and cardiovascular diseases.

Breast, prostate and cervical cancers are the most prevalent forms of cancer, according to KENCO, which comprise community-based organisations active in awareness, education, screening, prevention and patient support.

Catherine Naserian recalls how she watched helplessly as her father fought cancer before succumbing to the disease six months later after being diagnosed with prostate cancer. The old man was diagnosed in December last year.

As the family walked from one hospital to another in search of a specialist, the man passed on in May. “At first, we never got adequate assistance as we moved from one hospital to another before being referred to the right consultant at Kenyatta National Hospital. Unfortunately, my father died before being put on chemotherapy,” says Naserian.

A regional cancer registry at the Kenya Medical Research Institute (KEMRI) indicates that about 80 per cent of reported cases are diagnosed at advanced stages, when little can be done in terms of curative treatment.

According to Dr Zipporah Ali, the national coordinator of Kenya Hospices and Palliative Care Association (KEHPCA), the hardest hit are patients from rural and far flung regions, who travel all the way to Nairobi to seek medical attention.

“Although there are good things going on, we could do more through public-private partnerships, especially on awareness. Sometimes patients are forced to incur the extra cost of accommodation while waiting to be attended to, which is spiritually, emotionally, psychologically and socially draining,” she observes.

The National Cancer Control Strategy 2011-2016 was to develop an infrastructure to consolidate prevention, screening, diagnosis, treatment and care for patients, as well as invest in equipment needed to deliver the outlined services.

Five years down the line, cancer cases continue to rise with many victims opting to seek medication abroad, with India being the preferred destination.

Cancer results from the failure of the mechanism that regulates normal cell growth and cell death, leading to uncontrollable proliferation of cells, destruction of neighbouring tissues and spread of the disease to other parts of the body.

It is a disease that can affect anyone, anywhere and anytime, with possible causes linked to genes, lifestyle, environment, age and immune system.

Some of the signs and symptoms include unexplained weight loss, prolonged fever, fatigue, prolonged and unexplained pain, skin changes, change in bowel or bladder movement, sores that do not heal, white patches in the mouth or white spots on the tongue, unusual vaginal bleeding or discharge, thickening or lump in the breast or other parts of the body, and indigestion or trouble swallowing, among others.

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