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…Agony of cancer victims battling system breakdowns

By Chioma Obinna

Decades ago, cancer was among rare diseases in Nigeria. Today the story has changed. The situation is so bad that almost every day there are new cases in various hospitals across the country. It is almost becoming like malaria.

According to experts, although everyone is prone to cancer, some people are more at risk due to factors such as environmental, genetic, habits and chronic infections. 

According to the World Health organisation, WHO, in 2015, cancer was responsible for 8.8 million deaths.

Globally, nearly one in six deaths is due to cancer.   As the second leading cause of morbidity and mortality worldwide, it is said to have approximately 14 million new cases in 2012. The number of new cases is expected to rise by about 70 per cent over the next two decades. Meanwhile, approximately 70 per cent of deaths from cancer occur in low- and middle-income countries.

The burden of cancer in Nigeria is unknown; mainly because of lack of statistics or under-reporting but the country ranks among countries with the worst cancer death ratio of four in five persons.

According to statistics from WHO, about 100,000 Nigerians are diagnosed with cancer yearly while about 80,000 die from the disease. This brings the consequences of the cancer epidemic to 240 Nigerians every day or 10 Nigerians every hour dying from cancer.

Despite these scary statistics, late-stage presentation and inaccessible diagnosis and treatment are commonplace in Nigeria. Right now, out of the seven cancer treatment centres in Nigeria, none of the radiotherapy machines is working effectively.

Many cancer patients are dying in their numbers due to the non-availability of radiotherapy treatments. Many who have started treatment cannot complete it at the stipulated time.

From federal and state health institutions to privately owned facilities, the situation is the same.   Sunday Vanguard reports:

Will I ever survive?   This was a question asked by a cancer patient. Mrs. Grace Akoni was diagnosed of breast cancer in December 2015. Since then, she has been battling with treatment.   A mother of two and a civil servant, coping with the cost of treatments has remained a challenge.   But the determination to survive and see her children grow has been her strength.

“All was well with me until I noticed a painless lump in my breast. I noticed early because I usually examine my breasts. I was taken to the Lagos University Teaching Hospital, LUTH, where it was removed and confirmed cancerous.”

The news of her status almost shattered her.   Her family was thrown into mourning even though she had a painless lump.   “I returned home and wept uncontrollably.   I was faced with the fear that people hardly survive cancer.

I came back and told my husband. My children could not understand because they were little children. But they were worried because I kept crying morning and night. We cried together.” Coming from a poor home, Grace battled the odds to raise money for her treatment.

“I went to my church and other churches for assistance.   I practically begged from family friends.   At a point it became embarrassing moving from churches to mosques to raise funds to complete my chemotherapy,” she narrated. In February this year, she had surgery and was placed on eight sessions of chemotherapy.

“The first time I visited a treatment centre, I was like, how will I pay for this?   I had the first surgery in March 2016 and was placed on eight sessions of chemotherapy.”

Grace could not pay for the treatment at once. But she did it. She was spending over N200, 000 for each session of chemotherapy in a private hospital run by a specialist who also works in one of the government -owned health institution.”

Today, she has finished her chemotherapy and was supposed to move on with radiotherapy, a high-energy ray used to destroy cancer cells. Unfortunately, the breakdown of radiotherapy machines in the country is stalling her treatment and hundreds of others.

“I cannot continue the treatment because none of the machines is working.   I was at LUTH recently; it has been down for two months now. This is my dilemma.

“But for how long shall we continue to suffer because of lack of treatment facilities?”

Grace is still looking for answer to her question.

In the case of 30-year-old Nurat Salmon, a graduate of mass communication from Lagos State University, LASU, her story moved virtually everyone at the launch of a cancer foundation in Lagos to tears when she recalled her journey with cancer since November 2016.

Salmon regretted that cancer treatment in Nigeria is not an easy one. According to Nurat, the plight of patients is made worse by treatment that is too expensive and doctors that give no hope to patients. Describing the pain of chemotherapy as “crazy”, the victim said it had been hurtful.

“I lost all my hair, the weakness after each injection was a big challenge. My biggest challenge now is that six out of the seven radiotherapy machines in the country are bad. It is really bad news for a cancer patient. We have only one radiotherapy machine working in a private hospital. In that hospital, to use the machine costs about N600, 000.

“How can one machine serve over two million cancer patients? The disturbing part is that when I went to LUTH, I was told the machine was down and they did not know when it would be fixed.”

“I just finished chemotherapy.   I am glad to tell my story because cancer is not a death sentence. Cancer does not kill, it is depression that kills.”

Nurat appealed to the Federal Government to come to the rescue of cancer patients. “We said we want to reduce the deaths from cancer, how do we do that? How do we pass the message that it is not the end of the world?”

Nurat, who said she was planning to go to Benin Republic for radiotherapy, stated: “I want government to move into our health system. I am not a doctor but I have read a lot. I can say that our medical system is lagging behind. Government should support the treatment cost of cancer patients in Nigeria. Those who don’t have the money are dying.”

Grace and Nurat may have been lucky to still be alive. Austin Nwaorie was not so lucky.

He died last month.  Why? He could not continue his radiotherapy treatment and his cancer continued to spread. He had done chemotherapy and had started radiotherapy before the machine broke down. So he was referred to one private hospital in Lagos.   At that time, the machine was the only functioning machine around.

One of his siblings narrated his story to Sunday Vanguard, “When we got there (private hospital), we was scared of the crowd. Some victims came all the way from the North and the South-East. Sometimes, we had to sleep in the hospital in order to see the doctor early the next day.

“When we could no longer bear the situation, we took him from Lagos to Benin but the radiotherapy machine in Benin was equally not working.   We decided to go to Enugu where the situation was the same.   At this point we were hoping to bring her back to Lagos because we were told that Ibadan was also down. Unfortunately, he could make it. We decided to tell the story of our brother to let the society know what it is like to be a cancer patient with the hope that this will bring needed attention and succour.”

Health watchers are worried that despite the huge burden of cancer in Nigeria, the ailment is under reported apparently due to inadequate diagnostic facilities, limited access to care, inadequate technical manpower and infrastructure as well as the poor quality of cancer data systems.

The six most common cancers in Nigeria are those of the breast, cervix, prostate, colorectal liver and NHL.

The Minister of Health, Prof. Isaac Adewole, upon assuming office in 2015, announced that government would develop plans to address the challenges facing cancer victims. But almost two years after, the situation remains the same.

Also at an event in Lagos recently, the minister said his ministry would partner Sovereign Investment Authority to acquire cancer treatment facilities. According to him, about 80 per cent of cancers literally can be cured through preventions and early detection.

Chief Executive Officer of an advocacy group, Care Organisation Public Enlightenment, COPE, Mrs. Ebunola Anozie, said many Nigerians undergoing treatment for cancer in Nigeria have tales of woe to tell.

“Can you imagine going to queue at the hospital for radiotherapy as early as 2 am? This is disheartening. And victims often have to sell their properties to stay alive because of the high cost of treatment and medication”, Anozie said.

“It is quite unfortunate and obvious that as a country, we are yet to make cancer a priority. We are so complacent on issues concerning our health sector.”

Saying cancer cases are more prevalent in the western world {developed countries), she explained however that mortality rate arising from the ailment is higher in the developing countries like Nigeria, blaming   98 per cent on late presentation, fear of the unknown, illiteracy, taboos, religious beliefs, poverty and our lackadaisical attitude to health issues.

Noting that early detection and treatment of any form of cancer is vital, the activist stressed the need for a Comprehensive Cancer Centre.

Anozie advised that Nigeria should take a cue from neighbouring countries like Ghana where many Nigerian cancer patients run to for treatment.

She traced the poor state of cancer treatment facilities in the country to persistent power outage, saying this kills the performance of the machines.

“Our government is yet to realize that Nigerians are willing to spend money to remain alive as long as necessary tools and expertise are made available.   Well, it is indeed sad that it is not a priority for our government.”

In a report, a consultant paediatric oncologist and lecturer, College of Medicine, University of Lagos, Prof Edamisan Temiye, lamented the many frustrations of families who have been impoverished due to cancer.

Temiye said the cost of treating a cancer patient would treat many patients with minor illnesses.   “In LUTH alone, we see

an average of 70 to 80 new cases of various cancers annually. Success rates are just marginally improving because they are presenting late and when some of them start treatment and they are getting better, they will just disappear because they cannot afford the cost of next chemotherapy”, he said

According to him, due to the epileptic power supply in Nigeria and inability of hospitals to generate power on a 24-hour basis, even if newer radiotherapy machines are procured, they will continue to face frequent breakdowns.

Temiye stated that to get cancer treatment right, the first thing the country needs to do is to ensure that each centre has more than one modern machine of different types. “The second thing we need to do is to tackle electricity problem”, he added.

Also in a chat with Sunday Vanguard, Dr. Adedayo Joseph, founder, Dorcas Cancer Foundation, called on government to provide enabling environment for private people to thrive in cancer treatment business.   According to her, as long as the issue of electricity is not properly taken care of, the machines will continue to malfunction.

Joseph said a break in radiotherapy treatment has implication for the patient as the cancer cells will multiply faster than they were growing before, thus reducing the chances of a patient surviving.

Also speaking on cancer treatment in Nigeria, a professor of anatomic anthology, College of Medicine, University of Lagos, Fatimah Abdulkareem, in a lecture entitled, “Epidemiology & Incidence of Common Cancers in Nigeria,” noted that cancer is a public health problem world-wide affecting all categories of persons but under reported in Nigeria.

According to him, although the burden of cancer in Nigeria is unknown, inaccurate population statistics have made age specific incidence rates impossible or, if available, inaccurate and large proportions of the population never seek orthodox medical care and so are not recorded.

She said Nigeria has 11 cancer registries located in various tertiary hospitals but most of them are poorly funded.

She disclosed that data from various parts of the country show that cancer incidence is increasing with female cancers leading and changing pattern has also been noticed from all the regions of the country.

Abdulkareeem said although available data are hospital based, cancer incidence is rising in Nigeria due to poor awareness about risk factors.