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September 26, 2018

[VIDEO] Cancer plagues poor families unable to raise medical fees

Children with cancer sit on chemotherapy chairs handed over to Kenyatta National Hospital by Classic 105's Maina Kageni, February 2016. /PATRICK VIDIJA
Children with cancer sit on chemotherapy chairs handed over to Kenyatta National Hospital by Classic 105's Maina Kageni, February 2016. /PATRICK VIDIJA

Scientists in the early ’90s predicted cancer treatment would by now be advanced enough to contain the disease.

Instead, two decades later, the disease has steadily climbed to become what Kenya Network of Cancer Organisations chairperson David Makumi calls "the plague of the 21st century".

So far, very few cancer treatments have qualified as a solution, despite the prohibitive cost of anti-cancer drugs.

Gilgil siblings Kevin and Mercy rued this reality recently as they marked the death anniversary of their mother, who succumbed to lung cancer five years ago.

A single parent, the mother was a casual labourer in a Naivasha flower farm. Kevin believes the cancer was caused by herbicides she encountered in the farms without protection.

Her cancer was detected long after it had began, and efforts to seek medical attention were thwarted by the costs, pushing the mother to the grave as the children watched helplessly.

Kevin, by then a form four leaver, was forced to become the breadwinner and guardian of his younger sister, who was in form one.

"She had been working in the flower farms for 15 years, and what she earned is what took care of our needs. We both managed to clear secondary school but none of us advanced in our studies because of lack of funds," Kevin says.

LETHAL LATENESS

According to the World Health Organisation, cancer is the second-leading cause of death globally and the third-biggest killer disease in Kenya.

A significant proportion of cancers can be cured by surgery, radiotherapy or chemotherapy, especially if they are detected early.

Some 30 per cent of cancers are curable if detected early, 30 per cent are treatable with prolonged survival if detected early, and 30 per cent of cancer patients can be provided with adequate symptom management and relieving care.

However, the Kenya Medical Research Institute documents that 80 per cent of cases reported are diagnosed at an advanced stage, leaving few options for remediation.

Globally, nearly one in six deaths is due to cancer. In Kenya, cancer’s morbidity rate [seven per cent of deaths per year] is only surpassed by infectious diseases and cardiovascular diseases.

An estimated 40,000 new cancer cases and 28,000 cancer deaths occur each year.

Makumi says apart from poverty and late diagnosis, factors hindering cancer treatment include lack of or uneven distribution of cancer diagnosis and treatment facilities, personnel and equipment.

Cancer arises when normal cells develop abnormal lump growths that transform into tumour cells. These changes are the result of the interaction between a person's genetic factors and external agents.

The external agents include physical agents like radiations, chemical agents such as tobacco, contaminated water and biological agents, such as infections from certain viruses, bacteria, or parasites.

WHO says major cancer risk factors worldwide include tobacco use, alcohol use, unhealthy diet and physical inactivity. In fact, globally, cigarette smoking has been identified as the major cause of cancer, killing 50 per cent of its users.

But in Kenya, leading cancers are, in women, breast (34 per 100,000) and cervical (25 per 100,000) cancer, and in men, prostate (17 per 100,000) and oesophageal (9 per 100,000) cancer.

POVERTY AND CANCER

WHO estimates that 70 per cent of deaths from cancer occur in low- and middle-income countries, including Kenya, and identifies poverty as a core reason why management of cancer has proved to be a difficult task.

The health body further states that only one in five low- and middle-income countries have the necessary data to drive cancer policy.

According to the Kenya National Bureau of Statistics, the average monthly spending per person in capital city Nairobi, which has an average population of 5 million people, is less than Sh5,995. This boils down to about a dollar a day, or about Sh100.

Makumi says most cancer patients in Kenya depend on donations and fundraising to meet the treatment cost, which might end up delaying the treatment.

“Most of the Kenyan population falls under the poverty category,” he said. “Once cancer attacks a poor person, the treatment ends up being a burden not just to the family of the patient but the community at large. Some patients are not able to raise the amount required to seek medication, leaving them helpless as the disease spreads.”

Makumi says patients go through troubling times when seeking treatment because Kenya’s largest health facility, the Kenyatta National Hospital, does not have enough radiotherapy machines and personnel.

Human capacity for cancer treatment in Kenya in the public sector is: four radiation oncologists, six medical oncologists, four paediatric oncologists, five radiation therapy technologists, three oncology nurses, two medical physicists with only four facilities in place.

In 2017, only 26 per cent of low-income countries reported having pathology services generally available in the public sector.

Most patients have been forced to travel to India, which is a favored destination for cancer treatment, with statics showing that those affected are spending up to Sh8 billion annually.

Makumi says Kenya still lacks the capacity to handle the increased number of cancer cases, resting the patients’ hopes on Indian hospitals.

In Kenya, only eight facilities offer cancer treatment: KNH, Moi Teaching and Referral Hospital, MP Shah, Nairobi Hospital, Aga Khan, Texas Cancer Center, Cancer Care Kenya and Beacon Health Services.

Besides the treatment cost, patients far from the health facilities have to cater for their stay near the hospitals. This gets worse when the patients have to seek medication overseas.

A whole cycle of treatment in India could cost at least Sh5 million and move up to Sh20 million.

Makumi says between 30 per cent and 50 per cent of cancer deaths could be prevented by modifying or avoiding key risk factors, including avoiding tobacco products, reducing alcohol consumption, maintaining a healthy body weight, exercising regularly and addressing infection-related risk factors.

Around one-third of deaths from cancer are due to the five leading behavioural and dietary risks: high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use and alcohol use.

GOVERNMENT INTERVENTION

 The National Hospital Insurance Fund plans a new fund to finance outpatient treatment for chronic diseases like cancer, diabetes, kidney failure and hypertension in public and private hospitals.

In the 2017-18 financial year, NHIF made a Sh1.3 billion payout, an 11 per cent increase from Sh1.2 billion in the previous financial year.

 Unfortunately the amount has not been able to fully cover for patients, and they are required to top up funds as they attend treatment sessions.

According to NHIF data, radiotherapy is covered at a maximum of Sh18,000 per week (five sessions) up to a maximum of 20 sessions per family per year.

Chemotherapy Basic level at Sh25,000 per cycle is capped at six cycles per family per financial year, and Complex level up to Sh150,000 per cycle capped at four cycles per family per financial year.

Chemotherapy costs between Sh10,000 and Sh82,000 per session at the Kenyatta National Hospital. Patients are required to undertake six to eight sessions.

At a private health facility, the same treatment goes for a minimum of Sh35,000.

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