Why many Kenyans are dying of cancer

As the country comes to grips with the fall of three titans to cancer in a month, a chilling realisation is sweeping the country about the vulnerability of Kenyans to the disease.

Safaricom CEO Bob Collymore, Kibra MP Ken Okoth and Bomet Governor Joyce Laboso join a growing list of people dying of cancer. The deadly 'monster' claims 32,987 lives annually.

Oesophageal cancer has been found to be the top killer cancer in the country. Out of 4,380 patients diagnosed annually, only 29 survive.

The disease is most prevalent in Kisumu, Kakamega, Nyeri, Nakuru, Bomet and Eldoret counties, affecting both men and women. This bleak scenario is highlighted in the latest report by the National Cancer Institute of Kenya.

So, why are so many Kenyans dying of cancer?

The Star interviewed medicine professor Nicholas Abinya and three cancer patients at the Kenyatta National hospital on Monday. They cited the cost of treatment, staffing and equipment deficiencies in hospitals, and getting the wrong treatment.

EXPENSIVE TREATMENT

It's a hot Monday afternoon. Mary Akinyi, 45, stands patiently in a queue of about 60 people, waiting to undergo radiotherapy at KNH.

Frail and tired, Akinyi has no option but to remain standing as there are no empty spaces on the benches outside the chemo treatment room.

It's a grim life. Akinyi travelled from Kisumu to seek treatment in the largest referral facility in east and central Africa, but she may not get treated today.

"Every month I travel several times to Nairobi to seek radiotherapy. I need 25 to 30 sessions of radiotherapy per month," she said.

Akinyi has stage four throat cancer, but she tells me today's radiotherapy session might be her last.

Asked why she won't continue with the treatment sessions, the single mother of four children said she has used all of her savings for treatment.

"How will I pay for the cycles of chemotherapy and radiotherapy that I need? Who will I turn to for support on managing the side-effects? And how will I be able to make the eight-hour bus trip from Kisumu to Nairobi every few weeks to receive treatment?" she asked.

Akinyi is waiting on death any minute because she is unable to pay for her next sessions.

"Unfortunately, money is the green light to better healthcare. If you have it, then you're in a good position. For me, it's sad I will just die in the house," she said.

Listening to Akinyi talk about these concerns brings into sharp focus the myriad of challenges that people with cancer in Kenya face every day—from recognizing symptoms and getting an early diagnosis, to accessing appropriate treatment.

Patients pay Sh500 to Sh1,000 per session for radiotherapy in the state-run hospital. Chemotherapy costs Sh6,000 to Sh600,000, depending on the drug used. 

In private hospitals like Cancer Care Kenya, it costs about Sh50,000 a week for radiotherapy. For chemotherapy, the cost depends on the drug used, with most ranging from Sh12,000 to Sh200,000 per treatment.

Most patients undergo many sessions of both radio and chemotherapy. The state-run National Hospital Insurance Fund (NHIF) offers insurance to anyone over 18, with monthly payments based on income and starting from Sh150. Coverage was recently extended to provide Sh25,000 per patient towards cancer care.

But with treatment more likely to run into millions of shillings and private finance interest rates of 20-30 per cent, many people with cancer like Akinyi have to rely on the ‘harambee’ spirit of their friends and relatives to cover costs. Alternatively, they go without treatment.

A medical expert who wished to remain anonymous said, “Most people we see don’t have coverage, so they start treatment, but then 40 per cent don’t finish because of lack of finance. It’s a challenge for our patients.”

Radiotherapy sessions or chemos should not be missed, the source says many of those who skip sessions die of multiple organ failures.

WRONG TREATMENT

Abinya, the University of Nairobi head of haematology/oncology, says there are three types of cancer treatment: surgery, radiotherapy and chemotherapy.

The treatments in most cases are combined, depending on the type of cancer.

"If surgery and chemotherapy are administered to the wrong patient they die," Abinya said.

Chemotherapy, he said, is a process in which drugs are used to treat cancer. The treatment works through the whole body to prevent the spread of the disease.

Abinya, who received the Global Health Catalyst Award 2018, said the drugs used during chemotherapy vary, depending on the type and stage of cancer as well as the patient’s age and health. 

"Drugs used to treat cancer can be very dangerous and toxic. An expert needs to assess thoroughly whether a patient's body can take in chemo and survive by checking the patients' performance status," he said.

He said patients with low immunity due to advanced cancer or patients with weak bone marrow and tissue functions should not be put on chemo.

"Some doctors will rush a cancer patient to the theatre to operate on them without properly assessing their health condition. Hence, they end up killing the patient," Abinya said.

He said very many cancer patients die from wrong treatment procedures because some doctors are ignorant of the side effects of chemotherapy.

POOR FACILITIES IN HOSPITAL

The professor says it is critical for a cancer centre to have good facilities for supporting cancer patients once they have been treated.

"A good facility needs to have a very well equipped laboratory so that the patient's immunity, bone marrow, tissue function can be closely monitored to avoid wrong treatment," he said.

He said a good facility also needs to have trained nurses and doctors. "We are starting radiotherapy training at the University of Nairobi. The curriculum has been approved and will start from September," Abinya said.

The university is sourcing medical experts from abroad to train the students. Abinya said many lives will be saved when more medical personnel are trained in clinical oncology, which covers radiotherapy, chemotherapy and haematology.

The professor says without good facilities and trained personnel in the cancer centres, more patients will die of chemotherapy.

INADEQUATE STAFF

The assistant chief nurse at KNH’s cancer treatment Robert Makori told BBC they struggle to cope with patient volume.

“KNH is the only public hospital with both radiotherapy and chemotherapy, and many of our patients have to travel a long way for treatment,” he said.

“A person could be given an appointment but if they’re not feeling well, they can’t have their treatment and may not get seen that day.” 

Makori sees 15 new patients a day, so around 60 per week. An average of 60-70 people are seen on the centre’s chemo days (Monday, Wednesday and Friday) between clinic hours of 8am to 4.30pm.

From Monday to Friday, around 120-130 patients come in every day for radiotherapy.