by Saidat Akanbi
For those that present at the general hospitals, the diagnosis of cancer may be missed, as many of these secondary health centres remain ill-equipped in terms of both infrastructure and manpower.
February 4 marked the world cancer day, a day set aside for uniting in the fight against the global cancer epidemic whilst raising our collective voices in the name of improving general knowledge around cancer, encouraging its prevention, early detection and treatment. This year’s world cancer day, primary goal of which is to significantly reduce death and illness caused by cancer by 2020, focused on target 5 of the world cancer declaration: Dispel damaging myths and misconceptions about cancer. Globally, the common myths are :cancer is just a health issue; cancer is a disease of the wealthy, elderly and developed countries; cancer is a death sentence; and cancer is my fate. In Nigeria, one needs to add: cancer is a spiritual problem and can be treated as such; if I don’t think about cancer, I can’t have cancer.
Of late there has been increasing awareness about the existence of cancers in Nigeria, but what remains distressing are the flawed healthcare system, and the actions or otherwise of Nigerians with regards to early diagnosis and management. Two weeks ago, I alongside other colleagues organized a breast cancer awareness and screening programme for women in a community in Ibadan, attended by over seven hundred women most of whom had heard about breast cancer before but had never bothered to have their breasts checked by a health personnel, nor did they do the breast self-examination recommended to be done monthly, perhaps erroneously believing in their hearts that one couldn’t have a cancer as long as he did not think about it. Lo, and behold after the two day programme which offered free clinical examinations, breast ultrasound and fine needle aspiration cytologyetc, not less than twenty of them were found to have breast lumps and one had overt breast cancer.
It is not uncommon to see people who notice something unusual in their body but who would rather visit a chemist, a friend, or a neighbor who works in the hospital(not bothered that he may only be a hospital maid or clerk) for treatment. A woman with bloody nipple discharge had received several intramuscular injections and antibiotics (popularly called ’capsule’) at a patent medicine store and applied ointments including shea butter (called ‘ori’) for several months, so that by the time she presented at the hospital the breast cancer had spread to the other breast and was at an advanced stage. There are even patients that present to the hospital and wait until the diagnosis ‘cancer’ pops out, then they ask to be discharged against medical advice(DAMA, in the medical parlance) so they can seek traditional healers who would cast the evil spirit out. Not that the patients are very much to blame, the healthcare system is flawed.
For those that present at the general hospitals, the diagnosis of cancer may be missed, as many of these secondary health centres remain ill-equipped in terms of both infrastructure and manpower. I remember clearly the first autopsy I witnessed, as a medical student six years ago, was that of a six year old boy who was BID (brought in dead) after being managed for several weeks at a general hospital. He had complained of persistent headache and had been treated repeatedly for malaria, only to be found at autopsy to have a brain tumor, glioma. The story is different, though equally unpalatable, for patients who get referred to the teaching hospitals which are better equipped. For Mrs. Grace, a 32year old woman who was referred from a private clinic all the way from Benin to a tertiary hospital in Ibadan with a diagnosis of breast cancer, she lamented on how she and her sister had to sleep the night under a tree in the hospital premises as clinic was not until the following morning. Six a.m the following morning met her at the clinic hall though she wasn’t seen by the doctor until 2:20pm because she spent the first few hours opening a case note before joining the long queue of patients waiting to see the doctor. And after that, in her words… “I had to cost a medical test on the third floor, descend to the second floor to make payments, climb back to third floor to book for the test, then descend to ground floor to cost another test and back to second floor to make payments…”. That was just the beginning of the management that would go on for months and years, and which would likely be made erratic by either the inconsistent flow of funds or unpredictable industrial strike actions of the doctors or nurses.
The cost of management of cancer is alarming, especially considering that the disease is not covered for by the National Health Insurance Scheme. Reaching a diagnosis of cancer and determining fitness of patient for surgery or other modalities of treatment may cost patients money ranging from 100,000 to 150,000 naira to cover investigations from full blood count to ultrasounds, biopsies or hormonal assays. Needless to say that several poor Nigerians chicken out at this stage before even commencing treatment, and die silently at home amidst the tears of their loved ones. A mastectomy (surgical removal of a cancerous breast) costs nothing less than a 100,000 naira in the federal hospitals. Most surgical operations for cancers are either preceded or followed by chemotherapy or radiotherapy. The cost of a shot of chemotherapy varies from 20,000 to 500,000naira, for which a patient would receive several courses. Radiotherapy carries an additional challenge- apart from being unaffordably expensive to a common Nigerian(costs 120,000 per course), it is available at only five centres in Nigeria, with some being unreliable. For instance, the radiotherapy machine at the University College Hospital, Ibadan has not been working for two years now and all patients in the south west have to rely on the Lagos centres.
Another major challenge in the management of cancer in Nigeria is the lack of dedicated Cancer Care Centers as you would find in developed countries. According to Dr. Ademola, a lecturer and consultant surgeon in the department of oncological surgery, UCH, Ibadan “…the lack of cancer care centres does not allow for the streamlining of care of cancer patients and this deprives them of specialized care…”. Cancer is one of the diseases that should be treated only by specialists, but in Nigeria cancers are managed by barely anybody as long as the patient is willing to pay.Often, patients who present with cancers had previously had minor surgeries(e.g lumpectomy) done by general practitioners who did not deem it fit to send the removed samples for histology to determine cancerous potential.
Clearly, cancer is not one of the four-letter cuss words, so let every Nigerian feel free to talk about it. A whole lot still needs to be done on its awareness and in ensuring a healthcare system with an upgraded capacity to handle the increasing prevalence of these deadly diseases. Speaking generally about cancers, Dr Ademola said “the causes of most cancers remain unknown, and to prevent cancers, people are recommended to do the following: avoid cigarettes, avoid obesity, rational use of alcohol, and do regular physical exercise.”
Dr. Saidat Akanbi: (nee Bello) is presently undertaking the mandatory one year National Youth Service at the 2Div Military Hospital, Ibadan after graduating in 2010 from the University of Ibadan Medical School where she was a prize-winning student. She hopes to specialise in Public health & community medicine. She tweets from @drsaidah.
Op-ed pieces and contributions are the opinions of the writers only and do not represent the opinions of Y!/YNaija.
If the Radiotherapy Machine at the University College Hospital has not been working in the past two years, AGAIN it is unfortunate for this country. It is like this ALL OVER THE COUNTRY. What are the responsibilities of the CMD of UCH and even the useless Health Minister whoes sack has been widely requeted for but For Jonathans defiant and unfortunate refusal. God bail us out 0.
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