‘Govt should step in and help patients’

Ms Mary Ajwang’ walks slowly to meet us. Despite her warm smile, it is not hard to tell that she is not well. She is just from a seminar in a nearby church.

She leads us through an alley between mud-walled and corrugated iron structures that it so narrow, we have to walk in single file. A few minutes later, she ushers us into her home, a poorly-lit, crammed, one-room structure she shares with her 12-year-old son in the Kibera slum.

Ms Ajwang’, 42, was diagnosed with cervical cancer three years ago.

She is devastated not just by the disease, but also by  the fact that her younger sister, Mirriam Anyango, 31, had died just weeks earlier after battling non-Hodgkin’s lymphoma since 2011.

Ms Ajwang’ started bleeding in early 2014 but could not understand why her condition was not improving although she was receiving treatment, so she sought further medical attention.

“I was screened for cancer and diagnosed with cervical cancer,” she says.

It was a devastating blow for her, given that her younger sister was also suffering from cancer. Her illness increased the  burden of treatment for the modest family.

With no income, Ms Ajwang’ depends on well-wishers and family members. In fact, she could not seek treatment she badly needed immediately due to financial constraints.

GOT A SPONSOR

“I started chemotherapy in February 2015 after getting a sponsor. I attended four sessions and went for radiotherapy sessions for a month,” she says.

She sought treatment at a private hospital because she could not wait for her turn at the Kenyatta National Hospital, where she was slotted to begin treatment in 2017. 

However, the problem recurred in July 2015, and for the second time she delayed treatment until February 2016 due to lack of finances.  She completed the treatment in May but in June, it was found that she still had some cancer cells.

Until last week, she had not gone for crucial tests due to lack of finances.

“I was supposed to go for tests n in July but could not because I did not have the money,” she says.

She managed to raise Sh2,800 for the blood tests, but not the Sh8,000 needed for a chest X-ray.

And although she has a National Hospital Insurance Fund (NHIF)card, she has  not made any contribution for  several months, she explains.

Her first round of treatment cost more than Sh300,000, which she would not have raised without her sponsor’s help. And now she needs about Sh200, 000 for treatment.

A radiotherapy session costs between Sh3,000 and Sh5,000 in private hospitals while a chemotherapy session can cost more than Sh50,000, depending on the kind of cancer and drug used. Meanwhile, a radiotherapy session at the Kenyatta National Hospital (KNH) costs around Sh500.

PERMANENTLY IN PAIN

Ms Ajwang’ was working as a househelp but quit last year because she was permanently in pain. She started roasting maize in her neighbourhood but would get between Sh200 and Sh300 per day, which was barely enough for their upkeep. She abandoned the business when her condition worsened. 

“I have not paid rent for the last three months and fear that the landlord might lock my house,” she says, adding that she pays Sh1,500 per month.

Ms Ajwang’ reveals that she has a paternal aunt suffering from ear cancer, and that another paternal aunt died about 10 years earlier from cervical cancer.

After seeing so many of his relatives affected by cancer, Nicholas Sewe, Ms Ajwang’s brother, is reluctant to go for cancer screening. 

“I fear going for screening. I cannot take any bad news right now. But I will consider it,” he says during a separate interview.

As the first-born son, he shoulders the responsibility of taking care of his siblings.

“I have asked God many questions. I wonder why he was not being fair. There are times I feel so discouraged,” he says.

 “Treating cancer is very expensive and it has been tough seeing my sisters and aunts sick,” he says.

COULD THE FAMILY BE CARRYING A MUTATED GENE?

Dr Catherine Nyongesa, a cancer specialist working at the KNH, says the scenario could have been brought about by “bad genes running in the family”, but adds that there are other predisposing factors such as lifestyle, the environment, and behaviour.

Dr Nyongesa says it is advisable to seek intervention early: “Someone can modify risk factors, which include smoking and/or drinking alcohol.”

In extreme cases, a family member who fears developing cancer due to faulty genes can decide to undergo surgery like Angelina Jolie did, she says

Meanwhile, clinician Bryan Tabani who works at the Texas Cancer Centre in Nairobi says: “Cancer has many pre-disposing factors, and topping the list is inheriting the cancer gene.”

“If you learn that you have a family history of cancer, you should get screened frequently,” he suggests.

He adds that it was very important for people to avoid predisposing factors such as smoking, taking alcohol, avoiding certain foods which include red meat, air pollution and risky sexual behaviour.

“Cancer can be cured but it depends on the stage at which one seeks treatment. The earlier you are diagnosed, the better,” says Mr Tabani. “Most affected people seek treatment too late. Some come during stage four of the disease.” He stresses that women should be tested for cervical cancer at least once every year. “People fear going for screening. There is a need for enhanced public education on the importance of screening.”

But cancer screening is also very expensive.  For instance, Ms Ajwang’ spent Sh16,000 on the test.

According to the Ministry of Health National Cancer Control Strategy (2011-2016), about 80 per cent of reported cases of cancer are diagnosed at advanced stages, such that little can be done to save lives.  This is due to “low awareness of cancer signs and symptoms, inadequate screening services, inadequate diagnostic facilities and poorly structured referral facilities.”

Medics say that early diagnosis can help avoid scenarios such as that of the Sewe family.

WOMEN AT RISK

According to the Human Papillomavirus and Related Diseases Report for December 2015 by the HPV Information Centre in Spain, 12.67 million women above the age of 15 in Kenya are at risk of developing cervical cancer.

“Every year 4,802 women are diagnosed with cervical cancer and 2,451 die from the disease,” it notes.

Cervical cancer is the most common cancer in the country and also the most common among women between the ages 15 and 44, the report says.

About 9.1 per cent of women harbour the cervical HPV-16/18 infection at a given time, while 61.4 per cent of invasive cervical cancers are attributed to HPVs 16 or 18,” the report says.

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An ounce of Prevention is better than a pound of cure

The announcement in May 2013 by renowned American actress Angelina Jolie that she had her breasts surgically removed after learning that she was carrying a mutated cancer gene and was at risk of developing breast and ovarian cancer might  have shocked many people, but it was a bold move, given the consequences of the procedure, which disfigures a woman and can affect her self-esteem.

Ms Jolie’s mother, Marcheline Betrand, died of ovarian cancer in 2007.

A report by Cornell University in the United States says: “All breast cancer results from multiple gene mutations. The initial mutation can be inherited from one’s parents (familial breast cancer) or occur after conception (sporadic/random breast cancer).

The research, Family History, Inheritance, and Breast Cancer Risk, further says that “Inherited gene mutations play a role in about 27 per cent of all cases of breast cancer.”

The most common gene-related cancers include retinoblastoma in children and some forms of skin cancer. “We have four children (siblings) who have been receiving treatment at KNH suffering from skin cancer,” offers Dr Catherine Nyongesa.

Other cancers that can develop through mutated genes include those of the bowel, kidney, melanoma, ovary, pancreas, prostrate, thyroid and uterus.

“Geneticists estimate that only about two or three in every 100 cancers diagnosed are linked to an inherited gene fault,” reads a write up on the Cancer Research UK website.

Meanwhile, a report by Kemri in August 2011 says that in Nairobi, the the most common cancer sites in females are the breasts, cervix, uterus, stomach, oesophagus, colon, ovaries, liver which, together with others; account “for 78.1 per cent of female cancer cases.

Cancer cases have increased in the country in recent years, causing great concern to the government, especially due to the limited treatment facilities. 

The National Cancer Strategy (2011-2016) report states that “Cancer ranks third as a cause of death after infectious and cardiovascular diseases. It accounts for 7 per cent of the total national mortality every year”.

Data from independent sources indicate that 39,000 new cases of cancer are reported annually while the disease claims 27,000 lives in the country every year

However, the government estimates that “The annual incidence of cancer is about 28,000 cases, with an annual mortality of over 22,000,” the report says, adding that more than 60 per cent of those affected are below the age of 70.

“The rapid rise of cancers and other non-communicable diseases in the country was found to result from increased exposure to risk factors which include use of tobacco, harmful use of alcohol and exposure to harmful substances in the environment,” the report added

Other factors include HIV/Aids, the Human Papilloma Virus (HPV), Hepatitis B and C, which can cause liver cancer; bacterial infections such as helicobacter pylori which can cause stomach cancer; and parasitic infestations such as schistosomiasis, which can cause cancer of bladder.

Dr Nyongesa says Kenyans should register with the National Insurance Hospital Fund (NHIF) so that it helps pay the cost of treatment of cancer and other diseases.

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FYI

FACTS ABOUT CANCER

• Cancer ranks as the third cause of death after infectious and cardiovascular diseases in the country

• It accounts for 7 per cent of the annual total mortality

• More than 60 per cent of those affected by cancer are below the age of 70

• Cervical cancer is the most common cancer in the country