Why 27,000 cancer deaths annually indict Kenya’s health care system

Fatigue, pain in the back and prolonged bleeding. The symptoms read like those of a manageable health condition or disease, but nothing could have prepared this mother of three for the twin medical bombshell coming her way: pregnancy and cervical cancer.

Ann Maina, then expecting her fourth child, says the news “shook her world”, but it might as well have shaken her faith in everything, including the supernal.

She had experienced prolonged bleeding during her pregnancy when doctors decided to hospitalise her for one month as, five months into the maternity, they deemed her condition high-risk.

But not even the specialised care she received could save the pregnancy, and she lost the baby at six months. Doctors were fazed. How could that happen under their very watch? And what could they do to stop the bleeding, which was now getting out of control?

They called in the specialists, and, after further tests, Ann was diagnosed with cervical cancer.

The mother of three, the businesswoman who had found her solid grounding in a competitive market, this beautiful wife who had looked forward to an event-free life, now had to deal with the loss of a baby, and, as if that was not depressing enough, the effects of a disease that had led to that loss in the first place.

But, instead of taking the route to self-pity, Ann composed herself, rose up from the hospital bed and stepped out of the hospital, every bit a changed woman. Now 42, she today talks about the power of social support and adopting a healthy eating lifestyle to complement the treatment of cancer.

She has been in remission for eight years now after a rigorous phase of chemotherapy, radiotherapy and brachytherapy. Complete remission occurs when a treatment completely gets rid of all tumors that could be measured or seen on a test, while a partial response or partial remission means the cancer partly responded to treatment, but still did not go away.

However, experts warn that there is no way to tell how long a remission will last, so neither type of remission means the cancer is completely cured.
Ann attributes her ‘success’ to two things: the support she received from her doctors, and, most importantly, the ready shoulders she found in her family.

Starting a treatment regimen is one thing, she says, but dealing with the stigma and myths associated with the disease is another ball game altogether.

Consider, also, that counselling for cancer patients is lacking or, where available, sketchy, and you begin to understand why, for most, a positive diagnosis is as good as a death knell.

It is for this reason that Ann has established the Pink Ribbon Initiative to offer counselling services to patients. After a diagnosis, she explains, confusion sets in and the medical terms begin flying all over the place, often with little regard that the flow of information is faster “than your emotions can process”.

The news that you have cancer, therefore, can be quite debilitating if there is no psychological support.

David Makumi, the Regional Administrator, Cancer Programmes for Aga Khan Hospitals, agrees. “It’s normal to feel sad when you receive news about the nature of your cancer,” he says, “but this does not mean that you are beyond hope or help. Share your feelings with others in the same situation.”

With an estimated 3,000 women in Kenya diagnosed with cervical cancer, there is reason to worry. But Dr Gathari Ndirangu, a reproductive health expert, says this is a disease we should have conquered a long time ago. His argument is simple: if other nations have tamed the disease, there is no reason why we shouldn’t.

“The biggest obstacle to prevention and early detection is lack of screening, which commonly results from lack of awareness and poor access to screening and treatment services,” he notes.

But while screening can catch it while it is still young, vaccination can keep it at bay. Forever. Currently, two vaccines are available in the market against HPV 16 and 18, Dr Gathari says, noting that these are best administered to girls (and boys) aged between nine and 13 to protect them from the disease once they become older.

However, the vaccine comes with a rider. Girls vaccinated using the currently available HPV vaccines will still require screening in adulthood since the vaccines do not cover all high-risk HPV types. And, although the vaccines are currently available from private providers at a fee, the government is currently carrying out a feasibility study in Kitui County, where more than 21,000 girls have so far been vaccinated. Doctors hope that, through the project, seven out of 10 cases of cervical cancer will be prevented.

Specialists agree that, if diagnosed early, and with proper management, cancer is curable through radiotherapy, surgery or chemotherapy, singly or in combination.

And with four out of every five people diagnosed with cancer being in their advanced stage by the time of detection, low awareness about the signs and symptoms of cancer, socio-cultural beliefs and practices, inadequate screening services and inadequately equipped referral facilities are the main hindrances to early diagnosis.

Currently, the cost of cancer treatment is beyond the reach of many Kenyans, with more than 27,000 cancer deaths reported in the country every year.

However, public health specialists argue that it is safer and more economical to adopt both preventive and curative approaches if the disease is to be managed properly.

In Kenya, cancer is ranked as the third cause of death after infectious and cardiovascular diseases. Breast and cervical cancers have been identified as the biggest killers among women while prostate, oesophagus and Kaposi sarcoma claim the most lives among men in Kenya.

“If we are going to win the war against cervical cancer, screening and treatment must be provided to all eligible women, who must seek these services.

Men are strongly advised to support women to fight the disease,” Dr Gathari says. “It takes only a few minutes to save your life. Get screened today if you have not been screened in the past three to five years.”