KNH battles with cancer crisis

When James Mwangi’s father was taken to Kenyatta National Hospital’s cancer unit for radiotherapy last month, he was shocked to learn that the treatment could only be offered in July, six months down the line.

They went to a private doctor who insisted that the radiotherapy had to be done at an alternative hospital to manage the old man’s cancer of the oesophagus. He referred them to a private hospital where they were told a two-week dose would cost Sh80,000.

“The doctor told us that the only cheaper hospital was Kenyatta but with their radiotherapy machine fully booked, we had no option but to go to the private hospital,” recalls Mr Mwangi.

Through fund-raising, they managed to get Sh45,000 that they used as a down payment for the treatment. Many cancer patients are facing the same problem.

They have to wait for months to use the only machine that performs radiotherapy treatment at the biggest health facility in East and Central Africa.

The hospital has to turn away patients needing radiotherapy, except for emergency cases, because it cannot cope with the demand.

So far, there are 400 patients on the waiting list. The machine can handle only 100 patients in six weeks, after which another 100 patients utilise it for a similar period.

Each patient needs six weeks of intense radiotherapy treatment, leaving no room for a new patient to be admitted. Those on the waiting list can also hope that there will be few emergencies to disrupt the schedule.

This means that, other factors being constant, the 400th patient on the waiting list is likely to get radiotherapy treatment on June 15 to July 31.

High mortality

Patients who tried to get treatment at the hospital in January and February have been advised to go to MP Shah Hospital, the next cheaper option offering radiotherapy treatment. The problem, however, is the cost.

At Kenyatta National Hospital (KNH), patients pay Sh1, 500 per week for radiotherapy treatment while at MP Shah Hospital, the cost is Sh40,000 for the same duration.

Poor patients who cannot afford this amount have no option but to wait until July when the KNH cancer unit is expected to admit new patients.

The concern is that as they wait for the treatment, the disease is not waiting and the cancer is likely to be spreading to other critical organs of the body.

By the time treatment starts, the cancer could be so advanced that curing it might not be possible. In some cases, the only thing medical personnel can do is offer palliative care to such patients.

It is this delay that also contributes to the high mortality associated with cancer. According to Dr Anselmy Opiyo, head of KNH’s Cancer Treatment Centre, they have had to introduce a third shift to attend to the many desperate patients. About 25 patients are able to receive radiotherapy treatment during the third shift that starts from 6pm to midnight.

Due to the introduction of this shift, the hospital has increased the number of people getting radiotherapy treatment daily from 60 patients to about 90 patients. Those benefiting from these services are patients who have cars, can hire taxis, or are admitted to the hospital.

“Sometimes you look at desperate patients and feel depressed that there is nothing you can do,” says a nurse at the hospital.

To her, the most painful moment is when they have to ask cancer patients, the majority of whom are poor, to wait for four to six months or seek alternative treatment in private hospitals.

Even the third shift might not be a solution in the long-run for a hospital seeing between 20,000 and 25,000 new cancer patients each year. The hospital’s current capacity is for only 60 new patients per week or 2,880 patients in a year, which is about 12 per cent of the reported cases.

As a result of these huge numbers, patients who report to the hospital with cancer symptoms wait for four to six weeks before they can see the (0ncologist) cancer specialist, who will then order tests. It is only after the investigation report is ready that the doctor decides whether the treatment will be chemotherapy or radiotherapy.

The type of treatment depends on many factors, key among them being the type of cancer, how far it has spread, age, and general health.
If chemotherapy is decided upon, the patients waits for two to three weeks before the treatment is initiated. If it is radiotherapy, the patient has to wait for at least four months before treatment starts.

Dr Opiyo says the hospital needs four to six radiotherapy machines and 15 to 20 clinical oncologists to comfortably cater for the large number of patients seeking services at the cancer unit.

One radiotherapy machine of the older models costs Sh110 million, excluding installation costs of between Sh20 million and Sh40 million. New models cost over Sh150 million.

As the hospital battles with the equipment difficulties, it also has to deal with challenges originating from patients, many of whom arrive when their cancers are in the incurable late stages.

The plight of these patients begins at the district hospital. When a doctor suspects that there is a tumour, the patient is referred to a provincial hospital for further tests. Surgeons at the provincial hospital, if it has any, will remove the tissues and send them to KNH for a biopsy.

Lengthy process

A biopsy gives the prognosis of the disease. A measure known as the Gleason score, as shown by the biopsy test, informs the doctor how aggressive the cancer is and the form of treatment to be used.

The results of the biopsy are then sent back to the provincial hospital, which sends them to the district hospital where the patient was referred from. If the results are positive for cancer, the district hospital refers the patient to KNH for treatment.

This entire process, including some delays, takes no less than five months. Things get tougher when the patient arrives at KNH and is required to go through six weeks of comprehensive radiotherapy .

Many of them lack a place to stay as they have to report daily to the hospital for treatment. In such cases, the patient has two alternatives: to either get admitted to the hospital or stay in a hotel.

“Admission strains the hospital facilities,” says Dr Opiyo, “since the patient occupies a bed for six weeks for a treatment that in most cases does not require admission.”

Cases of patients selling land or other property to raise money to finance cancer treatment and their stay in Nairobi are not uncommon.

Cancer specialists say the only way to reduce the pressure on KNH is to have radiotherapy and chemotherapy services offered at the provincial hospitals and biopsy at county hospitals.