Long queues, high costs add to cancer patients’ agony

The lives of thousands of cancer patients in Kenya are at risk as they struggle to get treatment using the few radiotherapy machines at Kenyatta National Hospital.

Ms Monica Akinyi, a cancer patient in Kisumu, has to make several trips to Nairobi every month for radiotherapy but the long queues are a turn-off.

When she first visited the hospital, she waited for five days before a doctor could attend to her.

She was diagnosed with stage two cervical cancer on June 2017.

But because KNH has only three functional radiotherapy machines, she joined a long queue of cancer patients waiting their turn.

COST
She is lucky that she waited for three months. Some have waited longer than a year.

When she calculates what she spends a month, Ms Akinyi talks about Sh10,000, before adding the medication fee, which is Sh3,600 per session, and she needs 25 to 30 sessions.

“I use Sh3,000 for fare from Kisumu to Nairobi and I book a room for at least five days at Sh1,500 per day because I am not sure when I will see the doctor. I have to feed. It is very costly,” Ms Akinyi said.

Ms Akinyi pays for her sessions because she is not a contributor to the National Hospital Insurance Fund.

“I registered last month to be a member but I am told I have to wait for three months for the card to be in use. Before that, I have to pay in cash,” she says.

RADIOLOGY CENTRES
Kenyatta National Hospital is the only public treatment facility in the country for cancer, one of the leading killers.

It has three radiotherapy machines which, according to Dr Catherine Nyongesa, an oncologist at the hospital’s cancer centre, are overworked.

As global citizens mark World Cancer Day on Sunday, the reality that Kenya has only four radiology centres in Nairobi — with only one being a public health facility — is disturbing.

DEVOLUTION
A patient requires radiotherapy as part of the treatment.

Ms Akinyi represents thousands of Kenyans who have to travel from different parts of the country for radiotherapy services at KNH despite the national government making an effort to decongest the hospital by leasing cancer machines to counties.

A spot check by Sunday Nation at referral hospitals in the country revealed that most of them did not receive the machines.

Dr Juliana Otieno, the chief executive officer at Jaramogi Oginga Odinga Teaching and Referral Hospital, saidthat they did not receive the cancer machines, save for devices for diagnosis and minor chemotherapy.

“For radiotherapy and other advanced cancer treatment, our patients are referred to KNH,” Dr Otieno said.

EQUIPMENT
The same case applies to Moi Teaching and Referral Hospital and Kisii Teaching and Referral Hospital.

Moi Teaching and Referral Hospital chief executive Wilson Aruasa said they were expecting the cancer equipment under the programme in April.

“The equipment is under procurement now. Both a Linac and brachytherapy machine. We expect delivery, installation and commissioning by April 2018,” Dr Aruasa said.

With the huge number of patients flocking KNH, Dr Nyongesa says they attend to over 200 patients at the radiotherapy unit.

“We have three working machines for radiotherapy. Each machine can attend to 60 to 80 patients in a day, meaning we can see close to over 200 patients. Before we had only one which caused a lot of strain,” he said.

WAITING LIST
This means that over 200 patients are actively on radiotherapy at Kenyatta against an overwhelming 1,200 patients who require urgent radiotherapy on a daily basis.

This leaves about 1,000 cancer patients on the waiting list each day.

During the early stages of cancer, one needs 25 to 30 sessions of radiotherapy and, in later stages, about five to 10.

Dr Nyongesa is concerned about the long queues but says they are trying to make patients access treatment faster by navigating them at the cancer treatment centre.

“Before we had delays for over eight months but now patients should be able to start their chemotherapy and radiotherapy after four weeks,” she said.

She said the strain on public resources and staff is a reality since cancer is the third leading cause of death in the country.

SPECIALISTS
Dr Nyongesa said there are less than 10 oncologists at KNH who attend to thousands of Kenyans — two radiation oncologists and five medical oncologists.

But according to the National Cancer Network, in terms of medical expertise in the public sector, there are only four radiation oncologists, six medical oncologists, four paediatric oncologists, five radiation therapy technologists, three oncology nurses and two medical physicists.

Dr Nyongesa said that due to the huge number of people being diagnosed with cancer, the three radiotherapy machines are not enough.

“The doctors are overworking. We are setting up a cancer centre and training more oncologists to curb the challenges,” she said.

She also expressed concern about the need to create public awareness so that the number of late cancer detection is reduced.

“We are able to diagnose quite a number of cancers but most patients are coming for testing when they feel something is not right, but not just to check their health. At times, we die for lack of knowledge and poverty,” she said.

MYTHS
Dr Nyongesa said that four in five cancer cases are diagnosed at later stages due to societal myths and lack of cognizance associated with the non-communicable disease.

Cancer is the third leading killer disease after malaria and pneumonia, according to the 2014 Economic Survey.

Cancer awareness organisations estimate that about 40,000 new cancer cases are diagnosed every year, with 27,000 deaths, possibly due to inadequate treatment.

According to the Economic Survey 2013, in 2012, cancer was the leading cause of death in Nyanza, claiming 2,092 lives, Central Kenya (1,993), Western (1,985), South Rift (1,297), North Rift (1,044) and Coast (859).

None of these regions have radiotherapy machines.

Significantly, it was the second leading cause of death in Nairobi, Eastern and North Eastern regions after tuberculosis.