Across Nigeria, cancer patients who cannot get radiotherapy think about death every day, Paul Adepoju reports
For about 90 seconds she stared at nothing, just lost in her thoughts and short of words after her sister just told her she wouldn’t be able to come and stay with their mum in the afternoon which meant that Gladys, the youngest, would have to do a full stretch 12-hour shift by their sick mother’s side at the oncology unit of the University College Hospital Ibadan.
Although she appeared frail and weak, Gladys’ mum, according to her daughter used to be very active and happy – up until she was diagnosed with Stage 3B breast cancer in Enugu a major city in southeastern part of Nigeria. Her doctor recommended a combination of surgery (mastectomy), radiation and chemotherapy to increase her chance of winning the fight against the cancer. While she could get the surgery and chemotherapy at the tertiary facility in Enugu, she was referred to the UCH in Ibadan for the radiation treatment – only to be told that the old cobalt-60 machine had developed fault before she arrived at the hospital which meant that her family had to look elsewhere for the radiation treatment.
Although cancer radiation therapy is a 65-year old procedure following the October 27, 1951’s world’s first cancer treatment with Cobalt-60 radiation which took place in Canada at the 1838-founded Victoria Hospital London, Ontario, the treatment has undergone several advancements and modifications making it possible for the service to be offered at hospitals in different parts of the world – yet the equipment is hard to come by in Nigeria.
At the end of December 2015, media reports confirmed that although Nigeria used to have 7 radiotherapy machines, only two were functioning – each expected to serve one million patients since the country has about 2 million people living with cancer and 100,000 new cases are recorded annually. According to health business experts, investing in radiotherapy machines would be a smart business move since there are more than enough individuals that will readily pay for such services.
“I can assure you that if words go across the country that the equipment is somewhere, patients will be referred to the facility from across the country. It is a no-brainer. What I don’t get is why both government and private hospital managements are reluctant to invest in procuring the equipment or repairing the faulty ones. I cannot overstress the fact that there is market for radiotherapy in Nigeria,” said Funke Akinosun, a Lagos-based healthcare manager.
A closer look at a table published in the popular medical journal, The Lancet, revealed that the global recommendation is a radiotherapy machine per 100 kilometers and according to the table, Nigeria ought to have at least 145 radiotherapy machines although it only has two. HealthNewsNG also found that Ghana which has less than one-fifth of Nigeria’s population has more (three) functional radiotherapy centers for its 30 million people – two owned by government and a third center, which is the most advanced, is available at the Swedish Ghana Medical Center in Accra. We attempted to get a radiotherapy appointment from Nigeria and we were able to do so by just calling the hospital’s designated telephone line.
Algeria has 20, Egypt has 76, Morocco has 28 while Tunisia has 16 although it was recommended to have 17. The African country with the highest number of radiotherapy machines is South Africa with 92. If these other countries are able to make several radiotherapy machines available to the citizens, why is Nigeria unable to do so for its 2 million (and more) citizens living with cancer?
Expensive or not prioritized
HealthNewsNG investigations revealed that the cost of new modern X-ray radiation machine ranges between USD3 million and USD7 million which is much lower than the cost of several building projects underway in hospitals across Nigeria yet only a few have offer radiation treatment and many of those that offer the services are reporting faulty equipment. The UCH Ibadan where Gladys’ mum was expected to receive treatment is an example of such.
Just behind the hospital’s oncology unit, a multimillion dollar building project is underway for the institution’s Department of Immunology while elsewhere within the same teaching hospital, a multimillion dollar building project is underway for the Institute for Child Health – both on completion will gulp about a billion naira. With similar developments across the country, many industry stakeholders believe that the lack of radiotherapy machines are as a result of lack of interest among the decision makers who, they claim, are focusing on other things apart from radiotherapy for cancer patients.
“It is not that the money is not available or the machines are expensive, it is simply due to the fact that the hospitals don’t see procuring radiotherapy machines as a top priority. Our governments would prefer opening cutting the ribbon at a new ill-equipped but well painted but well painted hospitals to spending millions of dollars on cancer machines,” said cancer expert Dr. Francis Ihemedu.
Hurdles and bottlenecks for private practitioners
While there is a steady increase in the number of international private healthcare providers in Nigeria, speaking to the heads and reps of some of them revealed that that there is a reluctance to venture into radiotherapy.
According to the medical director of one of popular top tire private hospitals in Lagos, providing cancer radiotherapy treatments is nothing like any other procedures in terms of regulations and hurdles to scale.
“Don’t forget we are talking about a procedure that utilizes atomic particles here and you need approvals from several global, continent, national and local agencies. It seems as if government is even reluctant to allow private hospitals to offer radiotherapy services and this has to really change for the benefit of cancer patients in Nigeria,” he said while speaking on condition of anonymity.
Healthcare not yet a business
At Nigeria’s biggest medical event, Medic West Africa, several manufacturers of diagnostics and treatment equipment revealed that they were introducing newer approaches that would encourage medical facilities across Nigeria to be able to have the various equipment but they observed reluctance among representatives of the hospitals and cancer centers in attendance – something they said was as a result of the reluctance of Nigeria’s health ecosystem to view healthcare as a business in the country.
“It is an obvious impediment to cancer care in Nigeria that the country’s regulators are yet to see healthcare as a business as evident in the numerous impediments to health business operations. Medical facilities are not allowed to advertise and those that want to invest in procuring equipment are not very much guaranteed of returns on investments,” Akinosun said.
According to her, the fact that all the faulty radiotherapy machines in Nigeria are owned by government hospitals is a true reflection of the underlying problem in the nation’s healthcare system – nothing is at stake mindset.
“I strongly believe that a health facility that knows how much it is losing due to its faulty machines would speedily repair it; and a country that wants its health sector to grow by opening up the space to healthcare investors would be able to attract international healthcare firms that would invest in radiotherapy machines and other medical equipment that would improve the quality of life for Nigerian patients and ensure that cancer patients get the treatment they much deserve,” she added.
For Gladys’ mum, the family was advised to consider the National Hospital Abuja or the Usmanu Dan Fodiyo University Teaching Hospital, Sokoto. But there was a little problem, the queue for the radiotherapy therapy treatment is long and it would several months before it could get to her turn. Gladys said other family members were reluctant to go with her and she was beginning to come to terms with the fact that she may have to take care of her all by herself.
“I am not giving up though, my sisters know I will never give up but I think my mother has already given up. Yesterday she thanked me and said I should stop worrying too much about her and start living my life instead. Although she is the strongest person I know, our inability to get her radiotherapy meant that she spends each day thinking about death.”