Categories: Features

Cancer: The killer cankerworm

SADE OGUNTOLA reports that many cancer patients in Nigeria die needlessly every year due to lack of equipment for
diagnosis, even as a cancer centre envisioned by a late medical doctor to save patients’ lives through early detection and
diagnosis lie prostrate due to lack of funds to complete it.

Nigeria, a country of 200 million people currently has fewer than five functional radiotherapy machines, meaning one machine to about 50 million Nigerians! Thus, the scarcity of radiation therapy in Nigeria has led to higher costs of treatment.

In a country where the minimum monthly wage is about N30,000, breast cancer patients have to pay more than N1.5 million for radiotherapy treatment. According to the Nigeria National Cancer Prevention and Control Plan (2018-2022), cancer is responsible for 72,000 deaths in the country annually with an estimated 102,000 new cases every year.

The World Health Organisation (WHO) describes cancer as a large group of diseases that can start in almost any organ or tissue of the body when abnormal cells grow uncontrollably and go beyond their usual boundaries to invade adjoining parts of the body and/or spread to other organs.

The most common cancers in Nigeria are breast (36.5%); colorectal (11.7%); prostate (8.1%); cervical (7.2); soft tissue (6%); non-melanoma skin (5.2%); ovarian (4%); metastatic (4%); gastric (2.6%); thyroid (1.8%) and salivary gland (1.4%) cancers.

Several efforts have been made to improve access to radiation therapy in Nigeria with the most notable attempt being the launch of new machines at Lagos University Teaching Hospital in 2019. The NSIA-LUTH Cancer Treatment Centre was commissioned. However, this is only a drop in the ocean and as such deaths from cancer in Nigeria are still high.

A cancer centre to the rescue

Meanwhile, a health facility, Olajide Ajayi Cancer Centre, located at Eruwa, a town in Ibarapa area of Oyo State is still lying prostrate several years after its establishment. The late Dr Oluyombo Awojobi, who was the Chief Medical Director of Awojobi Clinic in the town had envisioned the Olajide Ajayi Cancer Centre to improve cancer care after he started noticing an upsurge in cancer cases.

In 2013, he started the construction of the centre, funded by donors and philanthropists, but it was still under construction when he died. Currently, the Cancer Centre is about 40 per cent completed, built to specification for the management of cancer. It also includes three bunkers which are over 80 per cent completed but further construction had been stalled due to paucity of funds.

According to Dr Ayorinde Folasire, Chairman of the cancer centre: “It is not yet completed but it is at a level that if there are machines to work with it, we can kick off with treatment. We will need also the laboratories, including equipment for cancer diagnosis. But at least we can start with the treatment end because there are a lot of diagnostic centers around.”

Speaking further, Dr Folasire said the centre is a separate entity from Awojobi Clinic as it is an NGO named after a surgeon and former Chief Medical Director at the University College Hospital, UCH, Ibadan, Professor Olajide Ajayi.

Dr Oluyombo Awojobi’s widow, Tinu, also stated that work had stopped at the cancer treatment site for seven years since her husband’s demise.According to her, “the centre’s board of trustees, which includes Dr Beneditus Ajayi and Professor Jide Ajayi, have been trying to get the place started; we did some business plans and had many business proposals, but nobody is coming in to help. We wanted NGOs or the government to take it over, making it functional.

“We are not asking for the money that has been spent because if care is not taken, we would not be able to make use of all the structures again. The cancer centre was never part of our initial plans; Awojobi Clinic, Eruwa, were enough to keep us going. It is a private hospital in a public service that offers all types of medical services, including surgeries.

“When it comes to the care of cancer, cancer treatment starts from the screening to know what it is and then it goes on to have some surgical procedure. On breast cancer, for instance, you identify it, check if it is removable, and then remove it. Later the person goes on to receive chemotherapy and then radiotherapy, which is the ultimate. That was why the centre was important.

“Our patients, when it gets to the radiotherapy stage will have to go to UCH, LUTH or other places. And you know that there are so many people suffering from this ailment. Sometimes, they will give them a year appointment and many of them will die within a year, because most of the time, cancer will reoccur. That was what propelled him, including Professor Rotimi Williams of the African cancer centre.”

Mrs Awojobi stated further that funding had been a major challenge adding that “at a time before DrAwojobi’s death, the WaterShed foundation came, wanting to help. They linked up with UBA and other banks, but the financial crisis in the banking sector foiled it.”

It was also gathered that after DrAwojobi’s death, DrAjayi and Engineer Yomi Akinsola, the vice-chairman of the board and the retainer engineer also travelled far and wide to try to seek assistance to ensure that the centre becomes functional, but nothing so far.

Cancer Patients in Search of Treatment

To underscore the problems of getting treatment for cancer, Sunday tribune encountered Mr Akande Ajibola (not really name), a cancer patient at UCH, Ibadan who spoke on some of the problems.

According to him, access to radiotherapy had been a challenge due to poor electricity supply, without which radiotherapy treatment can be given, nor the repair of the machine when it is bad.

“We have been here since three days ago (early in the week). There was no light for the engineers to repair the machine. If you had come yesterday, which was a clinic day, you would have met over 50 patients waiting to have radiotherapy. Many people had gone back; they should have provided more machines for treatment. Having to really on one machine is not appropriate,” he said.

Mr Akeem Haruna, also a cancer patient at the hospital, stated that poor maintenance was the bane of the radiotherapy equipment at the hospital. “We don’t even know how long the machine had been working and how well they had been servicing it. There is no generator to power it; even if it is working and the light is off, the next thing is for everyone to start to pray for light to be restored. We are not getting the desired result,” he said.

In spite of these issues, Dr Folasire assured of enough manpower to run the Olajide Ajayi Cancer Centre if it is made functional considering the increasing cases of cancer being diagnosed in Nigeria and the need for treatment.

According to him, “the incidence of cancer seems to be increasing because there is improved technology for diagnosis. In the past people didn’t know they were suffering from cancer and they died, but they now have diagnosis.

“However, although we have progressed in the diagnosis of cancer cases, it is not being matched with the facility for treatments. And so this was what drove the late Dr Awojobi to think about having a cancer centre that will be accessible to both the poor and the rich, rural and urban cancer centre, that was his aim.

“If this cancer centre will operate, it will be a lot of benefits for the whole. WHO recommended at least 400 radiotherapy centres for Nigeria. But presently today, we have just, maybe five running centres, in the whole of the country, both in the private and public sector.

“At UCH, Ibadan, we have only one Cobalt 60 machine that is moribund. It always goes down at will. The other machine is brachytherapy. Radiotherapy facility has both external therapy and brachytherapy. The external therapy is far more useful than the brachytherapy. Not all patients will require brachytherapy. Even the brachytherapy in UCH is running presently based on a PPP arrangement.

“Everywhere in the world, they are using linear accelerators for radiotherapy. UCH Ibadan, like Eko Hospital, is using Cobalt 60 even though this is old technology. Maintaining the Cobalt 60 machine is difficult because the companies that build them have folded up. So to get spare parts to refurbish it is difficult.

“So if the centre in Eruwa with buildings up to at least 80 per cent completion can take off, it will go a long way to help people with cancer. A lot of people are dying because there’s no facility for radiotherapy.

“In the past few months that our machine broke down, people could not get treatments. If you ask them to go to Lagos, they say that it is expensive. Some say they have no relatives in Lagos; some prefer to go and die instead of spending all that they have in Lagos.

“I’m really looking forward to resuscitating the cancer centre at Eruwa. A lot of money has gone into that project. It saddens my heart to see it going down the drains. In the past, in West Africa, UCH receives patients from the whole of West Africa for radiotherapy. But now those countries now have equipment for radiotherapy. In fact, Ghana now has many centres that they don’t need to come to Nigeria for cancer treatment.”

DrFolasire said that while cancers that come from the blood system such as leukaemia and lymphoma could be treated with chemotherapy, other cancers like breast cancer and prostate cancer require external radiotherapy. He added, “it is only a few conditions like prostate cancer that brachytherapy can be used to treat when it is detected early enough.

“Cancers have different behaviours. Like a different child born by the same parent, you cannot expect them to behave equally. Some of them are aggressive in their behaviour. Some of them are slow-growing. And so, once you give radiotherapy treatments, it helps to control those diseases.

“Even if it is early, you can cure it. If it is late, you use it to make sure that these people will not be in serious pain, though they are dying. So the need for radiotherapy is huge and this will go a long way.”

The age factor

Obviously, age is the biggest risk factor for cancer. In general, experts say people over 65 have the greatest risk of developing cancer while those under 50 have a much lower risk. Experts also say that more than nine out of 10 cancers are diagnosed in people who are 45 and older. Seniors older than 74 make up almost 28% of all new cancer cases.

Investigations also revealed that there are no cures for any kind of cancer, but there are treatments that may cure a patient with cancer. It’s rare for cancer to go away on its own without treatment; in almost every case, treatment is required to destroy the cancer cells and that is because cancer cells do not function the way normal cells do.

It is a known fact that when people hear the word cancer they immediately think it is a death sentence, but new developments show that there is an advancement in cancer treatments. That means patients are living longer and having a better quality of life. Many patients treated for cancer live out the rest of their lives and die of other causes. Many others are treated for cancer and still die from it, although treatment may give them more time: even years or decades.

However, cancer’s generally poor outcome in Nigeria is not unconnected with late presentation and inadequate diagnostic and treatment facilities. The cancer mortality pattern is quite different in Africa when compared to other parts of the developed world.

Ensuring access to quality cancer treatment service at a reasonable cost even in the rural area of Africa, Nigeria inclusive, could only happen when the likes of Olajide Ajayi Cancer Centre become fully functional. It is certainly one way to ensure that cancer diagnosis ceases to be a death sentence in Nigeria.

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