Prior to the outbreak of the coronavirus in Nigeria in 2020, cancerous infections had killed thousands of Nigerians and consigned many others to the sickbed. In this concluding section of a two-part piece, IMOLEAYO OYEDEYI reports how the pandemic’s containment efforts increased the fatality rate of cancer and disrupted the treatments of its survivors.
Costly ignorance
According to Dr Zainab Bagudu, MD/CEO of Medicaid Cancer Foundation, in a report by the Nigeria Health Watch, access to screening and diagnostic services is the most critical aspect of cancer care, and the lack of equitable access to these services remains the reason mortality rates for cancer in Nigeria and Sub Saharan Africa are alarmingly high, when compared to other countries. Surely, there is also the factor of public awareness, not least among women and in a country where access to public health information is poor.
Take the case of Mrs Omolayo Bello, a mother of two girls and a former cleaner at a bank in Agege, Lagos.
When this reporter met Mrs Bello, a widow, in June, she had been ill with cancer for about 27 months. Such was her condition that she could no longer walk; she relied on a wheelchair. At the time, her husband had died 18 months before at the Oke Odo General Hospital, Ile Epo bus-stop, along Lagos/Abeokuta Expressway, Agege, Lagos.
Narrating her experience, Mrs. Bello said: “My cancer problem started in June 2018. I will say it was ignorance that caused it, because I had always believed that the disease is hereditary. So, when I first saw a lump on my breast around that June, I never took it seriously. After some time, I called my husband and showed it to him, and he referred me to his sister, who is a registered nurse.
“The lady gave me some native grease and said that once I applied it, the lump would dry up. She claimed that sometimes,a lump may appear on woman’s breast, especially after monthly menstruation. So, I was calm. But after some time, some health practitioners came to our church on a health sensitisation visit. I showed the lump to them, and they said I should visit the hospital.”
Mrs Bello said as directed by the healthcare campaigners, she visited a private hospital in December that year and the doctor at the clinic, after examining her, recommended immediate surgery. She and her late husband agreed. The cost was N20,000. After the operation, the doctor gave Bello and her husband the removed lump and asked them to take it to a laboratory for medical examination to determine if it was cancerous. But instead of following the doctor’s instructions, the couple opted to throw away the lump. Four months after the operation, the spot where the lump was removed began to swell.
“I wish we had heeded the man’s advice that day, but we didn’t and four months after, the spot where the lump was removed became swollen. That’s why I said ignorance was part of what has compounded my problem. When the thing came back, that was around late February 2019, I showed it again to my husband and he said we would go back to the private hospital to remove it again. But I didn’t agree. I told our pastor and he advised me to go to the Ikeja General Hospital to get a referral letter to take to the Lagos University Teaching Hospital, Idi-Araba,” she recounted.
According to Mrs. Bello, at LUTH, it was confirmed that the sore on her left breast was stage-two cancer. This was May 2019. From the ward where she underwent tests including biopsy, she was referred to the oncology department for chemotherapy. She took only two cycles of neoadjuvant chemotherapy before her husband died on Thursday, November 7, 2019. Mrs Bello described her husband as her sole carer, who paid all her medical expenses to that point.
How Mr. Bello died
Narrating how her husband died, she said: “Very early on Thursday, November 7, 2019, my husband complained of headache and cold, so we took him to a private hospital. When we got there, they tested him and said he had malaria, and gave him some treatment. But he was struggling to breathe normally while also shivering. He groaned loudly every second. Unable to calm him, the doctor at the private hospital asked us to take him to the Oke-Odo General Hospital.
“At the General Hospital, the nurses carried out some tests on him, and said he had an ulcer. They gave him some treatment before asking us to take him back home. They claimed that his illness did not merit admission. But we could see that he was uncomfortable, so we begged that he be admitted if only for the night. I thought it was probably because they didn’t have a bedspace to put him. We couldn’t take him home, because he didn’t show us any sign of relief, but as the general hospital insisted that he would not be admitted, we thought it wise to return him to the private hospital we had visited earlier.
“When we returned to the private hospital and narrated what happened to the doctor, he asked the nurses to commence some treatments on my husband again. All these happened during the day. While the nurses were treating my husband, I briefly went to pick up my phone in the room next to where he was being treated. Suddenly, I heard the nurses shouting my name. I rushed down to his ward and saw him breathing heavily on the bed. Immediately, I went out to bring a tricycle with which we rushed him back to the Oke-Odo General Hospital. But as we got there, the nurses told us that he had died. So, we took his corpse to the mortuary, where we were told that he died of cardiac arrest.”
The COVID-19 connection
Her grief notwithstanding, Mrs Bello managed to complete her remaining cycles of chemotherapy in the last week of January 2020. By this time, COVID-19 had been announced as a global pandemic. The severity of the virus and the way it sneaked into Nigeria later compelled the federal government to put in place some curtailment measures. But the restrictions that came with COVID-19 affected the attention on other diseases.
After concluding her chemotherapy circles, she was given a letter to proceed to the surgery department at LUTH for mastectomy. The operation was scheduled for February, but Mrs. Bello said she was not able to undergo the surgery until six months later. The federal government ordered full restrictions of movement on March 30 as part of the COVID-19 containment measures. By the time Mrs. Bello returned to the hospital, the doctor said the cancerous cells in her breast had spread to other parts of her body, including her bones which later relegated her to the wheelchair.
Speaking as tears rolled down her cheeks, she said: “After I submitted my letter for surgery, the doctors asked me to go home and watch the condition of the sore on my breast and that if it did not become worse, I should come back in June for the surgery. I was told that if there were complications, I shouldn’t wait till that period before I check back at the hospital for the surgery. But it wasn’t until the end of March when I started experiencing some severe pains in my breast. But by then, movement had been restricted.
“For the entire period of April till June, I could not access the hospital. That time, I had completed my chemotherapy. So, there was no treatment whatsoever for me, yet the face of the sore was becoming wider day by day. I went through hell during that period. In July when I was able to access the hospital again, the doctor told me that if I had been able to receive treatment earlier, the cancerous cells in my breast wouldn’t have spread to other parts of my body and that the sore too would not have become as big as it turned out to be.
“Before that time, around mid-April, there was little movement. Then, I would go to the teaching hospital to explain my condition to a doctor, but each time I went, they would ask us to drop our cards somewhere and wait under a canopy outside, while they attended to people with symptoms of COVID-19. Even at the cancer treatment centre then, there were no oncologists on ground and the few other practitioners available only attended to those who hadn’t completed their chemotherapy and other related matters. It was really frustrating for me that period.”
The agony of 65-year-old Madam Yusuf
In Ibadan, Oyo State, Madam Fatimo Yusuf, who is also known as Mama Ibadan within her extended family, is a 65-year old whose cancer treatment was compromised by the measures put in place to check the spread of COVID-19.
“She can’t hear what you are saying, except you move very close to her and she fixes her gaze on your lips to comprehend the question you are asking,” Madam Yusuf’s daughter told this reporter at the waiting wing of the Radiation Oncology department of the University College Hospital (UCH), Ibadan, Oyo State, on June 3, 2021.
Madam Yusuf’s daughter, who doesn’t want her name printed, narrated how she received a call from her mother on July 13, 2020, from Ikoyi, in Ikire, where the old woman had gone for an event.
Her daughter said: “She told me that she was experiencing some pains in the downward part of her stomach. She said I should call my siblings and we should come and take her to the hospital, because she didn’t really know what was happening in her body.
“We ended up taking her to a private hospital in Ibadan. When we got to the hospital, they gave her first aid. They told us that she would have to undergo some tests, which won’t be immediate, because she was weak. But two days later, they directed us to Morokay laboratory in the Oluyoro area of Ibadan for the tests. After the test, we took the result back to the private hospital, where a doctor told us that Mama had ovarian cancer based on what he read in the test result.”
What is ovarian cancer?
Ovarian cancer refers to any cancerous growth that begins in the ovary, the part of the female body that produces eggs. According to Medscape, ovarian cancer is the eighth most common cancer in women and the 18th most common cancer overall. For Nigeria, no fewer than 2,238 people died of the cancer out of 3,203 confirmed cases in 2020, according to WHO. In 2019, only 744 patients survived out of the 2,783 recorded.
Speaking on the experience further, Madam Yusuf’s daughter said: “I could not imagine my mother having cancer as no one in our family ever had it. But while I was agonising over the news, the doctor came and immediately told us to take Mama straight to the UCH. But we could not get into the hospital until 12 days later, due to the COVID-19 restrictions at that time, though the state only had a dusk-to-dawn curfew. When we finally got to the UCH, the registration process was demanding.
“We kept moving from one department to the other, because we didn’t know the exact section we were supposed to go to as the doctor that referred us at the private hospital didn’t mention any particular department. He only told us to take mama to UCH. When we went back to the doctor to explain how hard it was to access the treatment centre at UCH, he only told us to continue using the drugs we purchased at his hospital until we were able to access the UCH centre.”
According to Madam Yusuf’s daughter, it took two weeks of visit before they made headway at UCH. The diagnosis was confirmed, but by then Mama Ibadan’s condition had visibly deteriorated. They later learnt that her spinal cord had been affected as she could no longer sit up voluntarily.
Between July when the sickness began, and December, Mama’s daughter said the family had become drained financially and exhausted emotionally as they ran from pillar to posts to cover the costs of medical tests and treatment.
She said: “When we came to the UCH in late July 2020, the doctor, after carrying out some tests on Mama, told us that the cancer had been in her body for a very long period of time, but she didn’t know. They said though the cancer first touched her ovaries, it spread to other parts of her body, which now made it hard for it to be wiped out.
“It was at this point that I remembered that she had first complained of having some pains around that May, but I could not leave my base in Osogbo for Ibadan due to the ban on inter-state movement. With the way she complained then, I thought it wasn’t serious, not until when the pain gripped her at the Ikire programme from where we took her to the UCH.”
Cancer returns after chemotherapy
Mama Ibadan’s daughter said after her cycles of chemotherapy, the old woman fared better in January 2021 as she started walking again. But during the last 10 days in February, her condition worsened as the weight loss, stomach pains and loss of strength in her legs returned.
“Her new condition took us back to UCH in March 2021. She underwent a blood transfusion, after which she was placed on another round of treatment. And it is on this that we have been since March till this June. It is really baffling to me, because it is like the disease is rising and falling. Since that March, we have been spending money on her again,” Mama Ibadan’s daughter said.
LUTH declines request
Nigerian Tribune asked the NSIA/LUTH cancer treatment centre and the oncology department of the Lagos State University Teaching Hospital (LASUTH) for data on cancer incidence and fatalities recorded by their respective departments during the COVID-19 restriction periods and also a statement on their individual cancer treatment capacity. While NSIA/LUTH did not respond to the request, an oncologist was sent to speak to this reporter by the PR department of LASUTH. The oncologist promised to return with the data, but had not done so at the time of filing this report. A similar request was made to the National Hospital, Abuja. However, an official to whom this reporter spoke said such data was not yet available for public dissemination.
The WHO baseline
According to an assessment report on the health system capacity of Nigeria contained in the WHO cancer profile published in 2020, for every 10,000 cancer patients, Nigeria has 0.5 numbers of external beam radiotherapy machines, 8.6 number of mammographs, 15.8 number of CT scanners, 5.0 number of MRI scanners and no single PET scanner as of the COVID-19 year.
On workforce, the WHO data suggests that per 10,000 cancer patients as of 2019, there were six radiation oncologists, less than nine medical physicists, around 30 radiologists, while the ratio for nuclear medicine physicians is 0.3; surgeons, 157.6 as of 2014, and 1,095 medical and pathology lab scientists as of 2008, yet the population of the country continues to soar above 200 million according to the World Bank.
As the country continues to grapple with waning medical infrastructure and an underdeveloped healthcare system, only time will tell what becomes of Mrs Bello and Mama Ibadan, who is now bedridden.
- This report was facilitated by the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under its Free to share project
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