Investigation: How government fails cancer patients in Nigeria

.Only 1 radiotherapy machine works at a time in Nigeria .Chemotherapy treatment beyond the reach of most patients .100,000 test positive to cancer yearly .Consultants in Oncology  very few Last week, cancer patients from different parts of the country, who are receiving treatment at the National Hospital, Abuja, staged a peaceful protest to draw government’s […]

.Only 1 radiotherapy machine works at a time in Nigeria
.Chemotherapy treatment beyond the reach of most patients
.100,000 test positive to cancer yearly
.Consultants in Oncology  very few
Last week, cancer patients from different parts of the country, who are receiving treatment at the National Hospital, Abuja, staged a peaceful protest to draw government’s attention to their sufferings.  They have been facing untold hardship accessing treatment due to the poor state of the radiotherapy machine in the hospital.
Radiotherapy is a form of treatment involving the use of high-energy radiation to treat cancer. It is part of the treatment plan of almost half of all the people who have cancer.
The patients lamented that their treatments were often interrupted, postponed, and sometimes even stopped because the electricity connected to the radiotherapy machine broke down and the hospital generator couldn’t power it.
A patient, Mr Tom Ugah, who spoke on behalf of other patients said he came from Calabar for the treatment, but had been suffering because of the failure of the machine and the postponement of sessions.
“I travelled from Abia State to Ibadan and Benin; but I ended up here because all the machines in the hospitals I went to were faulty. This is the situation of things.
“We want the federal government to know that we need more machines. There should be at least one machine in each of the geo-political zones of the country, if not in each state,’’ another patient, Mrs Ezinne Nwanosike.
Over the years, aside the burden of cancer itself, many patients groan under the high cost of treatment.
A young lady who identified herself as Pauline said her mother was referred to the National Hospital, Abuja from a hospital in Aba, Abia State as there was no radiotherapy in the area. Our reporter gathered that she and her daughter had slept on bare floor on walkways in the National Hospital for two weeks. And about 18 daily radiotherapy sessions were prescribed for her.
It was also gathered that their father, a low cadre civil servant, had borrowed money to enable them come to Abuja for the treatment, so they could not afford a hotel accommodation before she would be admitted into the hospital ward. And they had no relative to stay with in Abuja.  They were forced to always wake up early in the morning to bath and go to the Oncology Unit for the radiotherapy treatment.
Pauline told Daily Trust on Sunday that it was not easy for them to sleep in the open at night, especially when it rained, adding that her mother was always the most affected after treatment each day. Other families suffered the same fate, according to her. She wished her mother’s treatment would be successfully completed so that she could go back to school.
Pauline further revealed that some patients on admission had to abandon treatment due to lack of money. She said the hardship on cancer patients and their families would have been less if the treatment was cheap and affordable.
 Hajiya Hauwa Garba, a mother of seven, was also diagnosed of cancer. It took several months before she was able to access a hospital in her state capital after taking a lot of herbal medicine. She was later referred to the Ahmadu Bello University Teaching Hospital, Zaria, where she was told that the disease was already at an advanced stage. In Zaria, she waited several weeks but couldn’t access treatment because the machine was faulty. She was later asked to do chemotherapy.
Hauwa couldn’t afford the over one million chemotherapy naira drugs prescribed for her; hence she returned home and relied on herbal medicine and prayers until she died.
Mrs Bolanle Abayomi, a widow and teacher, who has been on treatment for cancer for seven years, said she had a very terrible experience in 2010 when the radiotherapy machine at the National Hospital broke down. According to her, patients were advised to go to either the teaching hospital in Zaria or Ibadan. She went to Ibadan, where she ended up spending three weeks without accessing treatment because session was done in batches. She added that it had not been easy for her to pay for treatments with her meagre resources.
Our reporter also met two ladies who wept helplessly at the surgical ward of the National Hospital recently. They wept because their uncle, who had been paying for their mother’s hospital bills, could no longer afford to continue.
Mrs Bolanle Abayomi was diagnosed with breast cancer and had already undergone surgery, but she still needed radiotherapy and chemotherapy for further treatment. The girls asked the hospital to discharge them because without their uncle’s financial support they wouldn’t be able to pay for their mother’s treatment. They said their uncle had already sold some of his properties for the treatment, and wished that someone would come to their help.
Mr Oluwale Martins is another cancer patient at the National Hospital. He recalled how the radiotherapy machine in the hospital broke down in 2013 and people were left stranded until some Egyptian specialists were brought in.
Malam Hamza Ibrahim, who has a huge tumour on his face and was referred to the oncology unit of the hospital, could not afford the treatment. And he resigned to fate. It was said that he became a nuisance to other patients and their relatives as the odour oozing from the tumour was discomforting.
Daily Trust on Sunday further gathered that, as a result of the inadequate and poorly maintained equipment and centres in Nigeria, rich cancer patients go abroad for treatment, but those who cannot afford such trips resign to fate and await death.
On the estimated number of cancer patients in Nigeria, Dr. Uchenna Onwufor, a consultant gynaecologist and executive director of Gynae Care Research and Cancer Foundation, said there were about 25 million people living with cancer worldwide, and it is estimated that by 2020, 16 million new cases would be diagnosed per annum, out of which 70 per cent would be in developing countries.
He, however, said that in Nigeria, there is no accurate estimate of the number of people living with cancer, but every year, at least 100, 000 cases occur.
“The number of cancer patients is steadily rising globally. The risk factors are all with us: environmental degradation due to oil spill, pollution from cars, fumes from generating sets and industries, increased rate of obesity, radiation from GSM masts and other radioactive materials like most gadgets we use. While the developed countries are putting measures in place to attempt to stem this tide, in Nigeria, we appear oblivious of this reality,” he said.
Dr Thomas Agan, the Chief Medical Director of the University of Calabar Teaching Hospital (UCTH) said that basically, treatment for cancer is usually medical, surgical or through radiotherapy, or the combination of all of these. He explained that radiotherapy, which is the usage of x-ray methods, involves the burning of rapidly growing tissues which can spread to the entire body if the patient does not report in time.
He said that radiotherapy required very expensive equipment, adding, “For anyone to use that method, it means that people must be trained in the use of such complex and sophisticated equipment. This is human capital development. An entire medical team must be trained. And there must be a conducive building for the equipment. It is a very sensitive, delicate and expensive equipment, which an institution cannot purchase alone. We do not have this machine at the UCTH.”
Findings by Daily Trust on Sunday revealed that there are about six cancer centres in Nigeria. Available radiotherapy machines are always breaking down because of the high patient load on them. In private hospitals where the machines are available, the cost is beyond the reach of an average Nigerian. Also, very few experts in the country can maintain them. And it takes several weeks or months to get foreign experts to repair the machines when they break down.
It was also gathered that few weeks ago, only the radiotherapy machine at the University of Benin Teaching Hospital was working in the entire country.
Studies carried out by the University College Hospital (UCH), Ibadan, showed that cancer accounted for 13.8 per cent of deaths in the hospital between August 2012 and July 2013. 
The report propelled the management of the hospital to acquire a Cobalt-60 machine for the treatment of radiation sensitive cancers. The machine was commissioned on December 16, 2013. 
The teaching hospital was recording an average of 300 to 400 cancer patients on a monthly basis while the machine was working at its optimal capacity. As a result of the machine, patients were referred to the UCH from virtually all parts of the country. But the machine broke down in May this year. However, according to a top official of the hospital, management has engaged the services of engineers to restore the machine.
A consultant radiation oncologist at the UCH, Dr. Olutoye Ogunnorin, said that pending the time when the team of engineers would put the Cobalt-60 back on track, physicians saddled with radiotherapy services are still seeing to the wellbeing of cancer patients referred to the institution from different parts of the country. He added that the hospital is known for both the treatment of cancer and a training centre for doctors. 
He further said there was an existing collaborative arrangement among frontline teaching hospitals in Nigeria, including the Lagos University Teaching Hospital (LUTH), the University of Benin Teaching Hospital (UBTH), National Hospital, Abuja; the University of Nigeria, Nsukka Teaching Hospital (UNTH); the Ahmadu Bello University Teaching Hospital, Zaria;  Usman Danfodio University Teaching Hospital, Sokoto; as well as a notable private hospital based in Lagos.
Ogunnorin said that over time, they had noticed that because of the sophistication of the radiotherapy treatment machine, at one point in time or another, one centre may be working in the country while another may either be servicing its machine or going through repair. “All of these centres usually communicate with one another. And then, of course, patients are referred back and forth whenever such situation arises as there is an existing collaborative arrangement among the various centres,” he added.
A source at the Ahmadu Bello University Teaching Hospital (ABUTH), Shika in Zaria, said the Department of Radiotherapy in the institution came into being in 2002; and since then, there has been only one radiotherapy machine. He said that having only one machine is not much a problem as not having the required components.
“The machine is supposed to have other components like simulator and a treatment planning system, which we don’t have in the hospital. And we have been treating patients like that. The machine we are currently using, which is Cobalt-60, is obsolete and the parts are no longer produced by most countries of the world,” he explained.
He said that getting the radioactive source for treatment is presently a challenge because of global terrorism and security challenge in Nigeria, adding that the world standard is that a radiotherapy machine should be a linear accelerator.
“About eight linear accelerators should cater for one million population, but we don’t have even one in Kaduna. Because it is old, the Cobalt-60 develops mechanical fault quite often. When it breaks down, we refer our patients to Sokoto or Abuja if their machines are in good condition,” he added.
Our source disclosed that this year, over 300 new cases of cancer have been seen in the Department of Radiotherapy of the ABUTH.
“We see an average of 16 new patients every week, and as such, there is the need for the expansion of the department, as well as the provision of adequate equipment for treatment. Members of staff should also be trained to use new equipment to achieve the desired goal,” he said.
He urged government to sensitize the public on preventable cancers and early detection of cancer such as cervical cancer, advising that vaccine for cervical cancer be made available at all general hospitals for all women who are sexually active; and for men, government can provide colonoscopy unit to screen men and women for coloretal cancer.
The University of Calabar Teaching Hospital does not have a radiotherapy centre. It urgently needs one because of the huge number of cancer patients who come from neighbouring states and countries to access treatment.
According to the medical director of the hospital, they come from neighbouring countries like Cameroon, Equitorial Guinea, Sao Tome & Principe. Also, people in Cross River, Akwa Ibom, Ebonyi and other nearby states who suffer from cancer travel from very far distances to Lagos, Ibadan, Zaria, among other places to get the services of the radiotherapy machine. Trauma and stress contribute immensely to the death of patients.
While emphasizing the need to make the UCTH a regional centre for the treatment of cancer, he said the challenge of managing patients in Calabar was enormous.
“The special therapeutic drugs are so expensive that patients are unable to buy them for their treatment. When they come in that moribund state, you, as a physician, will hardly allow them to die. Often, we tax ourselves to enable them get the treatment. The lack of radiotherapy machine has also compounded our challenge,” he said. He called on President Muhammadu Buhari to establish a radiotherapy centre in Calabar.
At the University of Ilorin Teaching Hospital, inclusive cancer patients told our reporter that the challenges they faced include waiting for a long time, from the time of diagnosis to the time of securing an appointment, as well as the time spent on the day of appointment with the doctor.
Other factors include poor electricity supply, insufficient manpower, and the number of patients. The cancer patients called for free or subsidised treatment and provision of adequate modern equipment, as well as the training of all health care professionals involved in the management of cancer.
The patients also complained of inadequate awareness, late presentations, lack of financial support and distance to functional hospitals.
According to Mrs. Usman-Folorunsho Huseinat, a master’s degree student at the Cardiff University, United Kingdom and a medical imaging scientist/medical radiographer at the University of Ilorin Teaching Hospital, there is no radiotherapy machine for cancer at the hospital. She said they usually send their patients to Ibadan or the Lagos University Teaching Hospital while some are sent to the National Hospital, Abuja or the teaching hospital in Zaria.
She said they hoped the hospital would have the equipment in future as many of them are now on training abroad.
Daily Trust on Sunday also gathered that there are about nine radiotherapy centres in the country, with one private, but only one out of the nine may be working at a particular time. As at the time of going to press, only the radiotherapy machine at the National Hospital in Abuja was functional.
Also, head of the Oncology and Radiotherapy Unit of the Lagos University Teaching Hospital, Idi-Araba, Professor  Remi Ajekigbe, said in an interview that they recorded about 3,000 cancer patients in spite of the fact that the machine broke down for four months last year, along with the strikes. He added that the cost of radiotherapy and chemotherapy treatment, as well as that of the equipment, partly contributes to the increasing number of deaths in the country. He said a radiotherapy machine costs about N70 million, aside the fees for the consumable.
 He said cancer treatment is expensive because the cost of procuring the equipment is high. Many public and private hospitals cannot buy and maintain the facility without getting assistance from the government, he added, and urged the federal government to assist health institutions in acquiring the equipment.
 “The government will be helping Nigerians if there is zero tariff on medical equipment. This is because it is the patient that has already sold many properties to pay hospital bills that will bear the burden of the high levies. And if they can’t pay, they will not get the treatment they need. We need more people to survive cancer in Nigeria,” he said.

The way out
To address the challenges of cancer patients, Dr Onwufor said the federal and state governments have a major part to play. He said  governments at all levels have not considered cancer an ailment of public health importance, that is why we still have very few radiotherapy centres in the country, with outdated machines that keep breaking down. According to him, worse still, there are very few oncologists in the country, and the cost of cancer care is very expensive.
“If the government can get serious about the health of its citizens, the hospitals can function optimally and give better care to patients who have developed cancer. This will help them live longer and have relatively healthy lives,’’ Onwufor said.
He said the Human Immunodeficiency Virus (HIV) was an enormous burden worldwide and the global community came together and provided funds to tackle it. “Before long, treatment was made free and people could access care and get free drugs. Now, we have people living relatively normal lives with HIV. The priority placed on awareness, early detection and treatment of HIV has provided the success story we see today. Such priority has not yet been given to cancer,’’ he added.
Onwufor further remarked that many cancer patients are resorting to herbal remedies because of the frustrations experienced by those who have visited cancer centres, including the fact that chemotherapy drugs are expensive and our hospitals do not have the capacity to manage the increasing number of patients. He said it’s because of the failure on the part of government that wealthy cancer patients seek treatment outside the country.
“The government has to urgently increase the number of functioning cancer centres in the country and ensure that they are properly equipped to cater for the increasing number of patients. Also, more doctors should be encouraged and sponsored to specialise in oncology to help manage patients. The government has to come to the aid of cancer clients by participating in their care. Basic management of cancer patients should be part of the National Health Insurance Scheme,’’ he recommended.
He added that more importantly, Nigerians need to develop a preventive culture, saying it is cheaper and less distressing to prevent cancers than to treat them.
“Majority of these cancers can be prevented. We need to, above all, to create a blueprint for screening and early detection for populations at risk of cancer. That way, people will be healthier and more productive. It’s not just about cancer, it’s about living well,’’ he added.
Also, the regulatory fees charged by the Nigeria Nuclear Regulatory Authority (NNRA) seems to be adding to the suffering of cancer patients as hospitals have to charge patients to be able to maintain and keep the machines running.
“There are also very few radiologists and radiotherapists in the country so that when the radiotherapy machines break down, time is spent getting the few experts around or looking for foreigners to come and repair them.
According to the chairman, Faculty of Radiology, National Postgraduate Medical College of Nigeria, Lagos, Prof. Abiodun Adeyinka, there is the need to reduce the NNRA regulatory fees to enable patients easily access the services of radiologists in the country and save more lives.
He said the NNRA, which regulates radiation practice, including x-ray and nuclear medicine, among others, has  increased the subscription fees for the use of radiation equipment to about N3 million. And this is killing opportunities for patients, as well as the operation of radiologists in the country.
“We have to look for N3 million every month to operate these machines. We appeal to the NNRA to review their policies. The amount is too high. All the teaching hospitals are complaining. Even the private sector is complaining because we cannot run a good health care when these restrictions are there,” he said.
He said there are less than 300 radiologists and about 35 radiotherapists in a population of 170 million people, adding, “It is totally inadequate. Radiology and radiotherapy go together. Radiology is for diagnosis while radiotherapy is for the treatment of cancer and other related diseases.”
Also, the chief consultant radiologist at the National Hospital, Dr. Olubunmi Olatunji, said the NNRA regulatory fees should be waived in government-owned hospitals as the high subscription rate is really affecting patients.