Dr Peter Kagotho of the cancer section at the Kenyatta National Hospital prepares a patient for therapy. The two outdated Cobalt 60 machines in use at the hospital cannot adequately meet the needs of the swelling list of patients referred to the facility, and medical specialists in the private sector argue that, at the moment, the country has few specialist cancer surgeons. This means that some of the work best handled by specialists is left to general surgeons, who operate on a broad range of diseases and conditions, especially in provincial and district hospitals.
The cancer situation in Kenya is worrying and is characterised by a rapidly growing demographic of new cases and few treatment and management opportunities.
This dark reality came to the fore after a mission from the International Atomic Energy Agency (IAEA) visited the Kenyatta National Hospital in June. The daunting report born of that visit was released recently.
“The cancer situation in Kenya is dire,” the IAEA audit reads in part, “with a severe lack of medical practitioners and a large number of new cancer cases being diagnosed annually.”
The IAEA may strike a familiar chord in the minds of many Kenyans, especially because of its activities in containing the nuclear arms threat in North Korea and Iran. But as cancer spreads its malignant effects in Kenya, all indications point to a bigger and more prominent presence of the agency on Kenyan soil.
Apart from controlling nuclear arms proliferation, the organisation is also a leader in the production of diagnostic kits and the treatment of some cancers.
The June mission, the first of its kind in the region, was aimed at “establishing a sound understanding of where Kenya stands in its attempt to control cancer, and what measures must be taken to ensure that the best possible treatment, prevention, and care measures will be available to all of citizens in the future,” according to the IAEA.
The task ahead is huge, no doubt, but experts have already embarked on the long voyage, says Prof N.A. Othieno-Abinya, head of oncology at the Aga Khan University Hospital and chairman of the Cancer Research and Communications Organisation.
“Although we don’t have reliable local data, we have started to record increasing cases of cancer in our hospitals,” said the consultant in a recent interview with DN2.
But despite the lack of reliable data, he says, two things are clear; cancer is not necessarily a disease of the rich, and that those who seek treatment do so quite late, when treatment is expensive and, generally, not curative.
Prof Othieno-Abinya, who also co-chairs a committee of the African Organisation for Research and Training in Cancer, advises Kenyans to adopt a routine screening culture so that the disease can be diagnosed early.
“Cancer seems to be running ahead of us,” he warns, adding that the Aga Khan University Hospital is already putting up a modern, appropriately equipped cancer screening and treatment centre.
A comprehensive cancer policy for the country has for years been crawling along the bureaucratic corridors and, as it trudges along, it will come out to the agonising reality that the only two therapeutic radiotherapy machines at the Kenyatta National Hospital are way past their use-by date.
The government has finally acknowledged that cancer poses a real threat to its people and, by extension, the economy. A paper it prepared specifically for the IAEA on the cancer situation in Kenya contends that, while a lot more needs to be done, something is already happening.
That “something” includes the recent adoption of the Alcoholic Drinks Control Act, 2010, which aims to restrain the consumption of alcoholic beverages in the country. The Act is relevant in the fight against cancer because alcohol has been found to be a major risk factor for cancers of the mouth and throat.
A study by the Kenya Medical Research Institute (Kemri) found that, of the 2,292 cancer-related deaths recorded in Nairobi during a two-year period, oral tumours claimed the biggest percentage of victims.
“Of these, cancer of the oesophagus was the leading cause of death, accounting for 10 per cent (236) of all cancer-related deaths,” says Joseph Omach of the Cancer Research and Communications Organisation, and who has been involved in compiling cancer registry data at Kemri.
Research also indicates that people who develop a liver condition called cirrhosis, in many cases caused by too much alcohol and hepatitis B and C viruses, can develop liver cancer. And women who take more than three alcoholic drinks a day increase their risk of breast cancer.
To complement the new alcohol law in the anti-cancer crusade is the recently passed anti-tobacco Bill, the government says. This is because smoking has also been identified as a major risk factor for cancer, and accounts for almost 30 per cent of all cancer-related deaths worldwide.
But this two-pronged campaign is likely to be hampered by the dismal availability of facilities in the country, a capacity that would otherwise help hospitals mitigate against the effects of the disease on the population.
The Kenyatta National Hospital plans to replace one of its decommissioned radiotherapy machines by 2011, even though this will hardly give the country any additional capacity to handle the current demand.
This leaves the private sector to take up the challenge. The Cobalt 60 machines used by KNH are the remnants of an old generation, and are equipped with limited capability to optimally treat complex cases. The only centre in the country with newer technology, called Linear Acceleration, is the Cancer Care Unit at the MP Shah Hospital in Nairobi.
But, while this technology is more accurate and handles a higher load than Cobalt 60, it is much more expensive and has very high maintenance demands.
“The machines require a resident engineer and, at the moment, we don’t have such a trained person in the region,” explains Prof Othieno-Abinya.
The installation of two such machines at the Aga Khan University Hospital, planned for early next year, will give Kenya the biggest cancer radiology capacity in Eastern and Central Africa.
The facility will provide wide-ranging treatment in both cardiology and cancer, including radiation therapy and open heart surgery.
“We have to make sure that we get it right by having the right personnel, equipment, and specialised buildings to house these technologies,” says Prof Othieno-Abinya.
However, radiology equipment is only part of the struggle against cancer since not all tumours require this kind of treatment.
“For example,” explains Prof Othieno-Abinya, “Bukitt’s lymphoma, which is a major problem around the lake region and at the Coast, is so aggressive that you can hardly use radiotherapy to cure it. Only appropriate chemotherapy can work.”
Most cancers, he says, require a combination of treatments involving chemotherapy, radiotherapy, and surgery.
A good cancer policy will require an effective drug regulatory authority that ensures that patients get the most effective treatments “because this is not a hit-or-miss disease”.
“A miss may not allow a second chance, and that may cost you a life. However, the high cost of cancer drugs — and cancer care as a whole — needs to be addressed,” says Prof Othieno-Abinya.
Spurred by the growing cases of cancer across the country, the Ministry of Medical Services has made public its plans to open specialist centres in all provincial hospitals. Currently, some patients have to travel more than 600 kilometres to Nairobi, only to be put on an eight-month waiting list.
Medical specialists in the private sector argue that, at the moment, the country has very few specialist cancer surgeons. This means that some of the work best handled by specialists is left to general surgeons who operate on a broad range of diseases and conditions, especially in provincial and district hospitals. This, of course, means that cancer patients are not afforded the opportunity to get quality care.
Dr Jessicah Wambani, chairperson of the Kenya Radiation Protection Board, says there is no academic institution in the country that offers medical physics as an area of study. “The five medical physicists we have were trained abroad,” she told an IAEA publication recently.
And, in a brief to the IAEA, the government says several medical doctors from provincial hospitals have already been seconded to KNH for training as radiation oncologists, while therapy technologists have been recruited for placement in peripheral cancer care centres.
On the flip side, the advent of more radiology machines and other recent diagnostic and imaging technologies presents Kenya with a new problem; that of over-exposure to radiation for medical staff as well as the use of old machines that may not guarantee the correct dosages to patients and users.
There has been an explosion in Kenya of many radiation-using medical facilities, such as CT (computed tomography) scanners, MRI (magnetic resonance imaging) machines as well as ultrasound services, without a corresponding training of technical staff.
According to the IAEA, Kenya has about 5,000 workers in radiation-related jobs at 600 medical facilities. However, only about a quarter of these nurses, patient assistants, dentists, radiographers, and radiologists are monitored for exposure.
“We don’t have national guidelines and standards in diagnostic radiology in Kenya… because we don’t have enough data due to lack of funds,” Dr Wambani told the IAEA.
The agency is working with the KNH and the Moi Teaching and Referral Hospital, Eldoret, to gather radiology dose information to create reference levels for Kenya.
And Dr Wambani says attempts are being made to expand the project to all the hospitals in Kenya’s eight provinces.