Rising cases of cancer trigger multi-billion shilling investments

The cost excludes regular check-ups that cost Sh56,000, drugs that range from Sh6,000 to Sh10,000, oncology consultation fees, which average Sh2,000 per visit, ongoing treatment and right diet.

Ms Muturi is among the rising number of Kenyans diagnosed with more than 100 types of cancers and are paying a heavy price as the disease shifts to developing countries where healthcare funding has been on the decline.

The World Health Organisation (WHO) anticipates that by 2030, developing countries will bear 70 per cent of the global cancer burden, straining resources and infrastructure.

At Kenya’s largest referral hospital, Kenyatta National Hospital (KNH) by 6 a.m on a Tuesday, already tens of patients are lining up for check-up or treatment.

It is the day the newly diagnosed are seen. By 7 a.m, there is no sitting space and patients squeeze themselves within the rows of benches to sit or lie on the floor. The smell of unchanged bandages and the crowded stuffy corridor seem not to bother anyone.

At the far corner, an elderly woman opens her bag, removes cups and a flask, pours porridge and hands over the cup to a sickly old man next to her. They had to be at KNH early.

“We attend to about 40 to 50 new cases of cancer per week,” says Dr Anselmy Opiyo, the head of cancer unit, KNH and one of the few oncologists in Kenya.

New cancer patients are booked in for radiotherapy until May, four months down the line.

Follow-up cancer patients are seen on Wednesdays and Thursdays and Dr Opiyo says KNH reviews 120 such patients per week.

The radiotherapy unit, which has two machines, takes in 150 patients per day and the sessions run up to midnight.

There are no official records on cancer in Kenya, but estimates show there are about 20,000 to 22,000 new cases every year.

The Economist Intelligence Unit, pegging its numbers on Globocan figures, notes that in 2009 new cancer cases in Kenya stood at 34,197 with those in 2020 expected to rise to 48,144 per year.

“All types of cancer are increasing in prevalence, much more in developing countries,” said Dr David Ndirangu, head of nuclear medicine unit in KNH. The rising number of cancer patients has forced hospitals to rethink strategy.

Many private hospitals have unveiled multi-billion- shilling cancer centres equipped with latest technologies such as linear accelerators, as they seek to meet the needs of the growing patients in search of specialised oncological care.

“We are investing in a new cancer care unit that will cost Sh0.8 billion and have a bed capacity of 50 patients,” said Cleopa Mailu, chief executive officer of Nairobi Hospital.
Cancer Care Kenya, adjacent to MP Shah Hospital in Nairobi cost over Sh500 million, according to Chiman Shah, the administrator. To-date it has benefited over a thousand patients. The cancer unit is a day-care facility that offers chemotherapy and radiotherapy and has two  state-of-the-art linear accelerators.
The facility also houses Faraja Cancer Support Trust, which provides information, emotional support and therapies, free of charge, to cancer patients and their caregivers. Therapies include reflexology, counseling, physical therapy and movement, body massage, lymphatic drainage, nutritional therapy, meditation, yoga and reiki.
The Aga Khan University Hospital, in partnership with the Agence Francaise de Development (AFD) established a world-class heart and cancer centre at more than Sh4.3 billion “comparable to the best centres in the West”.
Among the public hospitals, KNH has partnered with International Atomic Energy Agency (IAEA) to train more radiotherapists to serve the rising number of cancer patients. Seven Kenyan students are taking radiotherapy training in a project that has seen IAEA inject Sh22 million. KNH has also co-sponsored training of two oncologists in South Africa at a cost of Sh16 million.

The public hospital that bears the greatest burden of high numbers of cancer cases because of its subsidised rates has also invested in new cobalt radiotherapy machines worth Sh100 million and a simulator and earmarked Sh17 million for recurrent expenditure to run the cancer care unit as it seeks to see more patients and serve better.

The government is decentralising cancer management from the two referral hospitals — KNH and Moi Teaching Referral Hospital — to the provincial hospitals, a move expected to reduce early deaths.

As the world marks Cancer Day tomorrow, concern is how poor countries, which are now hit more by the disease, previously for the rich, will address the cost burden of patients, mostly the low- and middle-income earners.

Research shows more than 50 per cent of new cancer cases and nearly two-thirds of cancer deaths occur in the low-income, lower-middle income and upper-middle income segments in countries like Kenya.

“Chemotherapy treatment for breast cancer cost me about Sh500,000 for nine months, I was lucky, it was a small lump,” said a survivor who did not wish to be named.

This excludes the cost of drugs taken after the sessions, which range from Sh63,000 to Sh17,000, she said.

KNH charges Sh500 per session of radiotherapy. “For curative purposes, a patient does radiotherapy for six to seven weeks which cost Sh15,000, but for palliative treatment, it is one to two weeks which costs Sh5,000,” said Dr Opiyo.

Despite these subsidised rates, most of these poor patients have spent life savings on treatment. Thousands come in late while some will stop treatment due to lack of money and will die sooner than cancer patients in developed countries like USA suffering from the same disease.

“When new patients come in they have to be investigated and analysed.

Some join the waiting list for chemotherapy which is not long, about two weeks to four weeks and some wait for radiation treatment which has longer waiting time because machines are few,” Dr Opiyo said.

“I blame our referral systems. In most hospitals, there are no specialised doctors to early diagnose cancer. By the time a patient is referred to KNH it takes about three months after diagnosis is confirmed.

Then they have to join the waiting list for about two to six months depending on modality of treatment,” he said.

According to the Economic Intelligence Unit estimates, the new cases of cancer cost Kenya above the $19,468,216 (Sh1.7 billion) in 2009. But oncologists say this figure is way below what Kenya might have spent because some chemotherapy drugs used on patients with cancers that have spread can cost as much as Sh690,000 per dose. This excludes hospital bed charges and doctor’s fees.

There was a time cancer was seen as the disease for the rich, but this is fast changing as westernisation spreads fast.

The poor can now afford cigarettes, obesity numbers are rising in these countries and many low income and middle class have found comfort in sedentary life.

Affluence and urbanisation have become the road to early death. Increasing exposure to environmental hazards (carcinogens) is also to blame for cancer in Africa. Africa’s middle class has tripled over the last 30 years, with about one in three considered above the poverty line.

In 2010, 34.3 per cent of the African population, or 313 million people, were classified as middle class, compared with 26.2 per cent or 111 million people in 1980, the African Development Bank said.

This is the class that can spend between Sh180 and Sh1,800 a day, money that is, in some cases, channelled to luxury goods like high-fat diets, cigarettes and alcohol. “The increase in smoking in developing world since the mid-1980s is the single biggest cause of the predicted increase in new cancer cases and deaths,” noted the Economic Intelligence Unit report.

However, other experts say there is no one reason behind the soaring cases of cancer among the poor.

The cost implication is dire to the economy, and it will dim growth with money meant for development being channelled to treat the sick.

“Non-communicable diseases are a major barrier to economic growth and social development,” said President Mwai Kibaki, during the general assembly on prevention and control of non-communicable diseases last year.

The World Economic Forum last year noted that poor and middle-income countries will lose $7.3 trillion in output from heart disease, cancer, diabetes and lung disease by 2025, an annual loss of about four per cent.

When the Business Daily asked Ms Muturi how she raised the Sh2.6 million for the treatment, she sighed and said, “God is the provider.”

Risk factors

Forty per cent of cancers can be prevented by modifying or avoiding risks factors, according to a Kenya Medical Research Institute report. Prevention includes protection and promoting healthier lifestyles.

The Tobacco Control Law that banned smoking in public places, the law that prohibits advertisement, and sale to people under 21 years, the Alcoholic Drink Control Act to regulate the production, sale and consumption of liquor, and, importantly, the Draft Cancer Bill are seen as some of best mechanisms to cut down on new cancer cases.

But these are not enough. Kenya needs to train more doctors. It has an average 16 doctors and 153 nurses per 100,000 people, compared to WHO recommended minimum staffing levels of 36 and 356 doctors and nurses respectively per 100,000 population.

No budget

Oncologists are fewer. There are 20 in Kenya, but only four are trained both in radiotherapy and chemotherapy.

“The major concern is that Kenya has never had any designated programme or budget line for addressing cancer among other non-communicable diseases that are silent killers,” noted a 2011 policy brief on the situational analysis of cancer in Kenya.

“The way forward is for the government to accept that cancer is a problem, as serious as other diseases and get involved, develop proper infrastructure, train personnel, implement the cancer policy,” said Dr Opiyo.

Additional reporting by Rawlings Otini

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