It was early in the morning but the wall clock in the ward read 7pm. This dusty clock was not the only dead device in the radiotherapy unit of the Lagos University Teaching Hospital, Idi-Araba. The ward’s most important equipment, the radiotherapy machine, stopped working about four months ago. Ever since then, cancer patients who throng LUTH for various forms of medical treatment daily have had to fight cancer with their two hands tied to their back.
Rita Nwobodo, who taught at a private school in Warri, Delta State, is one of the cancer patients who fought and lost this one-sided battle with cancer. She succumbed to breast cancer, three months after the radiotherapy machine that could have helped her to win the fight packed up. Her husband, Tony, believes his spouse wouldn’t have died if the machine worked.
“Her death could have been avoided if Nigeria had more radiotherapy machines. She was receiving treatment at LUTH before the radiotherapy machine developed a fault. I still remember holding her in my arms and promising her that she would live to see the New Year,” he said. Rita died in November. Tony, distraught and angry that his wife’s chances might have been brighter if the machine worked, asked, “How many more cancer patients will die before the New Year?”
Radiotherapy is one of the key treatments that medical science uses to fight cancer. However, as Tony discovered during his search for treatment for Rita, only two government hospitals had radiotherapy machines in a nation of 170million people. The two machines are to be found at the National Hospital, Abuja and Usmanu Dan Fodiyo University Teaching Hospital, Sokoto.
“Travelling to Sokoto or Abuja was a major challenge. The distance would have been too stressful for her. It is really heartbreaking that Nigeria couldn’t save her life,” he said.
Ahmadu Bello University Teaching Hospital, Zaria, used to have a functional radiotherapy machine but SUNDAY PUNCH’s findings showed that it had packed up.
Raji Olayiwola, who frequently took his mother-in-law, Mrs. Wura Allen, 76, to the Lagos University Teaching Hospital for weekly treatment of cervical cancer, described the futile search of Nigerian cancer patients for quality medical treatment as ‘bitter.’
Raji said, “It has been a bitter experience for my whole family. Sometimes, I wonder how corruption was able to eat so deep into the health sector. One town in Nairobi, Kenya, has about six radiotherapy machines, why can’t Nigeria follow suit?
“Initially, we took her to Eko hospital (a private hospital) before moving her to LUTH. There, we didn’t stay up to two weeks before the machine packed up. We were then referred back to Eko (hospital) and some patients were referred to Sokoto.”
Nigeria’s radiotherapy machines
A consultant radiologist, Dr. Kolawole Braimoh, said there were eight radiotherapy machines in Nigeria— seven in government-owned hospitals and one in a private hospital. According to him, the hospitals with radiotherapy machines are LUTH; University of Benin Teaching Hospital, Benin; University College Hospital, Ibadan; National Hospital, Abuja; Ahmadu Bello University Teaching Hospital, Zaria; Usmanu Dan Fodiyo University Teaching Hospital, Sokoto; University of Nigeria Teaching Hospital, Enugu; and a Lagos-based private hospital, Eko Hospital.
Dr. Braimoh said five of these machines; in Lagos, Benin, Abuja, Enugu and Sokoto; were linear accelerators. Three were old Cobalt-60 machines, found in Zaria, Ibadan and Eko Hospital.
Dr. Omolola Fatiregun, a radiotherapist, said, “Currently, only two of these machines are functioning in Nigeria. This contributes to the delay in treatment, increases waiting times for patients, resulting in progression in growth of cancer cells as well as spread to other organs. Some patients would need to travel a distance of more than 600 km to access the nearest radiotherapy service. According to international best practice, radiation treatment facility within a 100 km distance is deemed appropriate. There is an obvious and urgent need for more standard cancer treatments with radiotherapy services in Nigeria.”
According to Braimoh, “Nigeria needs at least two functional ones in each of the geo-political zones of Nigeria, which makes 12 functional machines.”
As a result of this dearth of radiotherapy machines and first-class medical care, Nigerians, who have the means, travel to India with the hope of getting inexpensive, but quality cancer treatment. Medical treatment in India cost about Rs 30,000 ($453.86), which is about half of the fees that hospitals in Western countries charge, said The Times of India.
“I did not have enough money to take care of her trip to India. I’m a businessman. Right from when she was diagnosed with cancer up to the point of her death, we spent millions of Naira,” Rita’s husband said.
In a recent report, Aderemi Ajekigbe, a professor of Radiotherapy and Oncology at the College of Medicine, LUTH, disclosed that Nigeria had Women, Ajekigbe said, were at a higher risk of having cancer, with more than 40 per cent of cancer cases in Nigeria occurring in females. Topping the list of common cancer cases were breast and cervical cancer. ‘Cancer Epidemiology,’ a report compiled by a group of Nigerian health experts, states that about 100,000 new cases of cancer are diagnosed in Nigeria every year. A global report by Medical Xpress states that every year, more than 14 million people around the world are diagnosed with cancer; with men, 24 per cent more likely to be diagnosed with the disease.
Experts say the four most common cancers occurring worldwide are lung, bowel, prostate and female breast cancer. Ms. Elizabeth Foyeke, 59, is one of the millions of Nigerian women with breast cancer. Many of these patients, like Elizabeth, have no hope in Nigeria’s run down health care system. Elizabeth would like to travel to India for treatment, but she cannot afford to do so. God, and not medicine, is her hope, she said.
“My faith in God is my only hope. Life has been tough for me but God has been my source of strength. The thought alone that one has cancer is enough to kill one. I haven’t had surgery yet to remove the cancer tumour from my breast. I can’t even go for radiotherapy because the machine has broken down for the past four months. Every day, I tell myself that I am healed; I believe I am healed. I have no money to travel to India,” she said.
For Mrs. Ejiro Okafor, a mother of three, the longer LUTH’s radiotherapy machine remains inactive, the slimmer her hope of survival. Okafor’s case is worse than those of many Nigerian women with cancer. Currently, she is isolated in a separate room at the Lagos State University Teaching Hospital due to the offensive odour oozing from her cancerous breasts.
“The doctors can’t perform surgery because the tumour is big and there is the need to shrink the tumour,” she said, uttering each word with pain. “After the process, I will need to undergo radiotherapy, but there is no machine for that. I’m so scared. I don’t have the money to travel out of Lagos, not to mention outside the country.”
A key difference
When asked what LUTH was doing about the dead radiotherapy machine, the hospital’s Public Relation Officer, Mr. Kelechi Otuneme, said, “The repair work is in progress; very soon it will be completed.”
His colleague at LASUTH, Mr. Olasukanmi Idowu, said, “LASUTH has a mammography machine. It was handed over to the hospital and it should be installed soonest.”
When asked if the mammography machine is the same as radiotherapy machine, Idowu said, “This machine is in line with the treatment of cancer. We also have a digital X-ray machine; we don’t have a radiotherapy machine.” However, Braimoh and Fatiregun, were less ambiguous. A world of difference existed between the two machines they explained. One is a diagnostic machine; the other is used to kill cancer cells.
Braimoh said, “A mammography machine is a soft x-ray machine used to evaluate the breast. It is not specifically used for breast cancer evaluation. It is a diagnostic machine and not a curative machine. It is available in so many hospitals. It is used to diagnose breast releases or discharge, of which cancer is one of them.”
Fatiregun, who is also a fellow of the West African College of Surgeons, said radiotherapy was used as the primary treatment for cancer or in conjunction with other therapies such as tumour-removal surgery and chemotherapy.
Fatiregun said, “It is split into a course of small treatments. If you were to have the total dose in one go, it would harm normal body tissues too much. So, radiotherapy doctors split the dose into smaller doses that you have each day (or on alternate days) over a number of weeks. They call each dose a fraction. One may have treatment once a day for three weeks, from Monday to Friday, with a rest at the weekend.
“This means you will need to go to the hospital every weekday for that time. Or you may have treatment on alternate weekdays for five weeks. The length of your course of treatment will vary depending on your needs and the hospital where you are treated. The total dose of radiotherapy you get is usually about the same with each of these schedules.”
A solution explained
According to the Chairman of the National Consultative Committee on Cancer Control, Nigeria, Prof. Abayomi Durosinmi-Etti, there are two main types of radiation therapies: external beam radiation therapy (teletherapy) and internal radiation therapy (brachytherapy).
Durosinmi-Etti said, “Teletherapy is radiation delivered from a distant source, from outside the body and directed at the patient’s cancer site. Machines which produce different types of radiation for teletherapy include linear accelerators, Cobalth-60 machines. These machines treat deep-seated cancers from a distance between 80cm and 100cm away. Brachytherapy, on the other hand, treats the cancers by being in close contact with the tumour. ‘Brachy’ is from the Latin word which means ‘short.’ We use the brachytherapy for cancers of the female womb (uterus, cervix), oesophagus, skin of face, while teletherapy (long distance) is for more deep-seated tumours.”
Prof. Durosinmi-Etti said the problems with all Nigeria’s radiotherapy machines could be resolved within six months if proper attention, governmental financial and moral support are available.
“As a cancer expert, I strongly advise that a task force be set up to address and ensure all these machines are put back to use within the next six months while long-term plans for the establishment of more badly needed centres are worked out through budgetary allocation or Public Private Partnership. This will reduce the current high death rate and pain Nigerians go through from cancer,” Durosinmi-Etti said.
A report on Forbes.com stated that radiotherapy machines cost about $3m, which is about N800m. Experts says the majority of private hospitals in Nigeria lack the funds to purchase the machine. The fees charged for radiotherapy in the few highbrow private hospitals that have radiotherapy machines is beyond the reach of many Nigerians.
Patients like Iyanu Lekan, a 24-year-old diagnosed with cancer last year, believe that only government has the capacity to equip all its tertiary hospitals with radiotherapy machines. Iyanu wants government to declare a state of emergency in the health sector, with a special focus on cancer.
She said, “Each time I visit LASUTH for my treatment, it is a living nightmare. Cancer patients are suffering. President Muhammadu Buhari must know that in the next two, three years, more Nigerian women may die because of this crisis. He must provide the necessary machines that Nigerians need to fight this monster called cancer.”
“Right from February 2014, when I was diagnosed with breast cancer, till date, I have spent millions of naira on surgery and treatment. I am fortunate to have friends and family members who support me financially. Many cancer patients have no one to pay their bills. Cancer treatment is expensive and in the next five years, after I’m done with the drugs prescribed by an oncologist, I will need to undergo radiotherapy. I don’t want to wait till then before I personally join in the fight against Nigeria’s lack of radiotherapy machines.”
In her response to the lack of radiotherapy machines in the country, the Director of Hospital Services, Federal Ministry of Health, Dr. Patience Osinubi, said, “Attention is being channelled towards that area. The country should have at least four or five in each geo-political zone. It would still be grossly inadequate, but at least it would prevent people from travelling abroad for treatment. But we must be aware that these machines are extremely expensive, which is why the private sector needs to invest in this area. Government alone can’t handle this; we all need to join hands in this.”
However, some health experts have expressed dissatisfaction with the health budget in the last five years. In 2011, the health budget was N203, 338,852,933 while in 2012, the proposed budget was N4.749 trillion, representing about six per cent increase over the N4.48 trillion in 2011, the health budget was N282.77 billion. For year 2013, N279 billion was allocated to health, while in 2014, N262 billion was allocated to health. This year, the Federal Ministry of Health got N264.5billion.
Following government’s announcement that the health budget for 2016 is N221.7b, the lowest ever in six years, cancer patients may not be having any reprieve soon.