The plight of cancer patients in Kenya

I was very happy with the media coverage of the World Cancer Day on Wednesday February 4. All the major newspapers had articles and features on cancer, including extensive and frank analyses of the status of cancer patients and cancer treatment in Kenya. Both The Daily Nation and The Standard went further with editorials appealing for enhancing awareness campaigns on cancer and establishing better treatment in public hospitals in our country. And this is where I want to begin today.

You may not believe it but I am a victim of lack of awareness regarding cancer. A reasonably well educated African male who has been in public life for almost half his life became the Minister for Medical Services in Kenya in 2008. That was me. About a year after that I started going to the toilet to pass water rather too often. I went to see my doctor who immediately subjected me to a urine retention test. The result, he told me, was not really bad but he must have subscribed one or two drugs the details of which I cannot really now remember.

As time passed, I kept on having more urinary problems so he sent me to a specialist called a urologist who subjected me to what they called a Digital Rectal Examination (DRE), a rather uncomfortable and embarrassing experience where the doctor inserts his finger deeply into your anus and “fingers you” deep in there to feel the size and state of affairs of your prostate gland. Again I was told things were not really bad and we should just “watch it.” A few months later when I kept on complaining about frequent urination my doctor sent me to another specialist called an oncologist who now took some blood test to measure my PSA. The results showed my PSA was 12, and the doctor told me this was not too bad given my age. Nonetheless he prescribed some drugs since some infection had set in and told me to go back to see him after a month.

To cut a long story short, and a discovery in July 2010 that my PSA had shot to 34, and the advice that I go for a biopsy at the MP Shah Hospital, I finally came to the realisation that I had prostate cancer. The biopsy revealed that my Gleason Score was 7, and my oncologist told me this meant I had prostate cancer but I could be treated and he immediately put me on hormone therapy. It was from that moment that I woke up to the fact that I HAD CANCER! I could not believe it! How could I— repeat I—have cancer? It was not possible? I had not done anything wrong! Cancer was for others NOT ME! And what was I going to do? Were these doctors telling me the truth?

I started talking to several doctors; I was discussing this matter with my wife day and night to the extent that sometimes I thought I was becoming a nuisance. I started ploughing through the Internet, reading anything and everything about prostate cancer, PSA, Gleason Score, DRE, you name it. I HAD to get well.

I now learnt that PSA stood for Prostate Specific Antigen, a blood test that reveals the protein levels in the blood showing the presence and extent of prostate cancer. This protein is secreted specifically by the prostate gland, and its level in the blood can range from zero to hundreds and thousands; the higher it is the graver the situation. The normal PSA level is 0 to 4; beyond that matters become worse as the figure increases.

PSA levels are used to measure the presence and progression of prostate cancer as well as its possible recurrence after treatment.

I also learnt that the Gleason Score reveals the extent of prostate cancer in the prostate gland or beyond the gland. The higher the Gleason Score the more likely that the cancer may have spread beyond the gland, hence more complicated to treat. But this spread outside the gland is determined by doing a body and bone scan in the radiology departments of the major hospitals in Kenya; and it is a rather expensive undertaking. In my case the results were negative, and have been negative since following scans before and after treatment.

I got to know all this by reading and discussing extensively with my doctors. While before this I used to go to the hospital, be examined, be told what to do and go away. Not anymore. I want to know things, I want to constantly be aware of what is happening to MY body. It belongs to me; it is mine! Doctors should not just tell me to do this and that and I follow like a dumb sheep! I ask questions. After all doctors are doing their work, and most of the problems we go to see them about are now routine to them. After all they are not the sick ones; we are! And I am unique; you too are unique. Why should my case be routine?

So the first line of awareness is that we are all unique but we are all possible candidates of this or that cancer. The only way we can know is to have regular medical examinations to know our health status. Men in particular; we are the most complacent of the two sexes. We deceive ourselves that we are somehow immortal; we are not unfortunately. Regular checkups for prostate cancer after the age of 45 is a must for men. Knowing what the PSA is and means should be like knowing that Panadol helps when you have a headache. In other words you should know it by simply reading; you don’t need to be informed by a doctor like I was. A whole Minister for Medical Services and I did not know a thing about prostate cancer, let alone PSA! God help us.

And that is why my wife and I founded the Africa Cancer Foundation in July 2011 to increase awareness in our society. We hold cancer screening camps regularly in various counties, and we have screened thousands and thousands of people working with hospitals, medical practitioners and other partners. This weekend we have been having screening in Kayole since Friday. We are developing electronic platforms to access information and we have publications and fact sheets on cancer. We will provide information and link patients with medical centres which can provide treatment. As we grow, we hope to reach out even to more people throughout the republic since lack of awareness may be with us for a long time.

When discovered early cancer can be treated and is treated. The trouble is anybody who has neither money nor proper insurance is doomed to die in Kenya because we have extremely limited facilities for cancer treatment in our public hospitals. We need two things: universal health insurance so that anybody who falls sick can be treated anywhere, whether public or private; adequate specialised facilities and personnel in our public hospitals to deal with cancer cases.

Try as I could when I was Minister for Medical Services I could not get adequate support to do this. But we started and the mustard seeds we planted are beginning to show results. What the Ministry of Health has been doing is appreciated given the very limited funds it receives in the budget. But we must go further than this and leapfrog into the Singaporean experience where the mere fact that one is a citizen is a ticket to uninhibited access to proper health care, including cancer care.