A personal account of my journey with prostate cancer, search for treatment

By Anyang’ Nyong’oBetween 2009 and last year, I noticed that I was having problems passing water. I consulted my doctor who decided to test for urine retention in the bladder and possibilities of enlargement of my prostate gland. There was indeed good evidence of urine retention although my prostate was not significantly enlarged and a digital rectal examination (DRE) ruled out any presence of a tumour. I was nonetheless given some antibiotics to treat any possible infection of the prostate since my Prostate Specific Antigen (PSA), the blood measure of any presence of prostate cancer, was also elevated. This was a very conservative approach to a problem, which was eventually to become rather serious.In June, last year, although I was not due for my annual medical examination until July 29 that year, I decided to have the check-up a month in advance, as I was not comfortable with the constant rise of the PSA. The result of the medical exam revealed that the PSA was still rising; hence possibilities of cancer could no longer be ruled out. The doctor ordered a biopsy, which revealed prostate cancer that was rather aggressive in its progression.The news was, no doubt, not very easy to take. My urologist decided to put me immediately on hormone therapy. This is an injection that drastically reduces the production of testosterone, a male hormone, which acts as a fertilizer for the prostate cancer cells. When testosterone is removed or drastically reduced, the cancer cells go into shock, and some of them actually die. Hormone therapy is therefore a good emergency measure to stop the growth of the cancer while a more lasting solution is being sought.In my case, we decided to have a three-month hormone therapy treatment while I was deciding how and where to treat the cancer.As we were in the middle of the ‘Yes’ campaign and I was a co-convener of our team with my friend Kiraitu Murungi, and given that our Captain Raila Odinga was also indisposed, the three months gave me enough time to conclude affairs of the referendum before I could attend to my health matters.The challenges of the journey towards cure were many. First, I finally faced – at a personal level – the shortcomings of our health delivery system. After reading extensively on prostate cancer, cancer in general and the treatments available, I realised that we were 20 years behind countries like South Africa and India in using global knowledge and technology as far as cancer diagnosis, treatment, and care were concerned. Two, although we had some of the brightest minds around in terms of medical science, we had not availed them opportunities for continuous medical education: hence quite often they performed well below their potential. Three, we just did not have the necessary equipment needed for cancer treatment, and we were not exposed locally to the diverse technologies and sciences currently available for cancer treatment. For my stage of prostate cancer, I had no alternative but to seek treatment abroad if I wanted to live longer. What an indictment of the Minister for Medical Services in a Kenya aiming at meeting the MDGs within the next four years and fulfilling the aspirations of Vision 2030 in our lifetime. To add insult to injury, we dreamt of this Vision eight years ago when we worked on the Economic Recovery Strategy for Wealth and Employment Creation at the Ministry of Planning and National Development.Cancer is indeed treatable. As Prof Paul Farmer says in this month’s issue of Scientific American, some types of cancer can be prevented with vaccines. These are cancers like liver and cervical cancers. Certain head and neck cancers are also amenable to prevention through vaccination. Other cancers, like prostate, bladder, and throat cancers are curable through surgery, radiation and chemotherapy. Since one needs mainly linear accelerators in external beam radiation therapy (EBRT) in the treatment of prostate cancer, it is the most cost effective and efficient way to treat this form of cancer at the moment. Nonetheless, the technology is expensive, the knowledge takes time to acquire and the access to this form of treatment is still limited to developed countries. But it can easily be available in Kenya and be accessible to our people with a well-organised comprehensive health insurance system, institutional capacity to deliver cancer treatment and a patient care system that does not discriminate. Using a comprehensive social health insurance scheme, the ordinary masses will be catered for. As research advances in the use of stem cells and gene therapy in the treatment of cancer and other diseases, we need to be part and parcel of the current state of knowledge so that we are in time for the better future soon to engulf us.I went public with my condition after discussions with my family, my Permanent Secretary, the Prime Minister, the Head of Public Service, party leaders, and some close friends. The President was extremely supportive and graciously gave me leave to have my treatment abroad.My wife and I decided we inform the public because my predicament is not really a personal affair. It is a public affair and concern since Kenyans need to know where I have been, what I was going through and how my experience would help other people today and in the future. The public support we have received has simply been tremendous. Kenyans seem to be energised about finding domestic solutions to our own problems and making our health system the best in our region to help our neighbours as well. My experience at the University of California San Francisco Medical Centre at Mount Zion Hospital is a wake-up call for us in Kenya to build such comprehensive cancer care centres for our own people and for the eastern Africa region. We can do it. I have had extensive discussions with world-class doctors and professors here, some Nobel Laureates in medical sciences, who are ready to work with us in Kenya.—The writer is Minister for Medical Services

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