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By Hellen Miseda
It is early January and Aisha, 45, visits a county council dispensary in Malindi complaining of pain while swallowing solids.
The nurse prescribes antibiotics and she goes home to take the medicine diligently but the pain persists.
On returning to the clinic she is given stronger antibiotics and painkillers but the pain does not abate.
The visitations keeps her away from her busy routine of caring for her five children and running her mboga shop but weary Aisha keeps going back because she can tell something is seriously wrong. On her fourth visit she gets a referral to Malindi District Hospital.
Her case is assessed in early March at the district hospital and a doctor recommends a series of tests — blood, urine and stool. It takes two weeks before she knows the results.
At this point, her pain is unbearable but the tests do not reveal what is wrong.
The doctor recommends a biopsy but because the hospital has no laboratory for the test, the sample is sent to Coast General Hospital and she braces herself for another long and
Agonising wait for the results.
It’s May and the doctors’ verdict is in —Aisha has breast cancer.
By the time Aisha gets to Kenyatta National Hospital (KNH) two months later to start treatment, she is too feeble to stand the rigorous cancer treatment because she is in the final stage of the disease. The frail lady dies a few days later, her meagre resources spent on endless trips to hospitals. On her deathbed her earnest cry to those who were by her side was: "Please take the pain away."
That is the gruesome journey cancer patients who cannot afford the option of private hospitals go through.
Disease management
Aisha’s experience is just a tip of the iceberg. Myriad problems surround treatment and management of the disease.
Prof Walter Mwanda, chair of KNH Cancer and Blood Transfusion Department says there is need to rethink the whole referral system.
"Our health system is not working. At the top we are not getting the patients in good time. When officials ferry frail and sickly cows to Kenya Meat Commission Athi River slaughterhouse with no food or water to sustain them on the way, what do they expect? This is akin to what is happening in the referral system," he says.
He says when one is diagnosed with cancer they need adequate preparation at the lowest level hospitals to arrive at referral facilities in "good shape". "Health workers need to counsel the cancer patients on what awaits them at KNH and the long tedious journey of treating cancer. Mwanda says the system is so inept that in most cases by the time a patient diagnosed with stage one cancer reaches KNH the cancer is advanced .
Head KNH Cancer Centre Alselmy Opiyo says the referral system needs to be reassessed.
He says the best remedy for the problem is to declare cancer a national disaster. "We need to do this as early as yesterday," says Dr Opiyo.
He says the move is necessary to draw attention and resources towards fighting cancer. "We need to strengthen existing infrastructure and develop the manpower. More cancer centres are needed as KNH is overwhelmed treating people from all over the country with limited equipment and infrastructure," he says. With a waiting period of six weeks before a case is reviewed and treatment — chemo and radiotherapy — starts, Kenyatta handles 3,000 patients a year. This translates to 150-120 a day patients seen at the cancer centre where they get chemo and radiotherapy treatment. Everyday the cancer unit gets 40 new patients. The high number of patients against limited equipment and specialists overwhelms the hospital. The hospital has only four cancer radiotherapy and chemotherapy specialists.
Although subsidised by the Government cancer treatment is expensive. A radiotherapy session costs Sh9,000 and chemotherapy Sh20,000.
The doctor says battling cancer requires a multi-disciplinary team which includes medical, radiation and surgical oncologists, oncology nurses, psychosocial support, therapy technologists trained in their specialised areas. Satellite clinics are also needed in all dispensaries.
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