Cancer: Is it really a killer?

“We are many……..very many Kenyans!!!” those were the words of exasperation by “Mr M” (It is never too late to start ). He has texted me after he had arrived in India for the treatment of his wife who was recently diagnosed with cancer. This cancer is a bitch I tell you. One day you are planning out your retirement project, the next you are miles away from home getting treatment for this life changing disease.

In 2012 I blogged about “Doctors do get cancer too“. That was the first time it dawned on me that cancer does not discriminate even against age.
Unfortunately my doctor colleague died. Cancer is a bitch. Even after his fight, he was gone. Dust. Very sad. While reading the book “The Impatient Lange“, I was placed in the middle of the crisis of the HIV epidemic in the 80’s and 90’s. HIV at that time was equated with death. I saw this in the wards of KNH as a medical student and as a young doctor. Hopelessness in the dying patients and panic among the citizens. As HIV was the scourge of the 80’s and 90’s I think cancer is the scourge of our time.

Every family is grappling with cancer either “infected’ or “affected”(a line from HIV awareness campaigns in the 90’s). My dad had leukemia, my first taste of cancer. He never got to see me graduate from medical school. Since then I have close friends and relatives who have had about every form of cancer, from throat cancer, lymphomas, colon cancer, leukemia, prostate cancer( many!), bladder cancer, lung cancer, brain cancer to uterine cancer. This may seem like a lot, but it has been over a span of 15 years.

In that time, we have panicked, rushed people for treatment and cried many tears. However, I do not want it to look like all the cancer cases were all bad. Yes, the process of treatment is horrific….chemotherapy, radiotherapy and at times surgery. Brutal to the body. A soul breaker.However, there are many cases of remission (where cancer is undetectable using the current means of detection).This is as considered as close to a cure as possible.

I have a friend “J” who survived throat cancer after treatment in Kenya in the early 2000’s .There is ‘Mama K’ who survived colon cancer and was treated in Kenya while “Mama N” survived Uterine (uterus) cancer after she was also treated successfully treated in Kenya. There is “Gukaa Z” who survived prostate cancer after early detection and treatment in India . He went on to live for more than 7 years. Unfortunately “Gukaa Z” passed on from old age a year ago. Not from cancer. There is also “Dr K” ,a relative, who is currently in remission for prostate cancer after early detection and treatment in Nairobi. A former colleague “Dr G” survived leukemia after seeking treatment abroad. Finally a “Mama J” who was diagnosed with colon cancer and was successfully treated in Nairobi. However, she has to go to India for a special scan annually. These are the cases that come top of mind but there are “many,very many Kenyans!!!” as “Mr M” said.

All these stories point to a trend that is increasingly occurring. There are many patients going into remission. They are surviving the scourge of cancer. They are not cured, but have a second chance at life. The only set-back is the dark cloud of recurrence of the cancer lurking about.

What is clear, to me, is that we can treat cancer successfully in Kenya especially when it is diagnosed early. This is an unpopular opinion (India is a preferred destination) but these cases show that it is possible. I know for these successful cases there are many failed “cures” . This is also true for those who go abroad for treatment. Cancer is a bitch.

In the same way the HIV epidemic caused the most suffering among the poor, so is cancer. Cancer is very expensive to treat in the same way HIV was expensive to treat in the early days according to the book “The Impatient Lange“. Cancer is not only expensive to treat but also to manage the remission where diet and nutrition is key. Poor people cannot at times afford nutritious meals and this compounds recovery.

In the cases of remission I observed, there were certain patterns that were clear.

Number one is money. They had funds to allow them to go through the treatment of cancer. Chemotherapy and associated management in Kenya private hospitals costs about kes 1,800,000. That is on its administration only! There are doctors fees, bed fees, radiology(scans) and surgery fees. Depending on the type of cancer, radiotherapy is an added cost. Clearly treating cancer is not cheap and out of reach for the majority. Luckily for those who were remission a majority had private medical insurance covers and also used NHIF.

The second was pattern was that there was good coordination of the patient treatment. You see, cancer treatment cannot be treated by one type of Doctor. It needs a big team of medical professionals( not only doctors) from different specialties. This means you will meet many types of doctors/ medical professionals in different hospitals (even abroad), many tests done at different hospitals. Without proper coordination a patient can get lost in the bureaucracy of Kenyan Healthcare and give up. This is a true story even to those whose treatment is paid for by an insurance. In addition the Kenyan medical professionals unfortunately work in silos and have a huge workload. This requires the patient to have great support system to coordinate the treatment. In the hazy confusion and shock of being diagnosed with cancer the patient and immediate family members can delay treatment. This can also lead to poor decision making. This is where India beats the Kenyan system where you have a patient coordinator to ensure the patient does what is required at the prescribed time.

As I blog this “Mr M” is still in India and missing home as they go on the home stretch of his wife’s treatment. Our fingers are crossed that the outcome is that of remission as many other patients.

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