In West Africa, can­cer pa­tients forced abroad for treat­ment

Kuwait Times - - HEALTH & SCIENCE -

DAKAR, Sene­gal: Chris­tine’s doc­tor felt a small lump in her left breast at a checkup in 2015, though she was flooded with re­lief when the tech­ni­cians as­sured her they had de­tected noth­ing amiss. Still in pain more than a year later, she pushed for an­other mam­mo­gram. The 44-year-old mother of four was then di­ag­nosed with ad­vanced breast can­cer.

“It was the de­scent into hell,” she said. “You ask, ‘Why, why, why?’ ... I was so an­gry. Be­cause why in 2015 did they not see this, and why was it left for so long?” The word “can­cer” is rarely spo­ken in Sene­gal, syn­ony­mous with death in a coun­try where many like Chris­tine are only di­ag­nosed in the later stages of dis­ease and ra­di­a­tion ther­apy can be dif­fi­cult to ac­cess. Can­cer has be­come an emerg­ing pub­lic health prob­lem in West Africa, and the lack of strong pre­ven­tion, good screen­ing and treat­ment of­ten leaves out­comes grim. For that rea­son, Chris­tine and most other pa­tients don’t share their di­ag­no­sis, and they ask not to be iden­ti­fied by their full names.

Two new ma­chines

For now, ra­di­a­tion treat­ment is im­pos­si­ble with­out leav­ing the coun­try. Sene­gal’s sole ra­dio­ther­apy ma­chine, do­nated in 1989, broke down last year. Sene­gal’s gov­ern­ment had promised two new ma­chines by De­cem­ber, and they were de­liv­ered weeks ago, but pa­tients must wait un­til they are func­tional. In the mean­time, their only op­tion is to seek treat­ment in North Africa or Europe. “Wher­ever you go in Africa you have the same prob­lem. Late di­ag­no­sis is a fact ... and you don’t have the same treat­ment that you have in Europe or the United States or other de­vel­op­ing coun­tries,” said Ma­coumba Gaye, head of the ra­dio­ther­apy de­part­ment of Dalal Jamm Hos­pi­tal out­side Dakar.

The need for ra­di­a­tion in West Africa is greater, too. While about 70 per­cent of pa­tients might need ra­di­a­tion in de­vel­oped coun­tries, more than 80 per­cent re­quire the treat­ment in Sene­gal be­cause their cases are caught at more ad­vanced stages, Gaye said. The prob­lem is only ex­pected to worsen un­less im­prove­ments are made. The num­ber of can­cer cases in Africa is pro­jected to dou­ble be­tween 2008 and 2030 be­cause of an ag­ing pop­u­la­tion, ac­cord­ing to the In­ter­na­tional Agency for Re­search on Can­cer.

The Sene­galese Min­istry of Health did not re­spond to sev­eral re­quests for an in­ter­view on the bro­ken ra­dio­ther­apy ma­chine. The coun­try has been plan­ning to set up a Na­tional Can­cer In­sti­tute within five years, plus a reg­istry to track can­cer pa­tients. There is also a pro­gram to have mam­mo­gram ma­chines in all re­gions of Sene­gal by next year. Gaye said they hope to have the two new ma­chines up and run­ning by Septem­ber. Un­til then, Sene­gal’s gov­ern­ment is pay­ing for pa­tients’ travel to nearby Morocco, said Gaye, who is on the com­mit­tee that ap­proves who can get such fund­ing. He says some 70 pa­tients have been sent to Morocco so far. Treat­ing stage 3 to 4 can­cer costs at least $5,000-$10,000, he said, while pre­ven­ta­tive plan­ning such as a pap smear costs only $20. It’s unclear how many peo­ple have had to forego the im­por­tant treat­ment, but Gaye said it’s likely in the hun­dreds.

Hide their ill­ness

Chris­tine’s hus­band had in­sur­ance that al­lowed her to un­dergo ra­di­a­tion treat­ment in Casablanca af­ter her tu­mor was suc­cess­fully re­moved by surgery in Sene­gal in Novem­ber. She was for­tu­nate to have a daugh­ter who al­ready lived there, but still had to at­tend 30 treat­ment ses­sions by her­self. Chris­tine said she and other West Africans didn’t feel en­tirely wel­come in Morocco, adding to the bur­den of be­ing sick and try­ing to hide their ill­ness. “Treat­ment there was frus­trat­ing be­cause they were in­dif­fer­ent to me,” she said. “But when the Moroc­can pa­tients came in they got kisses, greet­ings and were treated with kind­ness.”

Wear­ing a wig, a bright pur­ple dress and a bra with in­serts, she said she hopes to start a con­sul­ta­tion ser­vice for oth­ers who have to fight can­cer, help­ing them find such bras and wigs. She es­pe­cially cred­ited Dr. Ab­doul Aziz Kasse, her Sene­galese sur­geon, with help­ing to save her life. Kasse has been at the fore­front of Sene­gal’s can­cer care for decades and has been push­ing for im­proved treat­ment op­tions and gov­ern­ment plan­ning to fo­cus on pre­ven­tion. Kasse has saved lives with mo­bile screen­ing units as well, say­ing that screen­ing can re­duce can­cer rates by some 30 per­cent. He now hopes to con­tinue help­ing oth­ers like Chris­tine by open­ing a new pri­vate clinic in Sene­gal’s cap­i­tal that would ex­pand treat­ment op­tions.

Once opened, it will of­fer ad­vanced tech­nol­ogy at a lower cost than treat­ment in Morocco. He and his French part­ners hope that their busi­ness model can be repli­cated with satel­lite fa­cil­i­ties in Burk­ina Faso, Ghana, Benin, Ivory Coast and Rwanda. Burk­ina Faso has no ra­dio­ther­apy ma­chine but ex­pects one by next year, said Paulin Somba, head of non-com­mu­ni­ca­ble and chronic dis­eases at Burk­ina Faso’s health min­istry. The gov­ern­ment has sus­pended since 2015 send­ing its cit­i­zens to other coun­tries for med­i­cal evac­u­a­tion be­cause of the costs - the low­est com­ing in at about 1.5 mil­lion CFA, or $2,500, he said. Be­cause of that, the death rate is at 50 per­cent, he said, adding that surgery and chemo­ther­apy are avail­able. — AP

DAKAR, Sene­gal: Dr Ab­doul Aziz Kasse looks at a mam­mo­gram that shows signs of can­cer in his of­fice at the Clin­ique des Mamelles in Dakar, Sene­gal.—AP pho­tos

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