Cervical Cancer: How Govt Gambles with Women’s Rights to Reproductive Health
Taking a journey into the lives of some women with cervical cancer, Omolabake Fasogbon in this investigation, reports that it is a not a good time for Nigerian women and girls given that actions and inactions of professionals and government at all levels are fueling the incidence and high death rate from the cancer type
Inside the Gynae B ward of the Lagos State University Teaching Hospital (LASUTH), a reserved section for the low- and middle-class women with all manner of reproductive system cancer, was filled to capacity with patients. While some were newly admitted, some have been on bed for close to three to five months with no significant signs of improvement.
Reflecting high cost of treatment, some, already well and discharged were held down till they are able to settle their medical bills.
With noxious smells wafting through the ward, the whimpering and bawling for early death by the patient, this reporter struggled to hold herself to initiate a discussion with some of the patients, even without a nose cover. Among them was Mrs Gbade (not real name), now deceased, whose ailment was at advanced stage of cervical cancer.
Writhing in pains she struggled to speak to THIDSAY; “I want to die” she cried out severally. As much as she was willing to bare her plight, her strength had failed her. Her husband, who eventually spoke on her behalf, said: “It all started early 2018 with bleeding that is different from her normal menstruation. I took her to Ikorodu General Hospital where after running all tests, it was detected that she had cervical cancer and was referred to LASUTH for proper treatment. But she refused to believe the report, saying, ‘I reject it in Jesus name’.
“She refused to go for treatment not until this year that the symptoms became severe. She eventually agreed to visit LASUTH where she ran advanced tests, after which they commenced treatment on her,” Mr Gbade recalled explaining that he has been on and off duty since his wife has been on admission, while his only daughter has stayed away from school just to take care of her mother.
Asides his monthly salary and bank’s savings, he said he has been approaching friends, families, colleagues and micro finance banks to raise over N500,000 for diagnosis and treatment which seemed not to have yielded positive result.
The money he said, also includes N7,500 for meals and bed space paid daily for more than one month. This they did daily before the wife finally died.
Mr Gbade is not pleased with the circumstances leading to his wife’s death despite the amount already spent. He blamed the doctors for not giving her the required treatment.
“I believe the doctors here were responsible for her early demise because two weeks ago, they called to tell me that she was okay and has been discharged but I refused that she should be discharged because all wasn’t well with her. Here is someone declared okay and fit, but could not walk from her bed to the entrance of the ward, still bleeding and yet could not eat. I made sure I bought and did all they asked me to do to avoid excuses. The doctors abandoned her because they said she was at advanced stage.”
Another patient, 55 years old Mrs. Sola, (again not real name) a widow, and nanny is crying for financial support from government and well to do Nigerians to save her life from stage one cervical cancer.
“It all started last year with bleeding, I thought it was my menstruation returning because I had already reached menopause. But when the bleeding became too much and started clotting, I suspected danger which prompted my visit to LASUTH. After series of tests, I was told I have cervical cancer.
“I have been in and out of hospital because I can’t afford to continuously pay for bed space when I’ve not even raised money for all the tests and treatment. My only son is a private school teacher, while I am just a widow feeding on what I get from my nanny job,” she explained.
As the sound of her cry overshadowed her utterances, her 28-year-old son took over the discussion. Trying to hold back tears, he said: “Honestly, I’m tired. This is too much for me. There is no one to turn to and the government is not helping. We were here in July before my mum’s case became this bad, but because we didn’t have money, we were asked to return when we are buoyant. So far, I have spent almost N400,000, yet doctors said they haven’t commenced the proper treatment as she would still need to undergo major surgery”.
Grim Picture
Gbade and Sola are just a minute number among hundreds of Nigerian women who have either succumbed to cervical cancer or are still battling to get the required treatment. The cancer type is a threat to women folks across the globe and particularly in Africa. Globally, it is recorded that one woman dies of cervical cancer every two minutes.
It is a type of cancer that occurs in the cells of a woman’s cervix — the lower part of the uterus that connects to the vagina. Oncologists explain that it is usually preceded by a curable premalignant stage which can be detected by screening. Like every other cancer type with risk factors, cervical cancer too has its multiple risk factors, notable which is getting infected with human papillomavirus (HPV) usually transmitted via sex, amongst other lifestyle and dietary factors.
WHO records that it is the fourth most frequent cancer in women with an estimated 570,000 new cases in 2018 representing 6.6 per cent of all female cancers. According to the latest statistics published by the International Agency for Research on Cancer (IARC), an estimated 266,000 women die every year from cervical cancer, of which more than 85 per cent live in low-income countries. Without changes in prevention and control, deaths expected to rise to 416,000 by 2035, with over 95 per cent expected to be women living in poor countries like Nigeria.
In 2018, it was reported that about 119,284 new cervical cancer cases were diagnosed while 81,687 women die from the disease in Africa annually.
Cervical Cancer is 70 Per cent Preventable
As deadly as it is, cervical cancer is the most preventable cancer type. According to WHO, “Comprehensive cervical cancer control includes: primary prevention (vaccination against HPV), secondary prevention (screening and treatment of pre-cancerous lesions), tertiary prevention (diagnosis and treatment of invasive cervical cancer) and palliative care.”
Scientists have established HPV types (16 and 18) to be primary positive agent for the scourge. It is said that 99 per cent HPV is said to be the positive agent responsible for 70 per cent of cervical cancers and pre-cancerous cervical lesions.
This is why first of all, WHO recommends that two to three doses of HPV immunisation should be given to yet-to-be-sexually-active girls between ages nine to 14 to rule out cervical cancer as they advance into womanhood.
The HPV vaccine is proven nearly 100 per cent effective before a girl child is exposed to sex but less effective in women that are already sexually active.
However, with 43 per cent of girl children in Nigeria subjected to forced child marriage and accompanying sexual violence, the benefits of the HPV vaccine are more or less nullified by negative cultural practices that undermine the reproductive / sexual health rights of girl children.
Rating the efficiency of screening and treatment of pre-cancerous lesions recommended by WHO, Chief Clinical Oncologists at NSIA-LUTH Cancer Centre, Prof. Francis Durosinmi-Etti (OFR), said, the scourge can be cured if diagnosed at an early stage.
He explained further that while cancer in itself is categorised into four stages, (one to four), cervical cancer advances from zero to five, in which stages three, four and five are the worst of all.
“Cervical cancer can spread to stage three or four within 30 or 40 years depending on the degree of differentiation of cancer cells in the body. This is why regular screening is important to ascertain the health status for immediate treatment before it spreads to aggravation,” he said.
How Government Action Fuels Incidence Rate
As a result of rising incidence of cervical cancer deaths, WHO has declared a global call to action to eliminate CC to reach the goal of elimination through prevention.
In Nigeria however, government efforts to deal with cancer has been more of reactive than preventive.
THISDAY investigations revealed that enough is not being done to prevent the debilitating health condition, with treatment access and affordability a herculean task. This situation has given room for investors including government, to allegedly explore and exploit the situation to their gain.
A case in point is the outcome of Nigeria’s first ‘National Cancer Control Plan’, (NCCP), between 2008-2013. The plan has as its priority: public education, cancer prevention, early diagnosis and referral, effective therapy and palliative care.
While the plan was approved with a budget for implementation, not much was achieved as seen with the absence of HPV vaccine in the national immunisation scheme, high cost of vaccine in few hospitals, poor awareness and enlightenment as well as huge cost of diagnosis.
THISDAY also gathered that the budget for the plan was majorly expended on specious awareness, establishing oncology training for nurses as well as purchase of one accelerator each for Federal hospitals in Lagos, Zaria, Benin and Abuja.
Founder and National Convener, Women Advocates for Vaccine Access, Chizoba Wonodi said, “The awareness on cervical cancer and prevention is quite low. There are no large scale education and information effort from the government around HPV. Several NGOs conduct awareness raising activities, but these efforts are limited and not implemented to cover all states and local governments in the country”.
THISDAY investigations showed that the implementation pace is however slow due to inadequate budgetary provision.
The NSIA- LUTH Cancer advanced Centre is one of the proactive projects undertaken to combat cancer in the country. The project is structured under a public-private partnership (PPP) arrangement between the Nigeria Sovereign Investment Authority (NSIA), and LUTH.
While the establishment of the centre has been commended as it will provide much-needed treatment judging by the level of investment and expertise that went into it, stakeholders believe that more still needs to be done in terms of providing prevention services or have prevention centre in an addition.
For now, the centre is strictly operated as a business venture. The centre is branded as one of the best cancer treatment centre in the world, but it is also one of the most expensive in the country despite being a partnership project with the federal government.
Prohibitive Cost of Treatment and Failure of NHIS
At LASUTH, despite its inability to handle many of its present cancer cases, it keeps admitting cancer patients who in the end are later referred to other competent hospitals after patients might have spent a lot.
In addition to money spent on drugs and other treatments options, patients pay a compulsory fee of N7500 which covers for feeding and bed space for every day they spend in the hospital. Some CC patients stay as long as three to four months in the hospital.
LASUTH does not own a cancer linear accelerator and has only few consultants. It is also still lagging behind in the area of radiotherapy and chemotherapy. “The hospital is still struggling to meet with standards”, our source revealed.
Sharp Practices in LASUTH
A relative of a patient in LASUTH, Mr. Segun (surname withheld), shared with THISDAY how his mother was brought to the hospital and how her situation degenerated before she was referred to UCH in Ibadan.
“A consultant asked me to take my mother to Eko Hospital for radiotherapy because the clinic does not have the facility. This costs about N400,000. Shockingly, when I got to Eko Hospital, I met the same consultant that prescribed the radiotherapy for us in LASUTH, only for the consultant to tell me that my mother does not need the treatment option. This was after I had paid a non-refundable consultation fee of N50,000 and registration fee of N8,000.
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