Re­gion steps up war on can­cer as Rwanda opens treat­ment cen­tre

The cen­tre at mil­i­tary hospi­tal will re­ceive re­gional and in­ter­na­tional re­fer­rals

The East African - - NEWS - A JOINT RE­PORT The Eastafrican By Ivan R. Mugisha, Rose Mirembe and Sarah Ooko

Rwanda will open a re­gional can­cer treat­ment cen­tre later this month, a de­vel­op­ment that is ex­pected to not only ease East Africa's can­cer bur­den but also cut the costs in­curred by pa­tients when they travel abroad for di­ag­no­sis and treat­ment.

The cen­tre based at the Rwanda Mil­i­tary Hospi­tal, will re­ceive re­gional and in­ter­na­tional re­fer­rals, boost­ing Rwanda's pro­file in can­cer treat­ment.

Can­cer is re­spon­si­ble for the deaths of about 5,000 peo­ple in Rwanda ev­ery year, ac­count­ing for 7 per cent of deaths in the coun­try, ac­cord­ing to the World Health Or­gan­i­sa­tion. In the re­gion, Kenya has the high­est can­cer-re­lated deaths — about 33,000 per year, data from WHO shows. Tanzania comes se­cond with about 28,000 can­cer deaths per year, fol­lowed by Uganda at about 21,000.

To make can­cer treat­ment af­ford­able for the ma­jor­ity of Rwan­dans, up to 80 per cent of the pa­tients at the cen­tre will be hold­ers of Mutuelle de Sante and other lo­cal in­sur­ance cards. Mutuelle de Sante, the coun­try's com­mu­nity health in­sur­ance cover, puts Rwanda ahead of its peers in the re­gion when it comes to pro­vi­sion of health­care to cit­i­zens.

Tanzania also of­fers free treat­ment to its cit­i­zens once di­ag­no­sis has es­tab­lished the ex­is­tence of can­cer. Ki­gali's new can­cer cen­tre means that can­cer pa­tients in the re­gion have one more op­tion, out­side Uganda and Kenya.

“The new can­cer cen­tre makes treat­ment more or less com­plete in Rwanda. We an­tic­i­pate that we shall re­ceive pa­tients from neigh­bour­ing coun­tries who need treat­ment not avail­able in their coun­tries. We are ready to re­ceive in­ter­na­tional re­fer­rals,” said Lt­col Paci­fique Mu­genzi, direc­tor gen­eral of the cen­tre.

The cen­tre has the ca­pac­ity to han­dle 80 can­cer pa­tients a day but still faces a short­age of on­col­o­gists and other can­cer spe­cial­ists.

The coun­try has tried to bridge this gap by em­ploy­ing can­cer spe­cial­ists through its part­ner­ships with the In­ter­na­tional Atomic En­ergy Agency. It also sends some staff over­seas for train­ing.

“We have a group that will be go­ing for train­ing early in 2019. We ex­pect in our se­cond year to have many spe­cial­ists but at the mo­ment we have part­ner­ships to help us ac­quire the skills that we don't have here, as we wait for our own to qual­ify,” Dr Mu­genzi said.

“Those who are spon­sored to study on­col­ogy have to sign a re­ten­tion con­tract, and luck­ily most of those that I have in­ter­acted with are ea­ger to re­turn to work in Rwanda. There is a shared com­mit­ment to see this ini­tia­tive be­come suc­cess­ful and I have no doubt that they will come back.”

Rwanda plans to spend about Rwf3 bil­lion ($3.4 mil­lion) on train­ing 21 can­cer spe­cial­ists, com­pris­ing ra­di­a­tion on­col­o­gists, med­i­cal physi­cists, ra­dio­ther­apy tech­ni­cians and on­col­ogy ther­apy nurses.

In March 2017, EAC mem­ber states chose Uganda to host the $34 mil­lion re­gional On­col­ogy Cen­tre of Ex­cel­lence to of­fer qual­ity treat­ment to pa­tients from the re­gion.

Uganda's Mu­lago Hospi­tal has re­sumed treat­ing can­cer. Its ra­dio­ther­apy ma­chine broke down in 2016, lead­ing to a cri­sis in the re­gion. The $800,000 ma­chine was re­placed in Jan­uary 2018, with a ca­pac­ity to treat 120 pa­tients per day.

Rwanda and Uganda have for years been of­fer­ing cer­vi­cal can­cer vac­cines to girls aged be­tween nine and 14, but through its vac­ci­na­tion pro­gramme for girls, Uganda aims at erad­i­cat­ing cer­vi­cal can­cer by 2020.

Tanzania joined its two East African Com­mu­nity neigh­bours in April last year, be­com­ing only the seventh African coun­try to in­tro­duce the hu­man pa­pil­loma virus (HPV) vac­cine in its im­mu­ni­sa­tion pro­gramme. The oth­ers are Botswana, Mau­ri­tius, Sey­chelles and South Africa.

A large pro­por­tion of can­cer-re­lated deaths in Tanzania are at­trib­uted to cer­vi­cal can­cer, which claims 6,700 women a year, ac­cord­ing to the In­ter­na­tional Agency for Re­search on Can­cer (IARC).

Tan­za­nian Health Min­is­ter Ummy Mwal­imu said in De­cem­ber that out of ev­ery 100 can­cer pa­tients, 34 suf­fered from cer­vi­cal can­cer and 12 from breast can­cer. The govern­ment last year al­lo­cated Tsh7 bil­lion ($3,000,000) to the na­tion's can­cer treat­ment facility — Ocean Road Can­cer In­sti­tute — to boost treat­ment.

Dr Crispin Ka­h­esa, direc­tor of Can­cer Preven­tion Ser­vices at the Ocean Road, said the budget for can­cer treat­ment rose from Tsh400 mil­lion ($173,571) last year to Tsh9 bil­lion ($3,905,000). Can­cer poses an in­creas­ing chal­lenge to Tanzania's health­care. At least 50,000 pa­tients visit the in­sti­tute per year, out of whom about 29,000 die.

The Tan­za­nian govern­ment has in­vested in ad­di­tional ra- dio­ther­apy fa­cil­i­ties across the coun­try to com­ple­ment the ORCI, which is the only in­sti­tute that pro­vides ra­dio­ther­apy treat­ment ser­vices in the coun­try cur­rently.

The ra­dio­ther­apy sec­tion at ORCI also of­fers ex­ter­nal beam ra­dio­ther­apy treat­ment tech­niques for a pa­tient with ad­vanced can­cer stages. The cen­tre also of­fers chemo­ther­apy, ra­diol- ogy and imag­ing sec­tion (RIS), nu­clear medicine, screen­ing and brachyther­apy.

Can­cer can be cured if the pa­tient is di­ag­nosed early, but 80 per cent of the can­cer pa­tients in Tanzania re­port to hospi­tal when the dis­ease has reached an ad­vanced or ter­mi­nal stage, said Dr Maguha Stephano, a pub­lic ad­vo­cacy spe­cial­ist said. Prior to di­ag­no­sis, can­cer pa­tients also face hefty fees to pay for screen­ing and med­i­ca­tion, which is out of reach for an or­di­nary Tan­za­nian. How­ever, cur­rently there is a great need for trained staff at the Ocean Road In­sti­tute. The num­ber of Can­cer ex­perts have slight in­creased from 10 in 2012 to 40 in 2017.

They in­clude on­col­o­gists, nurse on­col­o­gists, med­i­cal physi­cists and car­dio ther­a­pists.

The IAEA fa­cil­i­tated train­ing of two ra­di­a­tion on­col­o­gists and two ra­di­a­tion ther­a­pists at lead­ing can­cer fa­cil­i­ties in Is­rael in De­cem­ber last year.

In Kenya, can­cer cases have been in­creas­ing over the years, put­ting a strain on the coun­try's health sec­tor and econ­omy.

Ac­cord­ing to the 2018 Globo­can re­port by the World Health Or­gan­i­sa­tion's In­ter­na­tional Agency for Re­search on Can­cer, at least 47,000 peo­ple get the dis­ease ev­ery year, out which about 323,000 die. This is an in­crease from the 41,000 cases and 28,000 deaths recorded six years ago.

The most com­mon can­cers in Kenya are breast, cervix, oe­soph­a­gus, prostate and stom­ach.

"Un­healthy di­ets and seden­tary life­styles that cause obe­sity are con­trib­u­tors to the rise in can­cer cases. We also have ex­ces­sive al­co­hol con­sump­tion and smok­ing that in­crease peo­ple's chances of get­ting the dis­ease," said Dr An­drew Od­hi­ambo, a med­i­cal on­col­o­gist and sec­re­tary of the Kenya So­ci­ety of Hae­ma­tol­ogy and On­col­ogy.

He says a ma­jor con­trib­u­tor to can­cer-re­lated deaths is the late di­ag­no­sis of the dis­ease.

"Most peo­ple come to the hospi­tal when their can­cer is al­ready at an ad­vanced stage. This makes treat­ment ex­pen­sive and re­duces sur­vival chances. That's why we en­cour­age fre­quent can­cer screen­ing or check-ups."

Treat­ment op­tions for ma­jor can­cers in Kenya in­clude surgery (for re­mov­ing tu­mours or growths), chemo­ther­apy (use of drugs to kill can­cer­ous cells) and ra­dio­ther­apy (use of ra­di­a­tion to de­stroy af­fected cells).

Re­cently, doctors have in­tro­duced a new treat­ment method know as im­munother­apy that strength­ens the body's nat­u­ral de­fence sys­tem, hence en­abling it to stop or slow down growth of can­cer­ous cells. The im­munother­apy drugs, which are taken for life, cost about Ksh20,000 ($200) monthly and are thus only a pre­serve of the few can af­ford them in the pri­vate health sec­tor.

The new can­cer cen­tre makes treat­ment more or less com­plete in Rwanda.” Lt-col Paci­fique Mu­genzi, direc­tor gen­eral of the cen­tre

File Pic­ture:

A pa­tient lies in a positron emis­sion to­mog­ra­phy scan­ner for can­cer screen­ing.

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