By Kemo Cham
In October last year Khadija Konneh must have felt a second chance to life when the 23-year-old was presented with a return ticket to Accra in Ghana, where she was to undergo treatment for breast cancer.
Like many in Sierra Leone suffering from cancer (and their number is growing at an alarming trend, according to experts), the only chance of survival is through overseas treatment. This is because of the total absence of the requisite facilities locally. Yet very few people can afford the cost involved.
After months of search for funding, the mobile operator Airtel and few others came to Khadija’s aid. It turned out however that that was just the beginning of her predicament. Three months on, she is still in Accra hoping for support to complete her treatment.
Cremelda Parkinson Pratt, Executive Director, Thinking Pink Breast Cancer Foundation, where Khadija was diagnosed, helped lobbied support for her evacuation. The not-for-profit organization, also called TP,is dedicated to raising awareness on breast cancer, an ailment that the campaign group and several others say is eating fast into the fabric of society and wreaking silent suffering and deaths among women. The Foundation is one of only two such bodies in the country (the other one being the Welwoman Clinic).
Between January and November 2014, TP examined 1, 293 people for breast cancer complications, 80 percent of which (1, 038) were women. Some 339 were diagnosed with some form of the disease. These numbers would be higher if Ebola had not erupted. That’s because the Foundation suspended clinical examination in August as the epidemic peaked.
But breast cancer is just one type of cancer wreaking havoc on Sierra Leone. Cancer is a general term for a whole lot of diseases and refers to uncontrolled cell division that leads to abnormal growth and this is able to invade normal tissues or spread to other parts of the body.
The human body is composed of trillions of cells, all of which grow and die, eventually. And these dead cells need replacements for continuity of life. The uncontrollable growth of some of them, when interrupted by the application of extraneous materials, such as excessive alcohol, smoke and radiography, develop to cancer.
Globally, according to the World Health Organization (WHO), there were approximately 14 million new cases and 8.2 million cancer related deaths in 2012. The number of new cases, the UN health agency predicts, is expected to rise by about 70 percent over the next two decades. The burden is growing fast in Africa, where expert figures show an estimated 650, 000 people out of a population of 965 million suffering from the disease.
In Sierra Leone, as in almost all aspect of life, reliable figures for cancer prevalence are almost impossible to come by. But those in the know say it is a major problem and are warning that unless greater attention is paid, the cost would be massive. It is this concern, says pathologist Dr Semion Owiz Koroma that informed the establishment of the National Cancer Registry in 2012.
The registry was promoted as a means to facilitate the government’s effort to ensure functional and sustainable services for cancer care and, crucially, provide the basis for early diagnosis and treatment. It is expected to enhance the collection of adequate information on the types of cancer and the burden of the disease on the country.
Dr Koroma is head of the registry, and he tells Politico that despite promises by government, nothing has happened in terms of equipping the unit. Consequently, he adds, the chance of surviving cancer in Sierra Leone is “very slim.”
There are about half a dozen main types of cancer but the doctor, who by virtue of his work has dealt with countless cancer cases, says the most common types in Sierra Leone are cervical, breast, liver and prostate cancers, leaving the women folks particularly afflicted. But there are also the likes of Kaposi’s sarcoma and non-hodgkin lymphoma and bladder cancers which mainly affect men. Of all these, cervical cancer is said to be the most predominant in the country.
“Women are dying of it more than [they are of] Ebola,” says Owiz.
In one of a series of two articles on cancer, published in March last year on the online outlet Patriotic Vanguard, US-based Sierra Leonean nurse Dr. Angela MemunaDumbuya revealed that Sierra Leone had a population of 1.53 million women ages 15 years and older who were at risk of developing cervical and breast cancers.
“Current estimates indicate that every year 670 women are diagnosed with cervical cancer and 466 die from the disease. In other words nearly 70 percent of women diagnosed with cervical cancer will die of this preventable and curable disease. Despite this, cervical and breast cancer screening and treatment are not available to the public and little research has been done to understand the nature of these cancers in Sierra Leone,” she writes.
Cancer is second only to cardiovascular diseases among the four main non-communicable diseases (NCDs). The other two are respiratory diseases and diabetes. Experts say NCDs combined kill more than HIV/AIDS and malaria deaths put together. Yet most of the world’s attention is on the latter two.
The consequent neglect of NCDs in the national health system left many, especially the poor, increasingly resorting to consulting traditional healers and risk being subjected to witchcraft and possibly die in silence.
The government in 2013 launched its national NCDs policy which, among others, outlines a robust action plan to tackle these forms of diseases. Its approach to cancer is well captured in that document.
But implementation of the policy hinges entirely on availability of proper facilities, says Dr Owiz, recounting a frustrating reality in his daily routine as head of the cancer registry and pathologist.
He says radiology, which is central in cancer treatment, is non-existent in the health system and there is no oncology center and no designated pathways for cancer diagnosis and treatment. He also says his poorly motivated staff work in a poorly equipped laboratory.
During this interview, the elderly doctor, 65, and the only qualified pathologist in the whole country, was worrying to catch up with an appointment to collect a donated microtone.
“Even the equipment we work with I find very difficult to get,” he laments, adding that what little equipment they have is all courtesy of foreign donors.
Cancers, like the other major NCDs, have tobacco use, alcoholism, physical inactivity and unhealthy diets as their major risk factors.
When smoke, for instance, gathers in the lungs, it blocks the free flow of blood into the system thereby leading to the development of lumps which ultimately leads to the cancer disease. Alcohol also has its individual cancer-causing effect. But it becomes riskier for a potential victim when the two (alcohol and smoking) are combined.
Alcohol can act as a solvent, helping harmful chemicals in tobacco to get inside the cells that line the digestive tract. Alcohol is also said to slow down these cells’ ability to repair damage to their DNA caused by chemicals in tobacco.
A 2009 national survey revealed that 17 percent of Sierra Leone’s over five million people aged 25-65 were into alcohol. The same survey found 14 percent male and five percent female engaged in heavy drinking, and 34 percent uses tobacco. Such statistics spell doom for a country with such poor health infrastructure. However, because these risk factors are life style based, they are preventable, hence the need for emphasis on awareness, say campaigners.
There are four main types of treatment of cancer – surgery, chemotherapy, hormone therapy and radio therapy. Of these only surgery is available in Sierra Leone and at very minor level.
“Chemotherapy, for instance, can be done with certain drugs which only wealthy people can lay hands on,” observes Owiz.
Khadija, a nursing student with the ministry of Heath and Sanitation, is currently undergoing chemotherapy following a successful surgery. There is a desperate search for funding for the next stage of her treatment – radiotherapy. Her medical bill is short of $4,000, which include lodging, transportation and feeding.
Ms Pratt of the Thinking Pink Foundation says most of their patients who undergo mastectomy [removal of the breast] often require further treatment in the form of chemotherapy or radiotherapy. She says this is to avoid metastasis; that’s cancer cells spreading to other organs, which requires overseas travelling.
“It is so very frustrating to see a young lady suffer such a journey with very little hope: where the funding will come from? The Ebola virus took precedent and rightly so; but there are other serious diseases claiming lives daily. Cancer being one of them, not forgetting Cardiovascular diseases, etc,” she laments.
The Foundation’s statistics for 2014 revealed 271 of those diagnosed with some form of breast cancer failed to turn up for follow up treatment. This, Pratt says, was because a lot of these women could not afford to pay their treatment.
“Sometimes we try to source funds for them. That too is such a tedious task as. Sadly, Sierra Leoneans do not have the free spirit of philanthropy!”
“Sierra Leonean women suffer a painful journey when diagnosed with Breast Cancer. Dr K.S. Boima is our volunteer surgeon and Dr Owizz Koroma our pathologist. These two great men are very supportive to our work and assist women diagnosed with Breast Cancer through their diagnosis and treatment. But they need money to continue their practice and so does the Foundation. We need sustainable funding that will support the less privileged pay for their treatment and support for the Foundation in the area of capacity building, and awareness raising,” she adds.
Early diagnosis of cancer is important to ensure prolongation of the time before the disease explodes with the application of required medication and care. Even with all the resources, as was the case of a sister to the country’s Vice President, late diagnosis makes survival from cancer less likely. The VP’s sister was reportedly diagnosed with the disease last year. She couldn’t be evacuated because of restrictions due to the Ebola epidemic. She died.
This brings to focus the need for awareness on the disease, which campaigners like Alpha Bedor Kamara, West Africa Focal Person for the African Alliance on Cancer, say is very much lacking.
Kamara has been working on cancer advocacy for the last 10 years and almost all the cases he came across, he says, required beyond surgery. Among about 10 cases he’s worked on, only one, a 17-year-old boy, survived. All the other cases were diagnosed late and in the search for treatment abroad, they died waiting for help.
At 17 months Zainab Koroma’s family discovered she had an unusual eye formation. But they convinced themselves she had “supernatural eyes”. When they eventually realized it was a defect, they turned to traditional healers. By the time the family came to terms with the reality, it was too late. She died in 2011 at age six.
Images of the little girl in her dying days will leave you cringing. But Kamara says that was just part of the larger problem she faced.
“The odour coming from her was so unbearable even her father abandoned her. Her mother took care of her until she died,” he says.
“In the fight against cancer, it’s not just about saving lives [but] also supporting and caring for patients and families. We don’t have that culture.”
© Politico 04/02/15
