Cancer patients die as ‘elephants’ fight

The construction of a cancer centre at the largest hospital, the University Teaching Hospital in Lusaka, is designed to address this problem.

According to statistics from the UTH, more than 1,000 women die of cancer yearly at the institution.

This figure does not include the number of unreported deaths, especially in rural areas where many women die without any of treatment.

It is a most tragic situation. People wait for treatment that never comes. Worst affected are women suffering from cervical cancer that accounts for 32 percent of all cancer cases.

“They’re in a lot of pain and there is a not much that health workers can do for them. We do not have diagnostic and treatment facilities to help them,” says Dr Mulindi Mwanahamuntu who is head of the gynecology and Obstetrics department at UTH.

It is for this reason that the completion of the centre is being looked upon as a miracle that will immediately see more than 125 patients on government’s waiting list receive treatment, eventually saving many lives lost due too poor diagnosis.

The cancer centre should also save the government a lot of money spent on subsiding patients referred abroad for specialist treatment. For now patients needing vital radiotherapy treatment have to travel to South Africa and Zimbabwe where treatment ranges between K8 million (U$2, 222) and K24 million (U$6, 700).

It was the wish of Breast Cancer Trust Chairperson, Maureen Lewanika who died on October 24, 2006 to live long enough to see the centre open.

In an interview two weeks ago Mrs Lewanika said:, “Many cancer patients are too poor even to afford painkillers. My prayer is that the cancer centre opens to the public soon because this will bring an end to a situation where families are reduced to helplessly watching their loved ones die due to lack of cancer medication.”

Mrs Lewanika, who was wife of Zambia’s deputy chief justice, David Lewanika, was diagnosed with breast cancer in 1999. Every single year since then, she had undergone surgery to remove tumors. During one operation her right breast was removed.

While Mrs Lewanika may have considered herself fortunate to have had lived with cancer for seven years because she could afford to travel abroad for treatment, thousands of other patients are not so lucky.

For most of the developing world, the reality is of overstretched government-run health systems, where few cancer patients get screened, diagnosis comes too late or treatment is just not available.

For this reason that the construction and completion of Zambia’s first cancer treatment centre brought a sense of relief to cancer patients who have lived with the disease for many years but have been unable to afford medication.

But months after the centre was announced ready for use, the hospital remains deserted.

Although the Ministry of Health through spokesperson Dr Canisius Banda earlier this week said that the hospital was now operational after government through the ministry of Foreign affairs secured an oncologist from Egypt, the doors to the centre still remain shut. Cancer patients remain crammed in the wards of the University Teaching Hospital getting what little treatment is available .

Dr Banda explained that while the centre building was not in use, cancer patients were currently receiving consultations through UTH while awaiting a certification from Radiation Agency of Zambia before starting to use the building.

He said another delay in opening the centre was caused by government’s determination in finding a qualified oncologist specialised in the treatment of cancer to run the centre.

“It was important that before starting operations, we found an expert oncologist to run the centre,” he said.

But Dr Kashita Nkandu, questions the expertise of the new man whom he says was called out of retirement to run the centre.

Until recently, Dr Nkandu who is currently Zambia’s only qualified radiation oncologist was at the helm of the cancer center, but government’s decision to replace him with an Egyptian specialist caused a stand-off between him and the health ministry.

“The centre needs a qualified person to run it, but government brought in a 72-year-old man from Egypt and I have differed with the permanent secretary for the Ministry of Health on this matter because there is no need to bring in someone who is retired to serve as executive director,” said Dr Nkandu.

However, Dr Banda who refused to disclose the name of the new oncologist also declined to comment on matters regarding Dr Nkandu though he was quick to point out that the oncologist had the expertise to handle the intricacies of the centre.

Although Dr Banda insisted that the running of the centre did not depend on the four doctors studying in South Africa, a medical analyst who declined to be named said the centre was still lacking qualified staff.

MOH recently announced that it will spend US$499,200 to train four doctors studying in South Africa to specialise in cancer treatment, these Dr Banda says are additional steps that government has taken to ensure that the centre did not lack professionals in the field of oncology.

“These are an additional support system, the centre can run fully with the current staff that we have in Zambia. Our operations do not depend on those doctors currently studying, although their expertise once they graduate will only enhance our operations,” he said.

But according to the medical analyst, the situation at the hospital is worse than government is letting on. Operations have stalled because the centre lacks qualified doctors to operate the equipment, even with the new doctors coming, it was impossible IAEA would have enough confidence to let then run the centre because they will still lack experience.

The source said that major problems developed when it was decided that it should be autonomous from UTH. The centre which is situated within the grounds of UTH uses its electricity and water was expected to operate outside the control of the hospital.

In order for the center to run independently and professionally, the IAEA categorically recommended that it be led by an experienced radio-oncologist of international standing. Such an expert would build local capacity to take over in a few years.

“MoH tried to advertise this position internationally but the response was nil because of the package being offered. To run a hospital like this one is very involving and very technical because of the potential catastrophe that such high energy can cause,” explained they revealed.

After government’s failure to entice a foreign expert, they settled for Dr Nkandu to run the centre. Dr Nkandu, trained in Australia , is said to have been involved in conceptualising the project and was one of the few people that travelled with Edith Nawakwi, then minister of Finance, to OPEC countries to raise initial financing.

“Now that institutional politics have sidelined him when he believed that he had the right to be part of the controlling core team, it is understandable that he is angry with this politicisation. But he is right because the Armenian-born surgeon has never worked in, let alone, run a center this scientific,” said the source.

The center houses a cobalt-60 radiotherapy unit, a linear accelerator and other diagnostic and therapy equipment like mammogram facilities.

“I will tell you that the whole scenario is not good but at the core of this acrimony is the suffering patient. My assessment is that we are still quite far from treating our first patient, which could even be up to a year.”

The center was built with a US $5.6 million loan from the OPEC Fund for international Development, with technical support from the International Atomic Energy Agency.

Just like before, cancer treatment that includes chemotherapy, surgery or radiotherapy still remains the preserve of the rich few in Zambia.

It is expected that once fully operational, the cancer treatment, capable of delivering mega dose radiation therapy will treat over 1,200 patients both from Zambia and abroad.

Potentially, this should save many lives lost due to poor diagnosis or the lack of means to do this at most Zambian health centers. There are over 150 patients on government’s waiting list for immediate treatment.

The cancer centre should also save the government a lot of money spent on subsiding patients referred abroad for specialist treatment. For now patients needing vital radiotherapy treatment have to travel to South Africa and Zimbabwe where treatment ranges between K8 million (U$2, 222) and K24 million (U$6, 700).

The Zambian government covers most of the costs but a contribution is still needed from the patient, which few can afford since above 70 per cent of the population live in poverty.

But even those who can afford to make a contribution, the waiting period can last six months to over a year. That is a long time for a fast developing condition like breast cancer.

October 2006
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