01 May 2010

An unimaginable sentence, and yet one that I heard throughout conversations with cancer patients in Tanzania and Kenya.

Once thought of as a ‘rich world’ disease, cancer is a looming public health catastrophe across east Africa and the developing world. Rates of incidence of the disease are rising in low- and middle-income countries. People lack access to information on how to identify early signs of different cancers. Those who do seek treatment typically have few options. Medication is expensive. Facilities are few and overcrowded. Compounding the challenge are the many stigmas attached to the disease.

A patient diagnosed with cervical cancer in Kenyatta National Hospital told me, “With HIV/AIDS, at least I know I have a fighting chance. The antiretrovirals are inexpensive and readily available, and people can live with the disease. With cancer, we just don’t know how to cope.”

This week, this page will explore the challenge of cancer in east Africa by offering a profile of the IAEA’s work to fight the disease. Thanks for reading.

02 May 2010

Dar es Salaam: a teeming city set on the Indian Ocean coast in the corner of Tanzania. Choked with traffic. Congested with people. Movement and life everywhere.

Cancer is rapidly becoming a big problem in places like Dar. Minibuses and taxis belch out polluting fumes, diets are increasingly unhealthy, and the sedentary life of the city dweller are all factors leading to increased incidences of cancer in countries like Tanzania.

Making matters worse, this city of nearly 4 million people holds few options for cancer treatment.

Yet a beacon of hope can be found along Dar’s verdant shoreline. Ocean Road Cancer Institute is a small hospital, set up five years ago to offer much-needed cancer treatment to Tanzania ’s residents. At Ocean Road , hundreds of people daily are given access to radiotherapy machines, nuclear medicine, and chemotherapy drugs to fight the disease.

Walking into the center for the first time, I was struck by a hushed silence that hung heavy in the air. Young children sick with various cancers wandered about, intravenous lines protruding from their wrists. Adult patients waited for treatment, their faces drawn, exhausted from a long battle. Perhaps most noticeable, a few albinos, their faces devastated by the sun’s rays, stood out against the sea of black faces.

It had to be one of the saddest places I’ve been.

And yet, in spite of the bleakness of my surroundings, I couldn’t stop thinking of the thousands of Tanzanians out there living with cancer who don’t have the opportunity to receive care. I imagined the struggle they face with no diagnosis, no treatment options, no medicines to alleviate pain.

It’s strange to think that someone living with cancer could be lucky, but such was the case at Ocean Road.

03 May 2010

It was at Ocean Road that I met Muzne Abubakar Haibar, a sweet and gentle mother of four. Nearly 40, Muzne comes from Zanibar, a picturesque gem of an island known for its beautiful beaches and stony city center. About three years ago, Muzne discovered a lump in her breast, and quickly sought medical treatment. She was first diagnosed with breast cancer at Ocean Road in 2008, and had a partial mastectomy, or lumpectomy, performed at the time. Muzne immediately followed this treatment up with chemotherapy, and signs appeared positive that doctors had removed all cancerous tissue.

Unfortunately, the cancer returned months later, as Muzne began to experience deep pain within her chest. Her doctors then opted for a full mastectomy and a further regimen of chemotherapy.

 

“I thought I was ok then,” she explained, recounting the experience of losing a breast to surgery. Muzne told me about the toll that her cancer had taken, not just on her body but on her family as well. Since Zanzibar is a three-hour ferry ride to Dar es Salaam, she needed to be away from her family for weeks at a time for surgery, chemotherapy, and recovery.

Her fight took yet another unfortunate turn for the worse when doctors discovered that her cancer had metastasized, or spread, to her spine. The day we met, she began to receive radiotherapy, and still seemed hopeful that she would pull through.

03 May 2010

Ask ten people what they know of the IAEA, and you’re likely to be met with responses that touch upon the organization’s work in nuclear non-proliferation or its efforts to support the peaceful use of nuclear technology. They are often surprised to learn that the organization takes an active part in helping its member states to combat cancer.

For over three decades, the IAEA has played a humble yet important role in providing cancer-related assistance across the globe. In that time, over $220 million has been dispatched to support training and equipment in the areas of nuclear medicine and radiotherapy, and the work continues to expand. A particularly important and visible portion of the IAEA’s work to fight cancer lies with PACT, the Programme of Action for Cancer Therapy.

 

PACT’s primary goal is to help low- and middle-income countries to meet the growing need for cancer control services. With recent statistics indicating that 56% of new cancer cases and 63% of cancer deaths occurring in developing nations, the importance of PACT’s work cannot be overstated. PACT works by safely and efficiently mobilizing radiation medicine technology to places that need it. This work is done in close collaboration with a coalition of partners, most notably the World Health Organization.

04 May 2010

Among the most affecting and powerful experiences from the trip was spending time in the children’s ward at Ocean Road. Coming face-to-face with little lives that had been interrupted by various cancers is heartbreaking. But what struck me most was how avoidable many of the cases were.

One of the greatest success stories in oncology in recent decades has been measures to treat retinoblastoma, a cancer of the eye’s retina that typically occurs in early childhood. In developed countries, signs of the cancer are quickly picked up and over 95% of children are cured. It’s one of the more treatable forms of cancer as chemotherapy and other measures usually produce positive results.

Yet in Tanzania and Kenya, children and parents with lack of knowledge and no access to health care seek treatment in later stages of the disease, which increases the risk that the disease may have spread.

This served to drive the following point home: it’s not going to suffice to simply implement cancer therapy and viable health care strategies. Public outreach and education on cancer must play a strong role to foster early detection and screening for children and adults across the region.

06 May 2010

We traveled up country to Mwanza, Tanzania’s second largest city, to visit and meet with senior staff at the Bugando Medical Centre. The hospital, like so many across east Africa, is overburdened and understaffed, and serves a regional population of 14 million people. With a dearth of health services in the Lake Victoria region, many patients travel a great distance to Mwanza from neighboring countries Uganda, Kenya, Rwanda, Burundi, and the Democratic Republic of the Congo for treatment.

Over the last two years, Bugando has made the first steps to become Tanzania’s second center to offer oncology services. In collaboration with the IAEA and WHO, medical staff have received training in South Africa and Italy, a community cancer registry has been established, and plans have been drawn up for buildings to house radiation therapy equipment.

As we made our way to the oncology department, we passed a ward where a group of women and children quietly milled about. Some seated in bed, some standing, most receiving care for cancers of the breast and cervix.

We were introduced to the group, and within minutes, the room metamorphosed from cancer ward to fashion studio. Each of the women stood proudly before our cameras, wanting to be photographed.

“Me too! Me too!” they exclaimed, as we moved about the room, capturing each of them in moments that reflect a solemn strength and a frank openness that lays bare their struggle with cancer. They wanted to put a public face on their private battle, and for that, it was one of the most moving portions of the trip. As a small token of thanks, I’ve since printed copies of their photographs and sent them to Mwanza.

You can view a selection of their photographs below:

06 May 2010

At Bugando, I interviewed the Director General of the hospital, Dr. Charles Majinge. Since the Bugando Medical Centre does not yet have a comprehensive cancer unit, patients are referred to Ocean Road for radiotherapy. But for most people, making a 1,000 km (620 mile) trip is too costly, and many remain at home with no options for treatment.

In our talk, Dr. Majinge talks about the struggle his patients face, the types of cancer present in the Great Lakes region, and what the future looks like for Bugando.

Watch my interview with Dr. Majinge:

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18 August 2010

Torgbi Tsagbi is optimistic about his chances to beat prostate cancer

Not all is gloom and doom when confronting cancer in Africa.  Success stories are to be found across the continent, and I encountered one such case in Ghana.  Torgbi Tsagbi, an engineer from Kumasi, sat with me to discuss his battle with cancer in August.  Several months before we met, he encountered pain and difficulty urinating, and quickly became worried about his health.  

“I’ve known others who have had similar problems but ignored the warning signs,” Tsagbi explained.  “Months later, I’d lose them – they’d be gone.” 

Tsagbi quickly became worried about his health, sought medical attention, and was diagnosed with prostate cancer.  It is one of the leading types of cancer across Africa and the developing world, and prognosis is good if detected early enough.

“The treatment is expensive, and I have to make a long drive from Kumasi in the north to Accra in the south for radiotherapy, but my chances are quite good,” Tsagbi explained.

Tsagbi’s experience brought home the importance of early detection, of seeking medical attention when early warning signs appear.  Sadly, for many Africans afflicted with cancer, warning signs go unnoticed, are often mistaken for another malady, or are ignored.  Yet with prostate cancer, if detected early enough, prognosis is good for recovery.  Tsagbi is very optimistic that he will recover fully, and his success reminds us that cancer need not be a death sentence across the developing world.