Three months ago Tima Omary, 50, left her home in Arusha, northern Tanzania, to take her sister to the doctor. She hasn´t been home since.
Tima´s sister, Kibibi Stambuli, 43, had been complaining for months about chest pains and difficulty swallowing. But doctors in her home town of Tanga were unable to make a diagnosis: one said it might be pneumonia, another thought it was a stomach ulcer. The doctor in Arusha suspected cancer. He said Kibibi should go immediately to the Ocean Road Cancer Institute (ORCI) in Dar es Salaam, Tanzania´s only cancer and radiotherapy centre.
The two sisters travelled by bus to ORCI where Kibibi was admitted with oesophageal cancer. Both women wept when they heard the diagnosis. Kibibi says she knows cancer is very serious but she´s hoping the chemotherapy and radiotherapy she is receiving will help her to get better. "I just want to be healthy again," she says.
Tima´s home is now an open-sided shelter in the hospital grounds. Like dozens of other relatives who have travelled to Ocean Road to be with their loved ones, she is unable to afford hotel accommodation and has nowhere else to go. "I´m here to help Kibibi in any way I can, to keep her spirits up," she says. Even if that means foregoing personal comfort.
The two sisters´ story highlights the cancer challenges facing this East African nation of 37 million. With health services focused on communicable diseases like HIV/AIDS and TB, cancer has been largely overlooked and ignorance of the disease is widespread. Misdiagnosis is still common, while some 80% of cancer sufferers seek help too late for anything but palliative care. And because cancer services are concentrated in Dar es Salaam, patients from poor, rural areas have to make long and expensive journeys to get treatment.
Like many developing countries, Tanzania is seeing a rapid increase in the incidence of cancer - currently estimated at 35,000 new cases a year. ORCI has just 112 beds and 200 staff to cope with an annual intake of 3000 new patients and 10,000 follow-up cases. In spite of heroic efforts, its slim resources are already stretched to the limit. Waiting rooms are filled to over-flowing, radiotherapy machines work overtime and medication is frequently in short supply. Against this background, relatives´ needs come low down on the list of priorities.
Hoping to build Kibibi´s strength, Tima tries to supplement the basic hospital diet of beans and Ugali, a maize-based porridge. She cooks steamed fish and prepares flasks of milky tea, using a small portable stove that she keeps in a cardboard box. Tima does her best but admits she finds the lack of privacy and harsh living conditions difficult - especially sleeping on the hard stone floor, without mosquito nets.
Tima wishes the government would step in to help cancer patients´ families by providing them with proper accommodation at or near the hospital. Even better, she says, cancer diagnosis and treatment should be available at regional centres, to spare patients the long journeys and delays. Cancer experts agree. "We can´t expect all Tanzanians to travel to Dar es Salaam for treatment," says Dr. Twalib Ngoma, Executive Director of ORCI. "Cancer services should be available where most of the people are, that is, in the rural areas."
Through its Programme of Action for Cancer Therapy (PACT), and building on past and on-going assistance provided by its Technical Cooperation Programme, the IAEA is working with Tanzania to meet this challenge. As one of PACT´s Model Demonstration Sites (PMDS), Tanzania is supported and guided by WHO-AFRO, PACT and other interagency partners in efforts to build cancer control capacity and implement an effective National Cancer Control Programme (See: http://www-naweb.iaea.org/pact/afro.asp).
Gradually, the country is moving forward in its drive to provide cancer education, prevention, screening and early detection, cure and care services to all people in all areas. But there is still much to be done. And in the meantime, people like Kibibi and her dedicated sister, Tima, must wage the battle on cancer far from home, in the company of strangers.