When his two–year old son "Given" was diagnosed with cancer, Tanzanian farmer Frank Kamindu didn´t hesitate. He sold his two goats, borrowed US$65 from a friend, and set off with his little boy on a 900 kilometer bus journey to the Ocean Road Cancer Institute (ORCI) in Dar es Salaam.
"I didn´t know much about cancer," Frank recalls, holding his son close to his side. "Just that it was something very bad, usually untreatable." Doctors at the regional hospital in Mbeya in south–eastern Tanzania, where Frank first took Given, told him his only hope was to seek treatment for his son at ORCI. They were right. It is the only specialist cancer treatment and radiotherapy centre in this country of 37 million.
Built as a hospital under German colonial rule in the late 19th century, the handsome white building on the Indian Ocean was designated a cancer treatment centre by the Tanzanian government in 1996, with an annual intake of less than 500 cases. Today, ORCI handles 3,000 new cancer patients and up to 10,000 follow–up cases a year, a massive workload for a hospital with just 112 beds and 200 staff.
ORCI is Tanzania´s only provider of radiation therapy, a powerful tool for both the curative and palliative treatment of cancer. In July 2006, the IAEA provided the Institute with a Nordion Equinox 100 radiotherapy machine capable of treating more than 1,000 patients a year. A Nordion Equinox 80 machine, provided by PACT, will become operational later this year.
In recognition of ORCI´s pioneering role in cancer treatment and control, Tanzania was chosen in 2005 as the first of six PACT Model Demonstration Sites (PMDS). These are collaborative, interagency projects designed to help developing countries strengthen all areas of comprehensive cancer control.
Tanzania is facing a cancer crisis with some 35,000 new cases a year, but ORCI can handle only a small part of this burden. Its waiting rooms are packed, its radiotherapy machines work overtime and its wards sleep extra patients on the floor. The overcrowding extends to the circular pavilion on the hospital grounds where scores of patients´ relatives have set up temporary home. With little money and nowhere else to go, the open–sided structure is their only shelter from the alternating heat and torrential rain of the Tanzanian autumn.
The influx of patients is due to increased cancer awareness among Tanzanians, explains Dr. Richard Lyimo, Chief of Clinical Services at ORCI. But, tragically, the pattern of disease presentation has not changed. "About 80% of patients still show up with advanced stage cancer and can only be treated palliatively," he says. "Still, the fact that more people are coming to ORCI is a positive sign and should encourage all concerned to accelerate efforts to fight cancer."
Ultimately, Tanzania´s cancer crisis and ORCI´s workload can only be alleviated through an effective National Cancer Control Plan, providing cancer education, screening and treatment at regional centres across the country. Efforts for this are already underway and a Steering Committee, backed by PACT and its international partners, is now in place to drive the agenda forward. ORCI, drawing on its vast experience as Tanzania´s prime cancer care provider, is leading the way with training schemes and outreach programmes.
Given Kamindu was diagnosed with Retinoblastoma (Rb), a cancer of the eye usually afflicting young children. If caught in its early stages, Rb can be cured in 90% of cases. But in many developing countries cancer frequently isn´t diagnosed until far advanced, making it much harder to treat. When he arrived at ORCI in early May, doctors found the cancer in Given´s left eye had spread to surrounding tissue. The eye had to be surgically removed before the two–year old could start radiotherapy to destroy any remaining cancer cells.
"We´re pleased with the way he has responded to treatment," says Dr. Fatma Jaha, who is in charge of the noisy, over–crowded men´s ward where Given shares a bed with his Dad. Still, he needs a second course of 10 radiotherapy sessions before the two can go home to Ibeta, a remote village on the Tanzania–Malawi border.
Regional cancer centres will greatly improve patients´ chances of early detection and life–saving treatment. And they will spare people Frank Kamindu´s ordeal. All of his money has gone, swallowed up on travelling and living costs. And he fears the US$25 he left for his wife and two other children is also exhausted by now. With no telephone network covering their isolated area of Tanzania, the family has had no news of Frank and Given since they left home in early May. "I have no way to get information through to my wife. She must be desperate," Frank worries.
But for now he takes heart from Given´s obvious improvement. Sitting on the stoop outside the ward, Frank smiles as his son gulps down a milky drink. "It´s more than I dared to hope for," he says. Before his treatment, Given was ailing. He was in pain and cried a lot. Now he eats, he´s growing bigger, he plays with the other children. For Frank and Given, the long journey to ORCI was worth all the hardships.