The walls are freshly painted at Our Lady Hospice in Thigio, and the gardens are in full bloom. A sense of calm pervades this tiny building perched on a grassy hill, even though its patients have come here to die.
Originally established as a dispensary, the hospice now eases the passing of terminal cancer patients — a disease that has taken the residents of this quiet, lush region by surprise.
“People didn’t realise (cancer) was a big problem until we started visiting these homes and finding patients in a very bad condition” observes Sister Eileen, the hospice’s manager who has worked there for over a decade. “No drugs for pain, no running water in some of the homes, and the family not able to cope with the situation. And within the past few years, cancer seems to be on the increase in this country.”
Indeed, cancer currently causes an estimated seven per cent of the total number of deaths in Kenya — meaning that over 20,000 people die from the disease every year. The disease ranks as the third largest cause of death in the country and over 80 per cent of cases are diagnosed late, reducing patients’ likelihood of survival.
But change may be afoot: after creating a National Cancer Control Strategy and passing the Cancer Prevention and Control Act in Parliament, the Ministry of Health says it is planning to establish five new cancer centres across the country and is formulating new policies to improve medical management of the disease.
According to Dr Waihenya Mwangi, head of the Division of Non-Communicable Diseases at the Ministry of Health, cancer specialists met in January to begin drawing up new harmonised treatment guidelines that will be distributed to health care workers so that they are “empowered in their capacity to make cancer diagnosis”.
The guidelines, which Dr Waihenya says should be fully drafted in the next few months, will include a list of cancer drugs to be added to Kenya’s essential medicines list in a bid to make them more affordable for ordinary Kenyans.
That, according to campaigners, is vital to improving the lives of cancer patients in Kenya.
“As we are talking, the Kenya Medical Supplies Agency doesn’t buy chemotherapy drugs,” says Dr David Makumi, vice-chairman of the Kenya Cancer Association. “So there are many things to be put in place. As it is now, (chemotherapy drugs) are not stocked, or many of the rehabilitation drugs.”
At Our Lady Hospice in Thigio, palliative care nurse Elizabeth Wanjiku says even managing the pain of terminal cancer is impossible for many Kenyans without the intercession of charitable organisations like her own. Pain killers like morphine are too expensive for the average Kenyan, and require complimentary drugs to battle side effects like nausea and constipation.
“(Public hospitals) give just the bare minimum, sometimes no drugs. Other times you can’t get the drugs except through us because they are so expensive,” she says.
Part of the solution lies in the government making broader efforts to procure generic cancer-fighting drugs, argues Dr Vijaykumar Narayanan, a consultant doctor with Cancer Care Kenya,
“The chemotherapy medicines are prohibitively expensive here, so we need to have more generic preparations. One perfect example of this generic medicine is Herceptin, a very important drug in cancer management. We have the original brand, which is made by Roche company, and the cost will come to around Sh250,000 for one injection. The same thing is available in India for between Sh70,000 and Sh80,000,” he explains, referring to a recent decision by Roche to provide a cheaper, locally manufactured version of the drug for the Indian market.
Dr Waihenya says it is too early to say whether the government will seek to obtain the generic versions of cancer drugs where possible, but insists that the ministry is committed to finding affordable, good quality medicines for cancer patients.
It also intends to establish five new cancer facilities, he says, located in Mombasa, Nyeri, Kisumu, and Nakuru or Embu. The feasibility studies for the new centres have already been concluded and the ministry is now drawing up costing plans for the facilities.
Currently, Kenyatta National Hospital is the only public centre for radiotherapy treatment — an essential component of cancer care that uses high-energy rays to destroy cancer cells in patients. Moreover, the hospital relies on a cobalt radiotherapy machine, an outdated technology that cannot precisely target tumours and risks damaging surrounding organs.
Dr Primus Ochieng, an oncologist at KNH, says cancer services at the hospital are desperately over-burdened — the centre sees around 200 patients every day, and the waiting time to receive radiotherapy treatment is currently about six months.
“We have four radiation oncologists with other doctors working with them… then we have 10 nurses, and we have two machines. So everybody here, including the machines, are stretched” he complains.
“We acknowledge that the number of cancer patients overwhelms (KNH’s) capacity,” admits Dr Waihenya, “so of course there is an urgent need for us to establish other cancer centres. We have been strengthening the capacity of KNH, but I think the need for getting other centres cannot be over emphasised.”But even where treatment is available, misunderstandings surrounding cancer in Kenya are undercutting institutional efforts to control the disease.
“Before, most people used to think that if you get cancer, it’s a death certificate” says Dr Waihenya. “We are saying no, cancer is treatable when diagnosed early.”
Philip Odiyo Ouma, the patient support manager at Faraja Cancer, a non-profit organisation that provides counselling services to cancer patients and their families, says many of his patients believe they have been bewitched or cursed, or think that the disease affects only an elite sliver of Kenyan society — a perception, he says, that must be urgently debunked.
“It’s not just going to be a problem of the rich because cancer is affecting everyone across the board. It’s no longer the disease of the rich,” he warns.
Kenyans of all social strata are at risk of the disease, agrees Dr Narayanan, pointing to the widespread use of pesticides in Kenya’s agricultural sector, which are linked to an increased risk of cancer.
“It’s mostly an agrarian economy here. How much attention do they pay to the security of their staff? We have to ask these things,” he insists.
“We know there are certain chemicals that are associated with a slightly increased risk of certain cancers,” adds Dr Makumi. “We say that cancer control is not the job of the Ministry of Health alone. It’s multi-sectoral because the business of enforcing labour regulations lies with the Ministry of Labour. That has to be done,” maintains Dr Makumi.
Dr Waihenya insists that the Ministry is committed to working with the ministries of Labour and Environment, but warns that convincing other government departments of the importance of cancer prevention has been a struggle.
“We are comprehensively addressing the prevention of cancer. But convincing others… I would say that is one of the difficult parts,” he says.
In the meantime, according to some campaigners, it is imperative for the private sector to fill the existing gaps in cancer care.
“The Kenyan government is trying day and night, but it’s still not enough,” says Ms Wanjiku. “There is a need for the private sector to chip in because even what is funded to the public facilities is barely enough. Let me say it’s less than average of what you’d require.”
But making private institutions financially sustainable is a challenge, and most investors are unwilling to finance private cancer treatment projects, according to Dr Narayanan.
His organisation is one of the few exceptions to that rule; as the country’s first private cancer treatment centre and the only facility in the country dedicated exclusively to cancer, it is financed through the personal investments of its shareholders.
As well as offering free counselling and complementary therapies like nutrition advice and massages for patients through Faraja Cancer Support, Cancer Care Kenya boasts state-of-the-art linear accelerator radiotherapy machines — a safer and less invasive way to receive radiotherapy treatment.
But the high cost of quality treatment, says Dr Narayanan, discourages most investors from sinking money into similar initiatives.
“The running cost is expensive because you need to have an in-house biomedical engineer, the machine parts have to be imported, and we should have a dedicated power supply for these things,” he explains.
“And the personnel are a very, very big problem here. I come from India, our chief radiotherapy serviceman is from UK, and we had to send our Kenyan colleagues to South Africa for training.”
Despite seeing around 60 to 70 patients a day and charging between Sh30,000 and Sh80,000 a week for treatment depending on the patient’s income, Dr Narayanan estimates that the facility is currently operating at a loss of about Sh30 million.And while Cancer Care Kenya tries to make its services as affordable as possible, its treatment remains far beyond the reach of the ordinary patient.
“When we say this is the minimum amount you have to pay here, (patients) just disappear. They don’t turn up,” says Dr Narayanan.
Nonetheless, Dr Waihenya says the growing number of private facilities seeking to provide cancer care is all part of increased recognition of the devastating impact of the disease.
“Not just at national level, but also at the global level, the focus has changed to non-communicable diseases,” he says. “I think currently there is that shift toward non-communicable diseases, and also a shift in investment — even in the private sector — because of the realisation of their impact on the health system.”
Dr Waihenya says there is a shift in Kenyans’ attitudes, too.
“Across the board, I think now people are getting to realise the importance of screening for cancer and the importance of early detection,” he observes.
And despite the challenges that remain, campaigners say they are hopeful that the broad landscape of cancer care is improving.
“Things are looking up,” says Dr Makumi. “Maybe not as fast as I would want or many people would want. But, ’tell you what, now we have kind of a direction.”