EA steps up war on cancer as Rwanda opens treatment centre

Rwanda will open a regional cancer treatment centre later this month, a development that is expected to not only ease East Africa's cancer burden but also cut the costs incurred by patients when they travel abroad for diagnosis and treatment.

The centre based at the Rwanda Military Hospital, will receive regional and international referrals, boosting Rwanda’s profile in cancer treatment.

Cancer is responsible for the deaths of about 5,000 people in Rwanda every year, accounting for 7 per cent of deaths in the country, according to the World Health Organisation.

In the region, Kenya has the highest cancer-related deaths — about 33,000 per year, data from WHO shows. Tanzania comes second with about 28,000 cancer deaths per year, followed by Uganda at about 21,000.

To make cancer treatment affordable for the majority of Rwandans, up to 80 per cent of the patients at the centre will be holders of Mutuelle de Sante and other local insurance cards. Mutuelle de Sante, the country’s community health insurance cover, puts Rwanda ahead of its peers in the region when it comes to provision of healthcare to citizens.

Tanzania also offers free treatment to its citizens once diagnosis has established the existence of cancer. Kigali’s new cancer centre means that cancer patients in the region have one more option, outside Uganda and Kenya.

“The new cancer centre makes treatment more or less complete in Rwanda. We anticipate that we shall receive patients from neighbouring countries who need treatment not available in their countries. We are ready to receive international referrals,” said Lt-Col Pacifique Mugenzi, director general of the centre.

Cancer specialists

The centre has the capacity to handle 80 cancer patients a day but still faces a shortage of oncologists and other cancer specialists.

The country has tried to bridge this gap by employing cancer specialists through its partnerships with the International Atomic Energy Agency. It also sends some staff overseas for training.

“We have a group that will be going for training early in 2019. We expect in our second year to have many specialists but at the moment we have partnerships to help us acquire the skills that we don’t have here, as we wait for our own to qualify,” Dr Mugenzi said.

“Those who are sponsored to study oncology have to sign a retention contract, and luckily most of those that I have interacted with are eager to return to work in Rwanda. There is a shared commitment to see this initiative become successful and I have no doubt that they will come back.”

Rwanda plans to spend about Rwf3 billion ($3.4 million) on training 21 cancer specialists, comprising radiation oncologists, medical physicists, radiotherapy technicians and oncology therapy nurses.

Vaccines

In March 2017, EAC member states chose Uganda to host the $34 million regional Oncology Centre of Excellence to offer quality treatment to patients from the region.

Uganda’s Mulago Hospital has resumed treating cancer. Its radiotherapy machine broke down in 2016, leading to a crisis in the region. The $800,000 machine was replaced in January 2018, with a capacity to treat 120 patients per day.

Rwanda and Uganda have for years been offering cervical cancer vaccines to girls aged between nine and 14, but through its vaccination programme for girls, Uganda aims at eradicating cervical cancer by 2020.

Tanzania joined its two East African Community neighbours in April last year, becoming only the seventh African country to introduce the human papilloma virus (HPV) vaccine in its immunisation programme. The others are Botswana, Mauritius, Seychelles and South Africa.

A large proportion of cancer-related deaths in Tanzania are attributed to cervical cancer, which claims 6,700 women a year, according to the International Agency for Research on Cancer (IARC).

Tanzanian Health Minister Ummy Mwalimu said in December that out of every 100 cancer patients, 34 suffered from cervical cancer and 12 from breast cancer. The government last year allocated Tsh7 billion ($3,000,000) to the nation’s cancer treatment facility — Ocean Road Cancer Institute — to boost treatment.

Dr Crispin Kahesa, director of Cancer Prevention Services at the Ocean Road, said the budget for cancer treatment rose from Tsh400 million ($173,571) last year to Tsh9 billion ($3,905,000). Cancer poses an increasing challenge to Tanzania’s healthcare. At least 50,000 patients visit the institute per year, out of whom about 29,000 die.

The Tanzanian government has invested in additional radiotherapy facilities across the country to complement the ORCI, which is the only institute that provides radiotherapy treatment services in the country currently.

The radiotherapy section at ORCI also offers external beam radiotherapy treatment techniques for a patient with advanced cancer stages. The centre also offers chemotherapy, radiology and imaging section (RIS), nuclear medicine, screening and brachytherapy.

Strain

Cancer can be cured if the patient is diagnosed early, but 80 per cent of the cancer patients in Tanzania report to hospital when the disease has reached an advanced or terminal stage, said Dr Maguha Stephano, a public advocacy specialist said. Prior to diagnosis, cancer patients also face hefty fees to pay for screening and medication, which is out of reach for an ordinary Tanzanian.

However, currently there is a great need for trained staff at the Ocean Road Institute. The number of cancer experts have slight increased from 10 in 2012 to 40 in 2017.

They include oncologists, nurse oncologists, medical physicists and cardiotherapists.

The IAEA facilitated training of two radiation oncologists and two radiation therapists at leading cancer facilities in Israel in December last year.

In Kenya, cancer cases have been increasing over the years, putting a strain on the country's health sector and economy.

According to the 2018 Globocan report by the World Health Organisation’s International Agency for Research on Cancer, at least 47,000 people get the disease every year, out which about 323,000 die. This is an increase from the 41,000 cases and 28,000 deaths recorded six years ago.

The most common cancers in Kenya are breast, cervix, oesophagus, prostate and stomach.

"Unhealthy diets and sedentary lifestyles that cause obesity are contributors to the rise in cancer cases. We also have excessive alcohol consumption and smoking that increase people's chances of getting the disease," said Dr Andrew Odhiambo, a medical oncologist and secretary of the Kenya Society of Haematology and Oncology.

He says a major contributor to cancer-related deaths is the late diagnosis of the disease.

"Most people come to the hospital when their cancer is already at an advanced stage. This makes treatment expensive and reduces survival chances. That’s why we encourage frequent cancer screening or check-ups."

Treatment options for major cancers in Kenya include surgery (for removing tumours or growths), chemotherapy (use of drugs to kill cancerous cells) and radiotherapy (use of radiation to destroy affected cells).

Recently, doctors have introduced a new treatment method know as immunotherapy that strengthens the body's natural defence system, hence enabling it to stop or slow down growth of cancerous cells. The immunotherapy drugs, which are taken for life, cost about Ksh20,000 ($200) monthly and are thus only a preserve of the few can afford them in the private health sector.