Thursday, April 27, 2017

THINKING ALOUD : Challenges of caring for cancer patients in Tanzania



Professor Zulfiqarali Premji

Professor Zulfiqarali Premji 

By Prof Zulfiqarali Premji premjizulfiqarali@gmail.com

Cancer care is in a pathetic state and the problem is so huge that it is even difficult to find an appropriate method to measure its magnitude. Huge global inequities exist in cancer survival for women.

In low-resource settings, breast and cervical cancer disproportionately affect women in the prime of life, resulting in substantial economic and societal effects.

Cancer was once associated with affluence but now places its heaviest burden on poor and disadvantaged populations. There are three main reasons for rise in cancers viz. population ageing, rapid unplanned urbanisation, and the globalisation of unhealthy lifestyles. Non-communicable diseases including cancers have some common denominator, which are the risk factors (enemies). Indeed, Tobacco usage, alcohol intake, high blood pressure, diet and physical inactivity are indicated, at different levels, as risk factors. Eating healthily, maintaining normal weight, and exercising throughout life could avoid one-third of cancers. Chronic infections are also part of the risk factors, liver cancer is often causally associated with infection by the hepatitis B virus (HBV), cervical cancer is associated with infection by certain types of human papillomavirus (HPV), and stomach cancer is associated with Helicobacter pylori infection. By increasing the availability and access to vaccines like HPV and HBV, there could be significant opportunities to reduce cancer incidence and mortality in developing countries.

In women, cancer of the cervix and breast are the most common, while among men, Kaposi’s sarcoma, followed by oesophagus and head and neck cancers, are the commonest, there is evidence that incidence of cancer of the prostate is on a rapid upward trend.

Challenges

1. Lack of reliable statistics to define the scale of the problem of cancer is a key challenge. The data presented by ORH are proportions of patients by region and type of cancer treated at ORH. These data do not reflect the true burden of cancer and there is need for comprehensive national cancer registries, but this requires funds and human resource both are in short supply.

At every regional hospital a small team should be formed comprising of nurses, clinical officers and laboratory staff. They should be given specific training and be able to start some sort of screening program and be able to collect data for regional cancer registry.

2. The specialised human resource needed for cancer care is grossly lacking. Oncology training started at the Muhimbili University of Health and Allied Sciences (Muhas) some five years back. Apart from specialist training, middle cadre training is also needed; special training for nurses, clinicians, data clerks and also for pathologist, radiologist for confirmatory diagnosis. Equipment used in radiotherapy and for radiological diagnosis needs constant maintenance and repairs by bioengineers and they are also in short supply.

There is no short cut; the required human resource needs to be trained.

3. Cancer prevention and early detection are very important and since the country has to deal with an array of health problems with limited resources majority have no access to cancer screening, early diagnosis, treatment or palliative care. Patients present with advanced disease that is not curable and the delay is often due to a variety of factors. There is almost total lack of response capacity in the country for prevention, public education, screening and early detection, diagnosis and treatment, whether involving surgery, radiotherapy, or chemotherapy. Till recently Ocean Road Hospital was the only cancer treatment centre for the whole country. For a population of over 50 million every regional hospital should be able to treat the common cancers but this is not possible now thus at least the zonal referral hospitals should be equipped as treatment centres. Treatment centres should be started at zonal and with time at regional hospitals. The major challenge is radiotherapy machines, which cost a fortune. In the west these machines are regularly replaced in hospitals because a new version is purchased. The old machine is still functional and with appropriate contacts the machine can be donated, our ambassadors should be able to follow this.

4. There is very little ongoing health education campaign in the country to sensitise especially the rural population.

There should be a cancer health education campaign just like the one for HIV.

5. The private health sector has not actively come fourth to establish cancer treatment centres because perhaps the patients mostly affected are poor and the cost of treatment is high, hence most patients once diagnosed are referred abroad for treatment. The ministry of Health may wish to engage with the private sector to start screening and treatment service in private hospitals at affordable costs and monitor the quality of these services.

A start has been done to control cancer in Tanzania, if more resources are made available and with proper planning and political will cancer epidemic can be brought under control but if it will be business as usual cancer will claim more lives in this country.

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