Two weeks ago, I met a 60-year-old man at the hospital I’m stationed at. He was from Mweka in Moshi, but was undergoing chemotherapy at the Ocean Road Cancer Institute (ORCI) in Dar es Salaam since his diagnosis. He has rectal cancer that has spread to the lungs that caused him to suffer from uncontrolled passing of stool. Stool leaked unexpectedly even in public, thus he was planned for permanent colostomy, a procedure which could help him to improve quality of life and maintain his dignity as a human being an adult creature.
Rectal cancer means cancer inside the rectum; the last organ of the large intestine that connects to the anus.
Colostomy is a surgical procedure whereby surgeons make an opening by drawing the healthy end of large intestine through an incision on the front abdominal wall and suturing it into place. The role of the created opening is for attaching a special bag for draining stools/feaces. Colostomy can be temporary or permanent.
When the old man refused
His decision was not without foundation. The old man gave me two reasons, firstly he initially thought that he could be subjected to temporary colostomy for which he was ready, but having been informed that he was supposed to undergo permanent colostomy, the news shocked him to the core and he had to nullify his consent that he initially gave.
Secondly, his colleagues with a similar problem in the ward informed him that permanent colostomy is very expensive to the tune that he could have to purchase colostomy bag daily.
Colostomy bag is a removable and disposable bag attached to the created opening to allow sanitary passage of the feaces/stools for proper collection and disposal.
It’s gospel truth that he could have to buy it on daily basis, and he could need it more than once or twice. The cheap ones are sold at Sh2000 per bag, whilst the expensive ones are sold at Sh20,000 per bag. This could subject him to another formidable financial challenge.
Symptoms of rectal tumour
My esteemed readers let me at this juncture speak of this condition. I know you might be interested to know what causes it. The real causes are unknown but there are risk factors that may predispose an individual to it such as age above 50, smoking, family history, high fat diet, history of polyps, colorectal cancer or inflammatory bowel disease.
The main symptoms of rectal tumour is bleeding from rectum during bowel movement associated with painful bowel movements and the feeling that rectum hasn’t been completely emptied, even sitting may be painful. It is said that the person feels no pain from the cancer itself unless it spreads to tissues outside the rectum, such as the case of this old man whose cancer spread to the anus.
Doctors in Tanzania may diagnose the condition through a series of examinations and tests that are done in apple-pie order.
The stage of cancer dictates the decision making process in treating the tumour. He was first told to seek chemotherapy.
Surgical option can also be sought for treating both the symptoms and reducing symptoms, on top of that, radiation therapy can also be used to kill or let the tumour shrink.
Prevention strategy is early detection and removal of the initial lesions/precancerous growths.
Taking the case of this old man, he went to hospital late when the condition was severe and had already spread even to the lungs, could not tolerate any rectal bleeding. Therefore seek medical consultation at the earliest when you spot aforementioned symptoms.
But let’s go back. Did he accept the procedure? He agreed to be operated after being re-educated on benefits and risks. He said, “I have consented to the procedure after taking into account the shame that I face due to this problem.”
A note for the survivors
To the anorectal/ colorectal cancer victims and permanent colostomy users, do not be sad nor apologetic.
What you are going through is part of life. You all are the strongest people on earth, your inborn strength is the reason why you should be optimistic. Someone once said, ‘Life wouldn’t be fun if didn’t have its ups and downs, live happily, have unceasing hope.’ Moreover, you are not less a human being just because of what you are going through.
The author is a medical doctor, public health activist and a researcher based in Dar es Salaam