Cancer in Africa: Fighting a nameless enemy
By Kate Kelland, Health and Science
Corresponden Tuesday,
May 01, 2012
http://thestar.com.my/news/story.asp?file=/2012/5/1/worldupdates/2012-05-01T085208Z_1_BRE8400ER_RTROPTT_0_UK-CANCER-AFRICA-GHANA&sec=worldupdates
ACCRA
(Reuters) - In Emanuel Adu's language, Twi, people call the skin cancer that is
invading his cheek and nose "sasabro". It means a disease that eats
away at you. The 73-year-old former cocoa farmer has come to the Korle Bu
Teaching Hospital in Accra, miles from his home, to be treated with one of the
two radiotherapy machines in Ghana. "I had heavy bleeding and discharge
from my nose. The doctor told me it was cancer, a cancer called melanoma, but I
had not heard those words before," he explains in the consulting room. Most
of Africa's around 2,000 languages have no word for cancer. The common
perception in both developing and developed countries is that it's a disease of
the wealthy world, where high-fat, processed-food diets, alcohol, smoking and
sedentary lifestyles fuel tumour growth. Yet Adu's is one of an estimated one
million new cancer cases sub-Saharan Africa will see this year - a number
predicted to double to 2 million a year in the next decade. How can a continent
hope to diagnose and treat, let alone fight to prevent a disease that has no
name?
CANCER KILLS THE
POOR TOO
It's a
question David Kerr has been struggling with for several years. A cancer
specialist based at Britain's Oxford University and former president of the
European Society of Medical Oncology, Kerr set up the charity AfrOx in 2007 to
help African countries seek to prevent and control cancer. "There have
been some marvellously effective campaigns around AIDS, tuberculosis (TB) and
malaria, and of course infectious diseases like those are terribly
important," he said in an interview. "But already there are more
deaths in the world from cancer than from AIDS, TB and malaria combined." By
2030, according to predictions from the World Health Organisation (WHO), 70
percent of the world's cancer burden will be in poor countries, a prediction
Kerr says leaves most lay people, and even many doctors, "utterly
astonished". "They think cancer is a disease of the wealthy. But the
reality is that, in part because of success in tackling infectious diseases,
Africans are living longer. It's almost a booby prize that they're now living
long enough to get cancer." For many women in Africa, that means diseases
like breast and cervical cancer have become common causes of death before their
victims have begun to learn about them, let alone find words for them. A study
published in 2011 found that since 1980 new cervical cancer case numbers and
deaths have dropped substantially in rich countries, but increased dramatically
in Africa and other poor regions. Overall, 76 percent of new cervical cancer
cases are in developing regions, and sub-Saharan Africa already has 22 percent
of all cervical cancer cases worldwide. The same research found that some
poorer countries saw a rise in breast cancer cases of more than 7.5 percent a
year over the 30 year period studied - more than twice the global rate.
"EXPLOSION
OF CANCER"
Such data
come as no surprise to Verna Vanderpuye, a clinical oncologist and radiotherapy
consultant at the Korle Bu hospital where Adu will come for his treatment every
day for the next two weeks. "There's an explosion of cancer here,"
she said in an interview in her overrun consulting room. Unlike the diseases
she is trained to treat, the oncologist is a rare thing in Ghana. She is one of only six
trained cancer doctors who serve a country of 24 million people. Good
quality data are hard to come by, but Vanderpuye says the two main hospitals
equipped to treat cancer - hers and another further north in Ghana's second
city of Kumasi - are seeing between 5,000 and 7,000 new cancer patients a year.
"That's
just the tip of the iceberg. That's only those who actually come to the health
facilities. We don't really know what's really happening across the
country," she says. It seems a drastic situation. But Ghana has
come a long way. Until 2007, there were no oncologists at all - and that's
still the case in some neighbouring countries. Sierra Leone, for example, has more than 6
million people and no cancer doctors. "Countries in the region
like Sierra Leone, Togo, Guinea have absolutely nothing in terms of cancer
care," said Kerr. "That means Ghana's six or so oncologists have to
serve neighbouring countries as well." The result is that the reality for
many in Africa is that a cancer diagnosis means a painful and distressing
death. The overwhelming number of cases and the paucity of funds, doctors and
treatment mean it's difficult to know where to start, Kerr says. But cancer
experts - foreign and African - and patients and advocacy groups say what's
needed first is greater awareness.
KNOWING THE
ENEMY
Ellen
Awuah-Darko is doing what she can. The 75-year-old founder of the Accra-based
Jead Foundation for breast cancer says her own experience - of finding a lump
and ending up paying tens of thousands of dollars to be treated in the United
States - made her to try force change. "In America I had to put down
$70,000 (43,217 pounds) before they'd even talk to me," she said. "I
was lucky, I could afford it after my husband died and left me money, but I
thought 'why should I get treatment when others can't'." Now, every
Wednesday, Awuah-Darko goes with healthcare workers into communities in the
Eastern Region of Ghana to offer women breast screening. It's not the high-tech
mammogram or ultrasound scan women in wealthy countries are used to, but a
simple breast examination and a lesson in how to self-check. "Early
detection can save your life. I want everybody to know that. It's not something
people should be ashamed of or embarrassed about," she said. But she and
the handful of cancer specialists are fighting deep cultural resistance - not
only to the idea that cancer affects people here, but also to the idea they
must talk about it, look for it and recognise it to start fighting against it. Even
among the young and educated, cancer is often taboo. "They don't want to
use the C-word," says Vanderpuye. "That's also one of the main
reasons why someone wouldn't want to come here - because it means she has
รข€˜the C'.
"HUMONGOUS
FOUL - SMELLING TUMOURS"
In the
chemotherapy ward at Korle Bu, oncology nurse Juliana Tagoe, explains why
patients often don't want to talk about cancer. Many people see the disease as
a spiritual punishment, she says. "They think someone has done wrong and
this is the effect - God is punishing them. They feel stigmatised." In
rural communities where spiritual and tribal leaders are revered, the use of
prayer, ritual and herbal remedies is common. Awuah-Darko says witch doctors
tell patients with tumours to "treat it like a boil, and just put some
herbs on it". Others are told simply to pray for it to be taken away. In
the months or years that intervene, the tumours spread and grow to sizes barely
seen by doctors in developed countries. Kerr talks of patients in Africa with
tumours that protrude through the breast or encircle the whole chest, while
Vanderpuye describes patients with "humongous, foul-smelling tumours"
she has little hope of treating.
INFECTIONS
Both Kerr
and Corey Casper, who runs the Uganda Programme on Cancer and Infectious
Disease associated with the Fred Hutchinson Cancer Research Center in Seattle,
say another focus of efforts to tackle this looming cancer epidemic is to try
to prevent the cancers caused by infections. While many cancers are linked to
lifestyle factors such as unhealthy diets and smoking, a large number -
particularly in Africa - are caused by infections likes hepatitis B and C,
which cause liver cancer, and the human papillomavirus (HPV) that causes almost
all cervical cancers.
In
wealthy countries, having hepatitis vaccines as part of routine childhood
immunisation programmes, and introducing national campaigns programmes with new
HPV vaccines from drugmakers Merck and GlaxoSmithKline has brought rates of
liver and cervical cancer down significantly. If such nationwide HPV vaccine
campaigns could be introduced in Africa, experts say, the effect on rates of
death and disease could be dramatic. Global health groups are working with
drugmakers on securing a discounted price for HPV shots for poor countries, but
getting them to Africa could take years. Akosua - a name meaning
"Sunday" that this patient gives instead of her real name - has no
concept yet of how an injection made by a Western pharmaceutical company could
have prevented the cancer spreading inside her. The 48-year-old farmer has
cervical cancer and has suffered with a lot of pain and bleeding, but for now
the fact that she's come to the hospital and is seeing an oncologist is foreign
territory enough. "But I'm not afraid," she says. "I've been
seen by the doctor now. I know I am in the right place to get the right
treatment."
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