UNDERCOVER INVESTIGATION: Cancer Is The Disease, Nigeria’s Health System Is The Killer

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EDITOR’S NOTE: All the names of most cancers sufferers within the undercover elements of this story have been hid as a mark of honour for his or her struggles and respect for his or her privateness. An undercover technique was unavoidable, because it was the one method to verify the true high quality of healthcare obtainable to them in federal hospitals. SaharaReporters confirmed that the journalist is in possession of video and audio proof of ALL the findings of this story.

For a futile month in 2017 and two fruitful ones in 2018, investigative journalist ‘FISAYO SOYOMBO was accompanied by a non-public oncologist in going undercover at two main educating hospitals within the nation to establish the true high quality of healthcare obtainable to most cancers sufferers. Together, they uncover how the shortage of functioning radiotherapy machines is impeding the therapy of quite a few most cancers sufferers and aiding the unfold of the illness from some extent of their our bodies to others, leaving lots of them stranded halfway by their therapy and their households resorting to lobbying hospital officers. This can also be a celebration of affection — how most cancers sufferers are preventing to see each new day by merely in search of to repay the care and religion and sacrifice of their lovers.

This is without doubt one of the most intense, riveting love tales you’ll ever learn. Contrary to what it’s possible you’ll be pondering already, it isn’t set within the Hotel President Wilson in Geneva, Switzerland — the world’s most costly lodge — or within the well-known Burj Al Arab in Dubai, the third tallest and fourth largest lodge on the planet. It isn’t set in Paris, the fabled ‘city of love and romance’, both. Instead, this true life story is ready within the frenetic metropolis of Lagos, particularly domiciled on the gynecology ward of the Lagos University Teaching hospital (LUTH). Dateline, February 2018.

A darkish, lovely younger woman from Edo State — confined to the mattress by terminal illness — writhes in agony. She twitches her proper fingers however the remainder of the arm is static; it’s swollen and bandaged, the supply of monumental ache. She closes her eyes and grits her enamel as if mustering all of the power inside her in an try to say one thing to the physician, however she doesn’t. Weak and helpless, she provides up.

Her boyfriend — a darkish, good-looking, assured younger man from Delta State — minimize a forlorn image. The agony in his eyes is palpable; it’s clear he needs to assist, however he can’t. He can’t even maintain her fingers in his; one contact and he or she’d scream in excruciating pains. Instead, he stares at her in comfort, sporting a sombre look suggesting he would moderately bear the pains on her behalf.

THE POWER OF LOVE 

One of his girlfriend’s breasts has been minimize off; mastectomy is what the docs name it. It is from there that the most cancers raging by her physique emanated. In all, she has undergone surgical procedure, chemotherapy, radiotherapy — the three commonest medical options to most cancers — but her situation is deteriorating. She is turning into paler, dropping pounds, now unable to maneuver — as a result of the most cancers has so unfold around her physique that she now suffers from metastatic neuro illness. Also, as a result of most cancers, she has lymphedema, accountable for the swelling of her eyes and proper arm. She has intense chest pains and struggles for breath after weeing. She’s on oxygen as nicely. And what extra? Breasts don’t regenerate; that breast is gone perpetually. Still, he loves her.

“I love her so much. She was my crush then when we were in Uniben but she used to play hard to get,” he says. “I never knew we would meet again in Lagos.” For the primary time in a pain-laden 15 minutes, she blushes, her face lightening up and her lips slowly parting to launch such wonderful smiles that set one questioning simply how fairly she should have been in her more healthy days. Love, oh love! Such drugs even to the sick.

They have been courting for roughly six months. After dropping monitor of one another again in Benin, the place they each grew up, they met fortuitously on the streets of Lagos in January 2017. She had simply undergone surgical procedure on the time; and because the friendship blossomed, she informed him she had most cancers, and that one in all her breasts had been eliminated.

“Trust me, it wasn’t an issue,” he says of the breast elimination. “Even she was shocked [by my reaction] when she told me; I never felt anyway. If you love someone you have to accept them the way they are; it’s the truth. Life goes on. You can’t hold on to that, because it’s not her fault that she has cancer. I have accepted it.”

What he has accepted is commonly not really easy to cope with. As defined by the exterior oncologist who joined the journalist in getting into the hospital undercover, there are ample examples of husbands who divorced their wives after mastectomy, regardless of already having youngsters after a number of years of marriage. In truth, there are circumstances of husbands who prevented their wives from present process the process, regardless of figuring out that retaining the breasts actually meant a loss of life sentence.

One extra time she clenches her fists in ache and her man’s face contours right into a frown. It’s such an disagreeable sight to behold. For how lengthy will they endure this ache? When will she be sturdy sufficient to get out of the hospital and return to her regular life?

“I pity her a lot,” says the undercover physician. “But I pity her boyfriend more. This lady I see has one year — probably two more — to live. The doctors handling her case must have told her, and I hope she has told her man — because no doctor will. The doctor tells the patient the truth but no one else. There is a doctor-patient confidentiality that forbids the doctor from opening up to anyone else other than the patient.”

BLAME CANCER, BUT BLAME THE HEALTH SYSTEM MORE!  

When — or if — she dies, her loss of life shall be blamed on most cancers, however make no mistake: the Nigerian well being system would have been vastly complicit. Her loss of life would have been fast-tracked by the numerous inadequacies of a comatose public well being system. Why?

Last yr, she was scheduled to bear exterior beam radiotherapy (RT) therapy, ideally delivered by a machine known as Linear Accelerator, or Linac for brief. All linacs generate excessive vitality x-rays (photons), that are then rigorously aimed on the space of the affected person’s physique being handled by the Consultant Oncologist. First, LUTH’s RT machine isn’t linac, due to this fact incapable of manufacturing the utmost outcome. Two, she was scheduled for 18 programs. But after 10 rounds, the RT machine broke down (in June 2017). Thus marked the top of her radiotherapy therapy — simply on the midway mark. Almost one yr on, the machine hasn’t been mounted, neither has a brand new one been purchased.

In any case, there’s good cause to doubt the efficacy of these 10 periods, as she recollects the difficulties confronted by sufferers within the last days of the broken-down machine. “There were serious issues with the machine,” she says. “A lot of people were having complications; some were overdosed, others under-dosed.”

A LETHAL PAUSE

According to the undercover oncologist, the aborted process she was present process is known as ‘adjuvant radiotherapy’, that’s radiotherapy accomplished following a debulking surgical procedure (also referred to as tumor elimination surgical procedure).

“The courses are spread out in such a way as to target the remnant metastatic tumour cells,” he explains. “She was placed on 18 courses of radio, spread out over months, in order to deal with the problem cell by cell. So, what happened when the radiotherapy machine spoilt is that you stopped the process of clearing the metastatic cells.”

The implication is that these cells that had not been cleared after the 10 programs would proceed giving her signs manifesting as pains in elements of the physique. “Cancer cells feed on blood, so the person will still look sickly,” he says. That is one of the best state of affairs for the luckiest affected person.

“But the worst — which is usually the case and which has clearly happened in this case — is that the metastasis continues, which means as the cells around her breasts were being targeted, the metastasis could have gone to the lungs and could have even gone as far as the brain — because the process of spread is through the blood or through the lymph nodes,” he provides. “The patient can start coughing blood because the cancer has gotten to the blood, or you start seeing signs of encephalopathy because it has got to the brain. You see she complained about back pains? It is because the cancer has spread to her back. These are all favourable areas for breast cancer spread; breast cancer likes the brain, the lungs, the bones.”

She is clearly a sufferer of the system. Unlike most sufferers who report back to the hospital late, she sought medical recommendation as soon as she seen a lump in her breast in September 2015. After working a collection of exams, she was recognized with most cancers. She promptly started therapy, staying on chemotherapy for six months earlier than going below the knife in February 2017. This was adopted by took two programs of chemo after surgical procedure, earlier than enlisting for the botched radiotherapy therapy.

“I didn’t delay treatment at all,” she says emphatically. “Everything was rapid.”

STRUCK DOWN BY INDUSTRIAL STRIKE  

She’s not the one sufferer of the system, although. Of the dozen others whose tales can be touched on this piece, one decides to reveal all of it. As he explains, there’s nothing left of his human pleasure. All of it has been “taken away”.

Now 42, Muhammed Musa was solely 5 years outdated when his mother and father seen a small development round his proper eye. It was small but it surely wouldn’t go away. Best description to offer it: “permanent pimple”. As the years handed, it initially didn’t harm, neither did it rise in bulge. But as Musa approached adolescence, the pimple started to indicate that it wouldn’t be ignored. Then it started to multiply. From the eyelids, comparable sights instantly started showing on different elements of his physique. Rashes! So his mom thought, and thus she sought native therapy of their Village in Edo State.

In his mid-20s — now a person and now in Lagos — Musa sought medical assist. Cancer of the eyelids, the docs stated — with attendant tumours that wanted to be eliminated. This was disturbing information as a result of he couldn’t elevate the funds. “None of my people had money, as I come from a really poor family,” he recollects.

However, by 2004, he had managed to boost simply sufficient cash to take away the tumour. It was a minor surgical procedure. It regarded like he had seen the top of his travails. If solely he knew that was only the start.

Within two years, the tumour was again — this time on the left eye. He had barely recovered from his big indebtedness courtesy of the 2004 operation. Musa frantically started job-hunting, hoping to have the ability to save sufficient to sometime fund a second operation. But nobody would make use of a sick candidate. “That was how I suffered from 2006 till 2010/2011 when I eventually raised the money needed to remove the tumour,” he says.

AN EYE FOR THE SYSTEM  

The most cancers unfold from a watch to a different as Musa awaited the top of docs’ strike actions

Then one thing heartbreaking occurred. The National Association of Resident Doctors (NARD) launched into a nationwide industrial motion, after a collection of warning strikes, to “draw the attention of the Federal Government to the deteriorating state of the health sector and low morale of doctors”. As the motion coincided with Musa’s surgical procedure date, he missed an enormous likelihood. That was in April 2010. Two extra industrial actions adopted, and on every event, the sufferers had been discharged and nobody reached out to them upon resumption of labor. In all, Musa waited on the docs for therefore many months, “almost a year”. Of course, the most cancers wasn’t ready. It unfold so quickly that it value Musa his eye.

“When I started visiting the hospital, the tumour was quite sizeable, but not so big to the point where it would have affected my eye,” he says in a teary, regretful tone. “But the tumour became overlarge because of the strike action. The doctors would even admit us preparatory to surgery, but there would be strike so they discharged us each time.”

When the final of the commercial motion was ultimately known as off, LUTH didn’t attain out to him. He was “lucky” that the tumour was giving rise to wounds that wanted to be dressed, so he went to a non-public hospital the place the wound was dressed for ₦10,500. Subsequent ones had been to value ₦5,00zero per session. He didn’t have the ₦5,00zero when the second session was due, so he risked an unsolicited go to to LUTH to see if somebody may gown the “painful” wounds. “When I bought there I met the physician, and he stated they had been searching for somebody to ship to me, that the strike was over they usually wished to carry out the surgical procedure. So they gave me a date: March 14, 2011. But the tumour had grown so giant that docs stated he must lose his eye.

FORTY-TWO AND STILL SINGLE  

No spouse, no child at 42. Who will care for Musa?

Musa ultimately went below the knife, sacrificing his proper eye for the decay within the system. One extra growth: his different eye had grow to be badly affected by the wait; so, not lengthy after the surgical procedure, a tumour started growing there as nicely. In 2013, he was informed one other surgical procedure would value him ₦700,00zero. Unable to afford it, he opted to attempt the Lagos State University Teaching Hospital (LASUTH), the place he didn’t know extra dangerous information awaited him.

“Because the fees they charged was too much, I went to LASUTH at Ikeja. They said there would be consequences if they performed the surgery. One, the second eye would have to go. My ears would stop working. They would remove all the skin on my head, and use another to cover it. That was in 2013,” he explains, tears coursing down his eyes.

“I told them I couldn’t do it — because the left eye had already gone. If I should lose the right one, who will take care of me? Due to this problem, I am still single at 42. I don’t have a wife; I don’t have a child. So who would take care of me?”

‘I’M DYING BUT I DON’T WANT TO DIE’ 

Musa’s swollen legs

Back then in 2013, Indian docs informed him they might take away the tumour and in addition save his eyes. But it could value him N3.8million. however to pay that was somebody who couldn’t afford N700,00zero

By August 2016, the invoice had risen to N8.5 million. Without a job, somebody to care for him, and even cash to feed, Musa is all by himself at dwelling — someplace in Oshodi — resigned to destiny.

“In June 2017, I started experiencing excruciating pains in both legs; they legs swelled up, and at the end of the day, this one burst. You can see the opening,” he says, then provides in to a cough he had be making an attempt arduous to suppress.

“I went to Gbagada General Hospital,” he continues, “but they refused to attend to me. They said I should go back to LUTH, being my first clinic. When I got to LUTH, they said there was no available bed for me, and that they would take me to a private hospital: ₦50,000 deposit first, and ₦1million or more if I spent more than 10 days there. Even ₦5000 I didn’t have on me on that day, where was I supposed to get ₦50,000? from”

Musa’s drawback is past the tumour overshadowing his proper eye. To show this, he removes his shirt and folds up his knickers, revealing spots of rashes and tumours marauding his pores and skin. A thick stench directly rents the air on the penthouse from which the owner is already threatening to eject him for defaulting on lease.

NO FOOD, NO WATER, FAILING HEALTH  

More tumours are showing on Musa’s physique, they usually’re rising quick!

“I’m sorry, my brother, but I have nothing to hide any longer. If I die today, the people who will bury me will get to see the nakedness I’m hiding. Look at me, I’m dying here but I don’t want to die. Please help me,” he says tearfully.

“I’ve run everywhere possible… no one to help. I wrote to the Ministry of Health; I wrote to the Lagos State government. They said they had no funds to assist me. My brother, I swear to God, since yesterday, even sachet water I have not seen to drink.”

Musa did get some assist alongside the way in which, although. A home officer at LUTH picked curiosity in his case, and continued sending him cash even on the expiration of his housemanship and relocation from Lagos to Ibadan. That physician is now jobless, and as such, Musa is feeling the warmth.

“It is only this doctor that has helped me when capable. But since he lost his job, I have been in a bad situation here. It is only if someone remembers me and decides to visit, maybe one of my mosque members, that I get something to eat.”

The dangerous information is that it seems to be his situation might worsen. He is aware of as a lot, admitting: “You know, these skin rashes have now started developing tumours; the doctors said they have stayed too long on my body. The only thing they can face is the tumour on my eyes. And when they’re done facing that one, we will be dealing with more tumours from those rashes.”

NO RADIOTHERAPHY IN LAGOS, NO BIOTHERAPY IN ZARIA 

“Please help me, please help me,” a 64-year-old girl says in Pidgin English amid suits of cries and screams. “Doctor, abeg make una help me oooooooooo.”

Were the fundamental most cancers therapy procedures in place, this girl would don’t have any enterprise with admission at LUTH’s gynecology ward. By the lady’s account, LUTH referred her to the Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, to bear organic remedy (biotherapy for brief) — a sort of therapy that makes use of substances constructed from dwelling organisms to deal with illness. Biotherapy is taken into account superior to chemotherapy as a result of chemo medication can’t differentiate between most cancers cells and wholesome cells within the physique. As an outcome, chemotherapy causes injury to regular cells, which may end up in nausea, fatigue, hair loss and different negative effects related to the sort of therapy. Biotherapy, in the meantime, typically makes use of pure, dwelling substances that bolster the immune system’s capacity to battle most cancers. In addition, some types of biotherapy forestall particular most cancers cells from rising, and even kill them. Compared to different most cancers remedies, the negative effects of biotherapy are notably low.

After listening to the lady, the undercover physician explains what the LUTH docs should have been pondering, in sending the lady to Zaria. “Sometimes, as a doctor, you assess some patients and you see clearly that there is a limit to the external gimmicks that you can make. So you complement with biotherapy.”

Worried by how her two kids, each adolescents — one male, the opposite feminine — would survive ought to she die — the lady, a roadside roasted plantain vendor at Ojo-Alaba, Lagos, borrowed cash and endured a tumultuous highway journey to Zaria from Lagos. Without sufficient cash for lodge lodging, she slept out within the chilly throughout her few days in Zaria. That was in 2016. On arriving the educating hospital in Zaria, she was informed, first, that they weren’t anticipating any affected person from LUTH. The LUTH authorities hadn’t pre-contacted them. This may have been sorted out in a matter of days, however the larger drawback was that Zaria’s biotherapy machine had damaged down.

“It’s not only Zaria; I know two teaching hospitals in Nigeria with the equipment to carry out biotherapy, but none of them as functioned in the past three years,” the undercover oncologist provides. “In fact, presently, there is no functional biotherapy equipment in any public hospital in Nigeria. Long and short, biotherapy is currently unavailable in Nigeria — and this is a function of equipment, not expertise.”

Ever since, the lady has been frequenting LUTH for medication, exams and admission. But, on the proof of present pains, the most cancers in her cervix is spreading quick.

‘I DON’T WANT TO DIE… MY CHILDREN ARE STILL IN SCHOOL’

“Since then, I have been constantly complaining, especially regarding my stomach. It’s getting bigger and the pain is so much,” she says, once more in tears. “I have spent a lot of money too, and on many scans that cost ₦40,000, ₦30,000 each. There is nothing, including scans and injections, they recommended that I have not done or bought, but my belly is swollen now and won’t return to normal size.”

The girl bursts into one other spherical of please-help-me tears. The abdomen apart, her left leg has swollen up. Various scans on the leg have yielded no answer. She can also be one of many victims of the breakdown of LUTH’s radiotherapy machine; she had solely accomplished somewhat greater than half of the advisable radiotherapy periods when the machine broke down in June 2016. Twice — with biotherapy and radiotherapy — this nation has failed her. And that is after spending nicely over N1million on her well being. Bear in thoughts that this can be a roadside roasted plantain vendor, and that the abdomen and leg swellings and pains weren’t there pre-Zaria, when she first reported to LUTH.

“Please help me,” she sobs once more, louder this time, as undercover oncologist and physician make their means out of the ward. “Please, help me. It is the small money I make from my work that I use to send my children to school. I don’t want to run out of funds for their education. I don’t want to die while they’re still in school.”

A DAY AT LUTH’S ONCOLOGY AND RADIOTHERAPHY DEPARTMENT 

LUTH’s oncology/radiotherapy division… early within the morning

On a median day, the Oncology Department at LUTH is sort of a tripartite enviornment. First half, early within the morning, it takes on the appearance of a graveyard. We’re speaking 7:00, 7:30, eight:00am — most cancers sufferers, young and old, female and male, are trickling in, some for affirmation of subsequent laboratory exams, some for the highly-dreaded chemotherapy periods, others for affirmation of surgical procedure dates or for post-surgery analysis.

The ward is usually quiet at this stage, save when the acquainted faces of long-term sufferers interlock, paving the way in which for alternate of mild-witted niceties. Globally, most cancers is a typically lethal illness. But Nigeria is the place the loss of life ratio is highest: 805 of 1,00zero circumstances — or 4 in 5 most cancers circumstances — end in loss of life. According to statistics from the World Health Organisation (WHO), over 100,00zero Nigerians are recognized with most cancers yearly, with 80,00zero of them dying from the illness — a median of 240 Nigerians/day or 10 Nigerians/hour. As if that wasn’t sufficient, WHO has predicted that Nigeria can anticipate a 75 per cent enhance in cancer-induced loss of life by 2030. Add that to the chaotic and comatose well being system and it may be stated that in Nigeria, most cancers is considerably a loss of life sentence, the explanation the oncology ward often wears a sombre, gloomy look early within the morning.

Usually, from a couple of minutes previous 8am until 10am or thereabouts, a first-time customer could be forgiven for pondering he missed his means and ended up in a church! This is the second half, comprising reward and worship, sermon and altar name. Then the third and last half is the place the ward seems to be each like a hospital-cum-market: filling the attendance checklist, roll name of sufferers, loud complaints by indignant sufferers.

When the journalist visited the division one Thursday in March, all three situations performed out. First, the preliminary silence. But at eight:20am when a nurse is available in and tells the sufferers ‘Let us pray’, all the pieces adjustments. After the prayer comes a reward and worship session that begins thus at precisely eight:55am: O se o Jesu/a o ma yin o/o se o Jesu/Olorun ayo wa (Thank you Jesus we are going to reward you, the supply of our pleasure…). Soon, nurses and sufferers invite God to their midst to carry out miracles, singing: Yahweh/Your title is Yahweh/You are the miracle working God/Your title is Yahweh, and later Come and do your miracle as we speak/Your miracle as we speak….

PRAYERS FOR REPAIR OF RADIOTHERAPY MACHINE   

 Capital Expenditure For Federal Ministry of Health (2014-2017)
Infogram

One have a look at the sufferers and one may inform they regarded extra to God for assist than to the docs at LUTH. And it’s straightforward to see why: these of them scheduled for radiotherapy periods perceive that the docs can do no magic if the federal government continues ignoring the hospital’s broken-down RT machine. In any case, the nurse main the session quickly touches the matter as reward and worship morphs into full-blown prayers. “Let us continue to pray for Nigeria and for our government,” she fees the sufferers. “It is our right to have this radiotherapy machine but unfortunately our government is not up to date in this wise. We are optimistic that things will improve very soon, but we must pray so this can happen quickly.”

The finish of prayers at 9:22am isn’t it for the day, no. A feminine physician — tall, truthful and with a thick Igbo accent — takes over. It’s sermon time! It lasts roughly 20 minutes and is adopted by the altar name: those that wish to give up their lives to Christ have the possibility now. Of course, for a inhabitants of individuals bothered by a illness that interprets to a loss of life sentence of their nation, fairly a quantity offered themselves. Who would blame them? Better at hand one’s stay to Christ since Nigeria locations no worth on it, anyway. Altar name ends at precisely 9:49am; time, now, for the day’s essential actions.

As the sufferers be careful for his or her names to have their moments with the physician, there’s a big dialog about how the shortage of a radiotherapy machine at LUTH was compounding their woes. By the accounts of 5 sufferers, non-public hospitals are making the most of the hole.

HELPING PATIENTS SEE DOCTORS IS LUCRATIVE BUSINESS  

“I went to Eko Hospital after the breakdown of LUTH’s machine, and I was given a bill of N160,000,” says a slender, light-skinned girl. “But when I presented myself on appointment date, I was told that the cost had risen to N250,000. Apparently, Eko Hospital had become aware of the damage to LUTH’s machine, so they saw an opportunity to make quick money.”

“It’s blood money, I tell you!” one other affected person yells. “My own problem is that Eko Hospital is crowded these days; it’s so difficult to see the doctors.”

Having devised an underhand means across the problem, the primary affected person gives some fascinating recommendation: “There is that this boy who lives not so removed from the hospital; should you give him N500, he’ll go there round 2 or 3am to put in writing your title on the sufferers’ checklist for the day. I can hyperlink you to him if you’d like, however that’s what I do.

“I started doing it since the day my husband and I spotted robbers around Jakande and Lawanson [on Victoria Island] when we left home around 4am because I needed to see the doctor early. We had to stop doing that; we won’t die before death comes.”

Were the boy to do this for 10 sufferers daily, that’s N5,00zero every day — N25,00zero on the finish of the week.

Their dialog is interrupted by a girl who left her dwelling in Ikorodu at 5am so she may arrive the hospital in time to see the physician, however has now been informed, at 11:06am, that her file is lacking.

“What manner of nonsense is this?” the lady, darkish, ostensibly in her mid-30s, says. “Can you imagine such utterance? As if I took my file home the last time!”

She returns to the hospital employees after 15 minutes however she is informed to “stop disturbing us”. “This people are trying my patience,” she huffs. “I will leave them to their madness and go to my home, after all it is God who takes care of the sick.”

After about an hour of tussle, she is informed to see the physician; the file can be taken care of later.

File disappearances aren’t particular to LUTH. According to a physician, who requested to not be named due to her shut ties to the UCH, such disappearance as soon as valuean affected person’s life — not directly.

“Few years back while working at UCH, I had this patient whom I suspected had breast cancer. But to be 100% sure, I sent her to the lab,” she recollects. “She did the check, however when the time got here to gather it, UCH couldn’t discover her outcome. She was informed to pay a second time for one more check.

“But this woman never came. Instead, her church members convinced her to focus on prayers. Guess what, she eventually died of cancer. If UCH hadn’t lost her test, she would have started treatment fairly early, and maybe she’d still be alive today.”

AT UCH, NO CONNECTION, NO RADIOTHERAPY  

On his sick mattress on the University College Hospital (UCH), this 54-year-old affected by most cancers of the anus cutsan annoyed determine. Since relocating to UCH in February (and that is March), he has taken in 5 pints of blood — along with seven at LUTH. And he has suffered. Each time he tries to speak, he finds that the power left in him isn’t as much as it. Then he resorts to tears. “I know I will get well,” he says intermittently, “and when I get well…”

His spouse at all times cuts in: “Relax, honey; you will be fine.” She is his spokesman now. Not simply that, his number-one caregiver, his supervisor, his comforter, his pillar. Another traditional instance of how listless life can be with out love — how, with out love, hospitals can be quicker pathways to the graveyard.

“He was rejected at LASUTH because there was no bed space,” the undercover oncologist and journalist, who had discovered their means into UCH by the backdoor, overhear his spouse say to a good friend on the telephone.

Even at LUTH, there was no mattress area. But seeing how badly he wanted to be admitted, the docs took the troublesome determination of looking out around the ward to see who may very well be discharged. Finally, they discovered somebody whose situation they thought was the least vital, and despatched him dwelling; however ordinarily, that affected person would have remained on admission.

That admission at LUTH was short-lived, although. He wanted radiotherapy and was informed the machine would “soon” be repaired, however the wait was turning into countless. Earlier, he had additionally waited on the radiotherapy machine on the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, for greater than a month, however was ultimately informed it was “bad”. No longer keen to take dangers, he determined to attempt UCH. But there was nonetheless one drawback: it was January however UCH’s radiotherapy machine was already booked until April! Luckily, after his spouse known as a doctor-friend of hers, they obtained an expedited appointment. They arrived UCH in February, after greater than three months of rejection by LASUTH and ready on UCH and UNTH.

And so, whereas Eko Hospital is cashing in on a scarcity of radiotherapy machine at LUTH, UCH is smarting from it. At UCH, there’s elevated competitors for the machine to the extent that non-UCH sufferers don’t have any likelihood of going below its radiotherapy machine early sufficient until they’re linked to the hospital’s hierarchy.

On his illness, they’ve spent greater than N2million — greater than half of that as a result of countless look ahead to the machine. “We spent a lot of money on tests and drugs just to keep him in shape pending the readiness of the radiotherapy machine,” she says. “SO far, he’s had five radiotherapy sessions. Hopefully, he can get well soon.”

200 MILLION PEOPLE, FOUR RADIOTHERAPHY MACHINES  

 Capital Expenditure For Federal Teaching Hospitals In Nigeria (2014-2017)
Infogram

There are solely 4 functioning radiotherapy machines all around the nation to serve an estimated 200million Nigerians, but the International Atomic Energy Agency (IAEA) suggestion is one RT machine per 1million folks, that means Nigeria ought to ordinarily have roughly 200 RT machines.

Of these 4 functioning machines in Nigeria, one is owned by Eko Hospital, a non-public hospital. This signifies that of the 20 federal educating hospitals within the nation, solely three — UCH, Ahmadu Bello University Teaching Hospital Zaria and the National Hospital Abuja — at the moment have useful radiotherapy machines. The Usman Dan Fodio University Teaching Hospital Sokoto (below repairs), UNTH and LUTH have, however the machines have been down for various lengthy durations of time — that’s having like not having!

To put the scenario in perspective, 17 of Nigeria’s 20 educating hospitals can’t provide radiotherapy to most cancers sufferers. Also, radiotherapy is unavailable in all the South-South (comprising Akwa Ibom, Cross River, Bayelsa, Rivers, Delta and Edo states). Anyone recognized with most cancers on this area should journey out of it — both to Enugu within the South-East, Lagos or Ibadan within the South-West, or Abuja within the North-Central. This pattern is nothing new; there was a time in 2015 when solely two radiotherapy machines had been functioning in the entire nation.

‘OLD SCHOOL’ RT MACHINES  

A cobalt-60 RT machine bought in 2017 by the Ugandan authorities

Painfully, of the 4 radiotherapy machines obtainable throughout Nigeria, just one — National Hospital Abuja’s — is helpful for curing most cancers; all different three can’t. They are solely helpful prolongingan affected person’s life; extra like ‘you’re going to die anyway however let’s attempt to not make you die too quickly’.

So explains Runcie C. W. Chidiebe, a most cancers management advocate and Executive Director, Project Pink Blue.

“The radiotherapy machines at Zaria and Eko hospital are cobalt machines,” Chidiebe moans.

“I have interacted with so many medical physicists, clinical oncologists and radiation oncologists, and they will tell you that the beam produced by cobalt radiotherapy machines is not sufficient to prevent spread or even ensure any treatment or therapy; it is just good for palliative care only — that is the situation whereby you’re no longer trying to achieve cure but just to prolong the patient’s life.”

Chidiebe was shocked to seek out out throughout a current go to to Texas Oncology in Sherman, in US, that only one centre had two radiotherapy machines — one variam, the opposite linac accelerator — serving 100,00zero folks.

“None was cobalt!” he exclaims. “These are the newest machines that produce sufficient beams that can really contain the cancer and prevent it from spreading to other vital organs.”

THE RADIOTHERAPY HUSSLE IS REAL      

A varian linac RT machine in use on the National Life Cancer Treatment Centre of the Central Vermont Medical Centre, US

An anticipated consequence of the shortage of RT machine is the large competitors for periods within the three hospitals the place the service is on the market. In these hospitals, an appointment is extraordinarily troublesome to safe, and officers attempt their finest to not provide ensures on the steadiness of their RT machines.

“The machine is working,” a UCH official stated on the telephone when requested for a way quickly an appointment may very well be booked, earlier than rapidly including emphatically: “as of today!”

A contact within the radiotherapy division was provided, and, though the physician on the different finish hesitated to pin a date foran affected person that hadn’t been bodily examined, he ultimately stated: “If the patient comes and we discover that it is not an emergency, he cannot get a RT appointment before July.” That is 4 months of providing the most cancers unfettered entry to unfold!

FINANCING FOR ONCOLOGY MUST IMPROVE  

Chidiebe laments: No bone scan working in all the nation

So, what could be accomplished to bolster the standard of therapy obtainable to most cancers sufferers, significantly when it comes to entry to RT?

“Most of the RT machines break down intermittently,” says Chidiebe. “Some don’t even work up to one month. It takes months to get money out for maintenance, but cancer doesn’t wait; it keeps spreading. We have refused every year to invest in cancer control. Financing for oncology and radiotherapy is so poor; it has to be improved.” 

Another step, he explains, is for presidency to purchase the machine spare elements and preserve them, as a substitute of ready for the machines to develop fault.

“As I speak to you, there is no bone scan working across the country. We have two bone scan centres — UCH and National Hospital — but the problem is that there are no reagents,” he says.

“Can you imagine? The machines are there but no reagents. Isn’t it shameful? The nuclear medicine guys have to travel to South Africa to get these things. The Nigeria Customs Service are not helping issues, too, with the way they frustrate you with their corrupt demands when you try to bring these machine in.”

WHERE IS THE MONEY???   

Adewole, Health Minister

The most costly linac radiotherapy machines value between of $750,00zero and $1.5million (between N228 million and N456million, on the present CBN price), excluding related prices such because the vault that may home the system, therapy planning and oncology info system software program, lasers, and different equipment.

However, solely N55.6 billion was allotted to capital tasks within the ministry of within the 2017 finances. In 2016, it was N28.7billion, N22.7billion in 2015, and N49.5billion in 2014. In 2017, a complete of N4.01 billion was budgeted for all 20 educating hospitals; it was N2.4billion in 2016, N1.8bn in 2015 and N9.3bn in 2014. That’s grossly insufficient, contemplating the big gear deficiencies of these establishments, which maybe explains why University of Port Harcourt Teaching Hospital, regardless of receiving the most important share of the 2017 capital allocation (N492.8million), nonetheless doesn’t have a RT machine.

While the well being sector is incontrovertibly underfunded, it could seem that the larger drawback is monetary mismanagement, not under-funding. In the 2017 finances, N9 billion was particularly allotted to the acquisition of radiotherapy machines for some educating hospitals (and one other N117 million was additionally budgeted for cancer-related points).

Let’s make two unlikely assumptions: that the federal government purchases the costliest linac RT machine in existence (N456million) and the related prices are as costly because the machine itself (one other N456million). This would imply that on the very most, one RT machine would value N912million. Therefore, the N9bn finances would have funded the acquisition of 9 radiotherapy machines.

But in 2017, the federal government purchased just one RT machine — for the National Hospital! The query, then, is: the place is the remainder of the N8bn?

This was one of many many questions that may have been put ahead to Isaac Adewole, a Professor of Gynaecology and Obstetrics and Minister of Health, and Osagie Ehanire, Minister of State for Health, however neither responded to the e-mail and textual content message despatched to them.

THE LONG-TERM SOLUTION  

Universal Health Coverage (UHC) is the long-term answer, says Pink Oak’s Laz Eze

Dr. Laz Ude Eze, Executive Director of Pink Oak Cancer Trust — an NGO that raises funds to assist most cancers sufferers entry higher care — can’t perceive why Nigeria can’t reproduce the success of even neighbouring African nations in making high quality care obtainable to most cancers sufferers.

He recollects — and provides that “it is shameful” — that when all of the radiotherapy machines in Nigeria broke down, Nigerians had been travelling to Ghana for radiotherapy.

“These Ghanaian hospitals were not full-fledged government hospitals,” he says. “One was an initiative between the Swedish government and the Ghanaian government, bringing in some private investors. The hospitals where our presidents get treated abroad and all our public office holders run to with taxpayers’ money are not government hospitals. Most of them are private hospitals. So, why can’t we attract that level of investment here?”

The long-term answer to the most cancers problem, he’s sure, is Universal Health Coverage (UHC), a compulsory medical insurance for all Nigerians, enabling them to entry the best doable high quality of healthcare with out monetary issue. He says the nation’s decision-makers know this however the political will is missing.

“That ‘without financial difficulty’ is a keyword. The health sector needs much more money than government currently allocates to it,” he says.

“With the UHC, everybody contributes to a medical fund. Everybody can’t get sick on the similar time, due to this fact folks with most cancers can get therapy and don’t should pay out of pocket; and in the event that they should, it will likely be one thing the individual can afford.

“It doesn’t imply it must be completely free. But it must be that regardless of the extent the place the individual operates,an affected person will be capable of afford healthcare. He doesn’t must go bankrupt. You won’t want to decide on between feeding your loved ones and paying for his well being, or paying your baby’s faculty charges and paying on your well being. The alternative value won’t should be something that’s essential to you. So it’s similar to you wish to purchase coke — you recognize, that degree — and you’ll not really feel it. That’s the vacation spot

“And it’s something that, if there’s political will to get it done, within two to three years, we can have it. We may say there is no money, but there is money for things that government considers important. If they don’t have money, they’d borrow to fund it. So, all the solution to this is for the government, at federal and state levels, to consider cancer as an important challenge.”

‘SOMEDAY IN THE FUTURE, WE’LL PAY FOR IT’   

Would there be penalties if authorities continues ignoring the underwhelming high quality of care obtainable to most cancers sufferers? Chidiebe says sure.

“It means people will continue to die unnecessarily, avoidably,” he says. “And you know the saddest thing? Most people who develop cancer are the aged whom we need to mentor the young ones. We’re raising a generation of youth lacking in mentoring by elders; and someday in the future, we will surely pay for it.”

This piece was initially printed by the ICIR

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