It is no longer a secret that many Kenyan cancer patients flock to India seeking for treatment.
By March 2018, almost 9000, including Members of Parliament and Senators went to the Asian country.
Confession from cancer patients declared the poor state and suffering due to congestion at various health facilities.
High cost of living
One of the legislature, diagnosed with cancer, said that patients were grappling with high cost of living – sleeping on pavements since they cannot afford rooms. Staying in India for two months, he spend a whopping Kshs. 1.8 million which only few can afford.
Families and relatives spend a lot of money on transport and medication when their own is diagnosed with cancer and taken to India for treatment.
The media, on the other hand, receives medical appeals of patients grappling with cancer.
As much as we have cancer screening centres and special doctors in the country, majority seek treatment outside the country.
In a bid to understand why Kenyans, with poor economic support go to India, Dr. Mercy Korir of Health Digest (KTN News Kenya) talks to a consultant surgeon, Dr. Daniel Ojuka of Kenyatta National Hospital (KNH).
According to Dr. Ojuka there are few general surgeons in the country as opposed to the country’s 50 million people. He believes that the way surgeons are trained in the country, they can take care of most cancer patients.
“If you look at the number of general surgeons from the board’s registry there are around 300 – 400. They are retained in the registry and you use that against a population of 50 million. We are talking of 1 surgeon per 400,000 people that is certainly not enough according to World Health Organization (WHO) and LANCET indicators”.
Another major challenge inhibiting Kenyans from seeking cancer treatment at home is poor multidisciplinary approach used in diagnosing and curing of cancer. The approach involves taking the patients through the proper procedure without delaying the process.
“An example of breast cancer, most often solid tumours- tumours other than tumours of blood. Most probably they will require to see a surgeon and in the process of treatment you will require to make a diagnosis and for you to do it you need imaging – either ultrasound, CT scan, MRI to get an idea of what you are dealing with”, says Dr. Ojuka adding that more specialized medical doctors are needed including pathologist, oncologist, radiotherapist among others when diagnosing and managing cancerous growth.
Commonly, imaging is done by radiologist while tissue biopsy (part of the swelling or tumour) done by a cadre of doctors called pathologists.
Chemotherapy, which is done before or after surgery, is conducted by oncologist and at the same time patients may require radiotherapy done by radiotherapist.
Since cancer patients, in some cases, have higher metabolism and problem with nutrition, a nutritionist is also important along with cancer nurses who are involved in giving drugs to patients after diagnosis.
The multidisciplinary discussion, when all these special doctors see the patient as a whole, enhances easy understanding of the patient’s spectrum, shortening treating process and improves management of the cancer.
In most Kenyan public health facilities, such approach is not found due to the limited number of specialties.
“The pathologist and radiologist give their contributions of what they think the disease is and the extent of the disease. The surgeons, oncologist and radiotherapist then make a plan together. But if these specialist are in separate places, they may have questions and require to send the patients back to the other person, this process takes long time”, states Dr. Ojuka.
On the contrary, India health sector employ the multidisciplinary discussion approach and it improves the outcome.
The country’s biggest referral hospital, KNH, multidisciplinary approach is used to manage cancer.
“In KNH they have created multidisciplinary teams for most cancer patients. For instance, on Tuesday, breast cancer screening is done. On Wednesday, general screening is done”, adds Dr. Ojuka.
Kenyan health facilities, in the past recent, had been suffering from negative narrative which when juxtaposed with India’s medical tourism – which does the marketing itself, put the country’s cancer treatment in a tight spot.
Indian hospitals receive volumes of patients and the benefit of stable economy, the cost can easily be reduced unlike in the country where the number is less.
However, services like renal transplant, often done at KNH, is cheaper in Kenya than India.
“Marketing in India says cancer treatment cost is cheap but it depends on the type of cancer. For example, pancreatic cancer, most patients with this kind go to the ICU and it adds the cost”, observes Dr. Ojuka.
Local cost implications
The cost of consultation and tissue diagnosis is incurred. When doing the diagnosis, according to the consultant surgeon, biopsy is required which will be taken to the pathologist. Cost incurred include purchasing equipment like needle and using the laboratory.
Furthermore, when identifying the spread of the cancerous growth using modalities such as MRI, CT scan, additional cost is incurred. Imaging types depends on the kind of cancer the patients has.
Treatment cost also involves, for instance, surgery, where it is cheaper in public hospitals compared to private facilities where professional fee is mandatory. For public facilities the patient pays the bed, theatre, gloves, and drugs among other things including the ICU in case of complications.
“For modality of treatment, for example, if you go for surgery, in public hospitals, it is cheap because there is no professional fee – the hospital/government pays the doctor. Cost also depends on the type of hospital you go to – level 6 tends to be more costly. Private hospitals, apart from the above cost, patient will pay professional cost”.
Kenyan doctors can as well take care of patients with cancer if more surgeons are trained and advanced medical equipment placed in major public health facilities for screening and treatment.
Developing national screening also lessens the impact of the cancer especially when most patients in the country are diagnosed at later stage.