Daily Independent (Lagos)
Emma Maduabuchi
11 October 2008
Lagos — Despite known serious medical advancements in the care and treatment of cancers, Nigerians fall to the scourge that is currently ravaging the nation
Hajia Nana-Aisha Ali and Mrs Ramatu Adama were two of a kind. They had one thing in common, a bond of daughter-and-mother relationship. That bond was so strong that it was quite easy for neighbours and outsiders to see how deeply they loved each other.
Unfortunately, Adama was diagnosed of cancer in April 1998. It was a tough time for her daughter, who watched helplessly, in dismay as life was gradually squeezed out of her beloved mother. She could not save her mother from the agonising pain she went through until she finally passed on at the age of 51 in January 1999. Adama died of cancer.
Ali narrates her account of those nightmarish days and how her entire family was devastated as a result of that tragedy. However, the tragedy of the loss of a mother opened her eyes. It was then she began to realise how much cancer patients suffer, and how very little the disease is known in the country, and the little being done to control or combat it.
Her words: "My mother's case made me aware of the plight of the cancer victims and what significant roles our society must play to alleviate the pains they go through. I was disheartened to learn that a cancer patient needs to go very far to get assistance, which in most cases takes up the entire life savings of the family."
That was about nine years ago, and today cancer is still claiming victims. It has ravaged the Nigerian population that it can now be likened to a scourge. Nigerians have had to mourn two illustrious and iconic citizens, who died recently of cancer in foreign hospitals.
Yinka Craig, ace broadcaster died in far away United States of America (U.S.A.), at the Mayo Hospital Rochester, Minnesota early Tuesday morning, September 23. He was reported to have died of Non-Hodgkin's Lymphoma (NHL), described as a group of cancers that affect the white blood cells. Before his death, the founder of Ozzidi music, Sunny Okosuns had fallen victim of the dreaded disease. Just like Craig, Okosuns died of a cancer related ailment on Sunday, May 25, also in an American hospital.
Okosuns and Craig's ailments were wrongly diagnosed in Nigeria. They got to know their actual illness after a second diagnosis abroad. By then, it had become too late to save their lives.
Okosuns and Craig were regarded as role models and were adored by Nigerians for achieving national acclaim by investing greatly in their talents, and inspiring others to great accomplishments through patience and hard work.
Gani Fawehinmi tested the bitter pills of wrong diagnoses, but is lucky to be alive to tell his story. The legal luminary and civil rights activist confirmed in a widely publicised statement that he was indeed diagnosed of a different ailment in Nigeria. According to reports, he was being treated for pneumonia before he was flown abroad. He was taken to the United Kingdom (UK), when it became serious and apparent that the medical attention he was receiving in Nigeria was not improving his condition. According to one of his daughters, Rabiat, doctors in the UK had to diagnose Fawehinmi the second time where they discovered her father was suffering from cancer of the lungs.
"He was not given proper diagnosis of what was wrong with him in the hospital in Nigeria where he was first attended to. They told him that something different was wrong with him. Even when he was trying to make sure that everything was all right, it was obvious that something was wrong somewhere.
"So, when the proper diagnosis was made, from then on, the proper medications were prescribed. When he travelled to the UK, contrary to the insinuation that he had heart-related problem, doctors diagnosed that he had lung cancer," Rabiat said.
Fawehinmi is considered by many as a privileged Nigerian. He is fortunate that his ailment was eventually properly diagnosed and known. He has the wherewithal also to travel abroad for proper treatment. Many Nigerians who live on the lower rungs of the societal ladder who could not scrap up enough savings to pay for the poor medical services here in Nigeria may not be that lucky.
Oliver de Coque, the bearded highlife giant also travelled this unfortunate road. He died on Friday, June 20. His death somewhat generated some controversies. While family members described what killed him as a mysterious ailment, many suspected cancer. It is believed that if he was flown abroad like others, the ailment could have been properly diagnosed and discovered, and maybe, lived to give his own testimony. There was also speculation that he died because his family members probably could not raise enough funds to fly him abroad.
Cancer, according to Dr. Abiodun Popoola, a consultant oncologist at the Lagos State University College of Medicine (LASUCOM), is "an abnormal tissue mass; a growth of which is uncoordinated and uncontrollable even after the stimulus, that is, the thing that triggers the growth is removed."
The consultant says that cancer has the characteristic of spreading to other parts of the body, and can do this, either through the blood stream or through what medical experts call empathic drainage.
Treatment of cancer has been described as very expensive and clearly out of the reach of a large percentage of Nigerians. Emmanuel Okorafor, a Lagos-based pharmacist, explains that the disease is usually expensive because even while one spends to combat it, one is also investigating to determine the state of the disease.
"It is a very painful disease. It is very expensive as well as painstaking," Okorafor said.
For Dr. Ndi Okwuosa, the director of Golden Cross Hospital (GCH), Festac Town, Lagos, "managing the disease is very expensive. Unless one has government sponsorship, it would be almost impossible for an average individual in Nigeria to bear the burden."
The pharmacist, however, revealed that much progress is being made in the field, especially with the development of a new vaccine. He confirms that Cervarix has been developed by Glaxo SmithKline, which protects women against cancer of the cervix. According to him, this is a most rampant and deadly kind of cancer, which kills at least one woman every two weeks.
Okwuosa said that by December last year, Glaxo received from the US Food and Drug Administration (FDA) "complete response" in regard to approval of the Cervarix cancer vaccine. European regulators, he revelled, had also already approved Cervarix in September this year.
"Glaxo is trying to increase its share of the global cancer drug market, which is expected to jump from its current $35 billion to $66 billion by 2010," he said.
Saturday Enquirer also gathered that Merck & Co. (MRK), and Sanofi-Aventis SA (SNY), already have their cervical cancer vaccine, Gardasil, in both the U.S. and EU markets. But the reality on ground suggests that the excruciating poverty in the country makes it extremely impossible for most Nigerians to access the ordinary across-the counter drugs.
"How can such a people be able to pay cancer bills?" One analyst queried.
The consensus among a great majority of Nigerians is that so many ordinary Nigerians are perishing as a result of cancer and other deadly diseases, which are usually unknown to them.
But Popoola says that there is evidence that Nigerians do not go to the right places and often fail to seek help at the right time.
"At times too, when they are told that this thing is wrong with them, some would say 'no, it can't be me.' They now start seeking spiritual help and before they know it, the case is worsened.
"For instance, in the case of breast cancer, when the lump is detected and you want to remove the lump and eventually it is diagnosed as breast cancer and you tell such a person that what is actually needed to save her life is to remove the whole breast, the woman may run from the hospital and delay until the thing is advanced, likewise the case of some other cancers. If people go to the right place and at the right time, proper investigation would be conducted. We have found cases where people go abroad and still have wrong diagnosis as well," Popoola avowed.
The secretary-general of the Nigerian Medical Association (NMA), Dr. Kenneth Okoro stated that there are various categories of the possible causes of cancer. Describing cancer as "the malignant proliferation of cells in the body system" Okoro said that the likely causes of cancer could be attributed to three factors; environmental, genetic and chemical factors. He attributed the environmental factor to ionising radiation, where cell could be damaged via radioactive substances and rays that come into the earth's atmosphere from outer space and probably some other sources.
Popoola advocates change of lifestyle and culture of exercise among Nigerians. He believes that cancer is treatable provided, according to him, the patient presents himself or herself early enough.
"You can get good result. But, by the time it is advanced, it can rarely be treated. At that stage it can only be managed. It is evident that people always think of cancer as a terminal disease. This is not always true. It is not usually a terminal disease if the patient is presented on time. And most of the screening does not cost anything. In some cases the cost is very minimal that most people can afford," Popoola affirmed.
But majority of Nigerians die daily because they do not have the wherewithal to get precise help when they come down with the disease. Many have also died as a result of not having proper knowledge of what disease it is that killed them.
Cancer, according to medical experts, is not just one disease but many diseases. Medical researches have categorised different kinds of cancer that affect parts of the body. Those cancers, they said, take their names from the part of the body that they infect. For instance, in Nigeria, there is breast cancer, which experts say is the commonest among females, followed by carcinoma of the cervix.
A director at the Institute for Advanced Medical Research and Training (IAMRT), University of Ibadan, Dr. Clement Adebamowo also supports the view that the commonest among females in the country would swing between cervical and breast cancers. For men he said "it would be liver and prostate cancers, as the commonest. But all depend on the region of the country you are looking at. There are variations in the regions," Adebamowo said.
The cancer scourge is one debilitating experience no Nigerian would want to experience, no matter how highly placed as an individual or family in society. This is the motivation of Ali who started a non-governmental organisation (NGO), Cancer Mama Foundation of Nigeria (CMFN), a worldwide organisation established to help in combating the scourge after her beloved mother's demise.
As the Chief Executive Director of CMFN, Ali describes the disease as one that easily eats up a family's lifetime savings no matter how rich that family might be. She claimed that so little is known about cancer in the country and lamented that government has failed to raise the awareness in order to give the scourge the important attention it deserves. "There is just no awareness for people to know about this disease called cancer. Because of this lack of awareness, people have not found it necessary to go for regular checkup to make sure that the disease is diagnosed early enough. Once people discover the disease early enough, it would be quite easily treated," she said.
Cancer patients had only two places across the federation to go to in order to obtain treatment (radiotherapy) until very recently. These were the University of Ibadan Teaching Hospital (UCH), Ibadan and the University of Lagos Teaching Hospital (LUTH), Idi-Araba. But now screening and treatment of the disease can be accessed in Lagos State University Teaching Hospital (LASUTH), Ikeja and most other university teaching hospitals across the country.
Adebamowo, who is working with leading experts in the field to increase local skills and expertise, says that constant generation of knowledge in cancer treatment is necessary. He believes there should be concerted efforts at finding new and important ways of generating new knowledge about the treatment, which he called clinical trials mechanism. According to him, clinical trials benefit patients and institutions in many ways. It provides patients access to cutting edge treatment that is often not yet widely available, he further stated.
"It makes for close and detailed follow-up and also subsidises treatment of patients. Aside from that, it contributes to new knowledge that would benefit future generations," Adebamowo stressed.
There is also this belief, in many quarters, that a lot of misinformation has gone on about the possible causes of cancer. The Cancer Research Institute (CRI) of the UK explains that there exist up to 200 different types of cancer affecting different body tissues. It said that what affects one body tissue may not be able to affect another.
"Tobacco smoking, when breathed in may cause cancer of the lung; and the excessive exposure of one's body to the sun may also give someone melanoma cancer on the leg. But the sun would not be able to give one lung cancer, and smoke on its own part, would not give somebody melanoma," the body said.
CRI further claimed that apart from infectious diseases, other diseases are multifactorial, and that cancer being not an exception means that there are multifarious factors involved in its causes, even as there is not one single cause for any one type of cancer. The causes range from differing combinations of two or more of the following: the kind of dietary intake by people, genetic factors, hormonal changes, radiation, tobacco, weight and physical activities. Others are age, the workplace and environmental factors.
But there are efforts in Nigeria and elsewhere to combat cancer. Some include the cancer News On the Net (CNON), a website dedicated to bringing families latest news on the Internet. For instance, one of the latest information and campaigns it runs is that which gives the latest information that men should start the tracking of their Prostrate Specific Antigen (PSA) tests during early screening years. This is because it would afford them greater opportunity to identify trends over extended periods of time.
The University of Dusseldorf and former director of German Cancer Centre, Harald zur Hausen won Nobel Prize for Medicine. Zur Hausen's recognition came by way of his research idea that Oncogenic (cancer) human papilloma virus (HPV) causes cervical cancer, the second most common cancer among women. He was said to have discovered two new viruses, which were acclaimed to be of great importance to global health in the cancer treatment.
The Nobel laureate began the research in the 1970s, assuming that if HPV was causing the cancer it should be possible to detect it by searching tumour cells for a specific viral DNA. For 10 years, he searched for such different human papilloma virus types, and detected them in cervix cancer biopsies. The virus type he found, and later cloned, happens to be found in about 70 per cent of cervical cancer biopsies around the world.
It is believed that more than five per cent of all cancers worldwide are caused by persistent infection with this virus the Nobel Assembly had detected. And an estimated 500,000 women, the council further said, were diagnosed with the disease, and about 300,000 of those diagnosed die from it. Incidentally, most of these deaths are said to be from the developing world.
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