October is breast cancer awareness month. Women in Rwanda and across the world have been carrying out various campaigns to help increase understanding of the disease. The rest of us should take the opportunity to raise concerns about cancer generally.
Setting aside a time for cancer awareness is a positive move and marks progress in increasing awareness about a disease that continues to kill millions of people worldwide.
But it can only be the beginning because much ignorance about it remains, especially in developing countries.
For example there is a widely held belief that cancer only afflicts the affluent. The implication is that the poor, who are majority of our citizenry, have nothing to fear. Nothing could be farther from the truth.
They are just as vulnerable. The farm labourer in Rwanda is as likely to suffer from cancer as the CEO of a multi-national food processing corporation. The vendor of agro-chemicals in a shop in any small town in Africa is as susceptible as the head of an international chemical conglomerate.
That is one myth – that it is a class disease - that must be dispelled immediately.
Statistics about cancer make very grim reading, but also call for urgent action. According to the International Agency for Research on Cancer (IARC), there were 14.1 million new cases, 8.2 million deaths and 32.6 million cases of people living with cancer five years after diagnosis in 2012 worldwide.
Projections for 2030 indicate that there will be 23.6 million new cases each year, with 68% more cases in developing countries.
If this is not scary enough, look at the figures for developing countries. In 2012, of the new cases, 8 million or 57%, 5.3 million or 65% of deaths and 15.6 million or 48% of five-year prevalent cases occurred in the developing world.
In terms of mortality, among women, it is highest in East Africa.
There is therefore reason for concern. Danger is in our midst. The need for raising awareness could not be more urgent.
This danger is exacerbated by several factors;
First is the limited knowledge about cancer – how it sets in, its symptoms and what should be done.
The second has to do with two things – mindset and the tradition of our health services. We are informed that the most effective way of managing any illness is through early detection. This usually happens where people take regular medical examination to know their health status.
Few in Africa ever have one thorough medical check up in their entire life. They go to a health facility only when they can no longer delay the visit because their condition has got worse. In the case of cancer that is often too late.
Even when medical examination is a condition for employment or training, many people have been known to take short cuts. They collude with health workers and get a report certifying that they are fit and healthy without having to go through a medical examination.
In many cases health workers, often overworked an under-equipped, are in no mood to grant a request for a full check up.
The whole thing is simply not part of our culture, or we don’t know that such a service is available and is a right. Health services, too, and training of health workers seem to have been designed to treat, not to prevent.
The third is misdiagnosis. There have been cases of patients going to hospital complaining about a condition which might indicate the presence of cancer or indeed any other illness, only to get a wrong diagnosis and therefore wrong treatment.
Clearly something must be done.
First, people must be educated about the tell-tale signs of the different types of cancer and the need to seek medical attention as early as possible.
Second, we must make medical check up part of our regular habits, like wearing shoes or taking a bath before going to town have become among rural folks.
Above all, there must be more investment in a whole range of areas – in training of specialists as well as general health workers, in diagnostic tools and expertise, and treatment in general.
More health facilities should be equipped to manage a wide range of diseases. I know even the specialist centres we have are not adequately provided, but that does not stop us asking for more. Even the most advanced countries have not been able to stem deaths due to cancer, but that does not stop us trying.
Rwanda has some of the best public health practices. They should be extended to other areas like the treatment of “unusual” diseases such as cancer. Raising awareness is good but it should be matched by an improvement in medical services and a general mindset shift.