While we can see reductions in the mortality of infectious diseases such as HIV, Malaria, Tuberculosis, less controllable is the prevalence of non-communicable diseases (NCDs). Diseases like chronic respiratory disease, diabetes, cardiovascular (heart) disease, mental disorder and cancer are surging globally. Currently, cancer alone is reported to be causing more deaths globally than all of the infectious diseases mentioned above combined.
It was clear how the world responded to the epidemic of infectious diseases. Organisations such as PEPFAR ,Global Fund, Bill and Melinda Gates Foundation, World Bank and others all joined forces to deal with the widespread implications of infectious diseases. This response is something that is lacking in the war against NCDs and cancer in particular. While Sub Saharan Africa shoulders over seventy per cent of global cancer burden, it receives less than five per cent of global funding for cancer.
How can we respond?
In order to halt the increasing morbidity and mortality rates for cancer in Africa it is essential to have programmes that increase cancer awareness, and provide screening and early detection to the population. This, however, is just one component; the second is delivering standard treatment to patients where cancer is already diagnosed. This can include surgery, chemotherapy (drugs) or radiation therapy.
In East Africa, most of the countries are able to offer surgery and chemotherapies. However, currently only two countries, Kenya and Tanzania, are offering radiation therapy.
Radiation therapy is a very essential component of cancer care and control. It’s a kind of treatment that uses high energy to kill cancer cells in the body. Rwandans call it “gushiririza” which literally translates burning –I think from the fact that one of its side effect is skin burns. More than 50 per cent of all cancer patients will need radiation therapy at some point in their treatment – sometimes as the sole treatment or in combination with surgery or chemotherapy. Radiotherapy treatment is given in sessions, on average for a curative intent a patient can receive twenty five sessions which means around five weeks in total.
Summary status of radiation therapy in Africa
In 2010, the Directory of Radiotherapy Centres (DIRAC) reported that among 52 African countries only 23 offered radiation therapy services, leaving 29 others with no access to radiation therapy. A total of 160 radiotherapy centres were recorded in the continent with 277 radiotherapy machines. Not surprisingly though is the fact that the distribution of these machines is uneven: 90 per cent of these machines were accumulated in the North Africa and Republic of South Africa. Even in the states where radiotherapy facilities are present, there is only one machine serving entire population.
Currently, there are a total of eight radiation therapy centres in East Africa, but only six of these are in service, five are in Kenya (four in private hospitals and one in a public hospital). The other centre is in Tanzania (with one machine in the capital city).
Rwanda awaits own facility
In May this year, Rwanda, through Ministry of Health and Rwanda Military Hospital (RMH) Kanombe, signed a partnership deal for a radiation therapy centre to be housed at the RMH. The project was envisioned to be completed in 18 months. This comes as great news not only for Rwanda but also for its neighbouring countries. It takes only six hours from Burundi’s capital of Bujumbura to Kigali, and it’s easier for someone in the western Uganda to travel to Kigali than to Kampala. The machine will also serve the entire Eastern Congo as it will be a lot easier for someone in that region to travel to Kigali than to Kinshasa. A radiation therapy centre in Kigali will increase access for much of the East African population.
Setting up a radiotherapy unit is very expensive and there are many technical challenges involved. However, the most critical component is the human resources to run the facility. Key personnel in radiotherapy is paramount and include a radiation or clinical oncologist, a medical physicist, a medical engineer, a radiotherapist, nurses, among others. Currently, Rwanda has only one radiation oncologist, but has no medical physicist and no radiotherapist. However, we now the opportunity to train these specialised personnel to be able to provide the best services to those who will be coming to Kigali for management of their diseases. Radiotherapy, as the rest of cancer treatment modalities, is expensive, which poses a great challenge to our poor populations. For curative intent, radiation treatment on average costs Rwf2 million.
Investments at all levels will be critical to deliver radiation therapy to patients in need, but will also allow us to strengthen efforts in policy and continue the fight against cancer and non-communicable diseases.
The writer is an oncologist by training and Founder & Board Chair, Rwanda Children’s Cancer Relief