Cancer fight hamstrung by steep costs

AS the curtain came down on the hot month of October which is national breast cancer awareness month, so did the spotting of pink ribbons in commemoration of one of the leading killer diseases in Zimbabwe.

Faith Zaba/Paidamoyo Muzulu

Cancer, a noncommunicable disease, has become more deadly than the HIV and Aids epidemic, but the perception is that little has been done to prevent or treat it compared to communicable diseases such as malaria, cholera and sexually transmitted infections.

According to the national cancer registry, cancer is killing more people than malaria, tuberculosis and the HIV and Aids epidemic combined.

Many Zimbabweans are dying from the disease without being diagnosed or treated due to ignorance or failure to access medication because of the astronomical costs of cancer drugs and treatment as the country’s health system remains in a parlous state following a decade-long economic morass.

In Zimbabwe, where the majority of people live on less than US$1 a day, cancer is diagnosed at only two public health institutions, Parirenyatwa Group of Hospitals in Harare and Mpilo in Bulawayo, meaning most people are forced to travel long distances for treatment.

One of the elite who have survived breast cancer is the country’s former deputy prime-minister and MDC-T leader of parliament, Thokozani Khupe, who still spots a bald head after undergoing chemotherapy.

Khupe is one of the few lucky people whose cancer was diagnosed early, enabling her to seek costly treatment in South Africa before her condition had deteriorated to levels rendering the disease incurable.

A fortnight ago, Khupe shared her experience when she moved a motion in parliament seeking to introduce a levy to combat the disease.

“Statistics have shown that in Africa, the only time women discover that they suffer from breast cancer is when the cancer is in stages three or four,” Khupe said. “These are advanced stages; you cannot do anything about them. So what you will do is to watch these women die in agony.”

But most women are not as privileged or lucky as Khupe.
An elderly woman Mildred Chasi, who was diagnosed with breast cancer had to return to her rural home yesterday without any treatment after being informed of the costs of chemotherapy and radiotherapy at Parirenyatwa hospital.

Catherine Dube, an HIV-positive widow with three children from Highfield high density suburb, had to fork out more than US$1 000 this week alone for chemotherapy.

“I was diagnosed with cervical cancer in May this year and I was referred to Harare Central hospital where I had to pay US$200 for the staging tests after which I was referred to Parirenyatwa hospital,” she said after chemotherapy at the hospital’s radiotherapy centre yesterday.

“At Parirenyatwa I had to pay US$100, of which US$70 was for the blood tests and US$30 for the doctor’s fee. I was then told I needed blood transfusion and because Parirenyatwa hospital didn’t have blood in stock, I had to buy three pints of blood at US$359 directly from the National Blood Transfusion Service centre.”

With tears trickling down her cheeks, Dube added: “For cervical cancer, I have to have both chemotherapy and radiotherapy. Just for the first cycle of chemo, I had to buy drugs for US$400 and also pay an additional US$389 for the treatment. I don’t work, but lucky for me I have sisters and brothers outside the country, who are paying for the treatment and my children’s school fees.”

Her cervical cancer is now in stage 3B, which costs more to treat but there are no guarantees the treatment will beat the disease.

A local oncologist told Zimbabwe Independent chemotherapy costs between US$100, US$400 and US$1 000 per cycle depending on the stage at which the cancer is. A patient may need a minimum of six cycles and these can go up to 12.

A cycle includes the time when you have your chemotherapy and then break before the next treatment to allow the body to recover. Radiotherapy costs between US$3 000 and US$4 000 for a whole session.

A person with cervical cancer, like Dube, has to have both chemotherapy and radiotherapy, while a breast cancer patient needs six months of chemotherapy and thereafter radiotherapy.

Statistics from the ministry of Health show that on average 1 800 women are affected annually by either breast or cervical cancer. Of the affected, an estimated 1 200 die from the disease annually.

In Zimbabwe, breast cancer affects one in every 10 women and one in every 100 men who also have to battle prostate cancer mostly affecting males above 50 years.

Those that have successfully found a remedy and prolonged their lives are mostly the well off who can afford to seek treatment abroad where there is high-tech medical equipment and advanced medication.

Currently, cancer patients in Bulawayo have to travel to the radiotherapy centre at Parirenyatwa after machines broke down at Mpilo hospital.

Ruth Labode, a prominent medical doctor, pointed out that cancer treatment in public health institutions was a cumbersome and horrible experience for most women. She said women referred for treatment from rural areas are overwhelmed when they get to either Bulawayo or Harare for diagnosis. They have to wait for an average of six weeks to get diagnosed since the government has one pathologist who screens the specimens from the biopsies.

“There is only one government pathologist called (Maxwell) Hove who is based at Parirenyatwa. May God bless his soul for still remaining in government,” Labode said. “All these specimens are now sent to him at Parirenyatwa. It takes him about six weeks to give a diagnosis.”

The waiting period is a moment of anguish for most women as they do not have socio-psychological support but have to start imagining living with the disease.

Labode laments the lack of support to cancer patients as compared to HIV and Aids.

“Cancer has certainly become more fatal than HIV because with HIV, you know there are ARVs, you know there are some organisations that give all sorts of assistance,” she said. “Communicable diseases make a political statement which moves the whole nation. Resources are summoned while elsewhere cancer victims die slowly”.

Sister Patience Nyemba of the Cancer Association of Zimbabwe called on government to subsidise drug theraphy.

“It is expensive to get diagnosed and to get treatment. Maybe the government and corporate organisations should talk of a system or a pool where people can be helped,” she said.

“Everyone in Zimbabwe, not just government through subsidies, should play a role in assisting cancer patients. We are happy that government is coming up with a national cancer policy — maybe it will help people who need assistance. Cancer is killing more people that Aids, malaria and TB combined.”

Sources at Parirenyatwa said in September hundreds of people died from cancer. The most common cancers are cervical, breast, prostate, Kaposi sarcoma, non-Hodgkin’s lymphoma and squamous cell carcinoma of the eye.

Deputy Health minister Paul Chimedza said government is looking at means to increase public health funding so that health problems can be solved not in piece-meal fashion.

“Just for your information, the non-communicable diseases which include cancer, diabetes, hypertension, et cetera, are taking over from HIV in terms of the mortality and the morbidity that they cause.” Chimedza said.

“I agree, but let us make it a global levy and not just a cancer levy. Let us formulate a National Health Insurance Fund, where we will be able to fund the global health care sector,” he added.

A local oncologist who spoke anonymously as he is not allowed to talk to the press said government should strengthen existing institutions like social welfare so that it assists poor Zimbabweans who cannot afford cancer treatment.

“I don’t support free treatment of cancer but existing funds for instance from social welfare should come in and assist the poor with treatment because of the high cost of cancer drugs — the prices are just too high,” he said.

The oncologist also suggested more funds be allocated to Parirenyatwa and Mpilo hospitals for cancer treatment.

“In Zimbabwe, we should learn to take responsibility for health issues. Imagine, if each person just donates a dollar towards cancer treatment, or people, including the media, fundraise for the treatment; that would go a very long way in assisting patients.”