Ordeal for the poor on cancer treatment

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TODAY (last Monday) is Cecilia Munemo’s twentieth day of radiotherapy at Parirenyatwa Group of Hospitals in Harare, leaving her with five sessions to complete the expensive and stressful 25-day treatment which always leaves her feeling extremely weak.

Hazel Ndebele

Munemo (43), who wears a smile of relief just at the thought of completing her cervical cancer radiotherapy, narrates how she has had to remain strong while enduring the difficulties associated with cancer and its treatment.
“I was diagnosed with cervical cancer in December last year and before I started radiotherapy, I had to undergo four chemotherapy treatments which left me weak and in pain most of the time,” she said.

Despite the pain and stress associated with her condition, Munemo would travel to and from her rural home of Mhondoro alone to cut down on the treatment costs.

Due to her body being drained on many occasions she would rest in public places, including by the roadside, to recover some energy before continuing her journey.

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“The treatment was extremely difficult as I could not travel with a relative or friend each time I came for treatment, so that I could save money as I needed every cent I could lay my hands on,” she said.

For her session on Tuesdays, Munemo would bring bags and blankets because she had to sleep at the main hospital’s benches during the night as she awaited her next session the following day. But before and after her sessions, she slept on the lawn outside Parirenyatwa’s Radiotherapy Department, waiting for nightfall.

“I have no choice but to sleep at the hospital,” she says. “I cannot afford to spend US$50 per week for transport as I receive treatment five days a week, therefore I sleep here for the first two days of the week. I go home on Wednesdays, then spend the last two days of treatment here,” said Munemo.

“Transport to Harare from Mhondoro is US$5, therefore I need more than US$10 every day. It is cheaper for me to sleep here and buy food from the hospital canteen.”

Munemo said her husband, a high school teacher in Mhondoro, pays for her treatment from his meagre salary, making her treatment a huge financial burden on the family.

Radiotherapy costs between US$3 000 and US$4 000 for an entire course, while chemotherapy sessions costs between US$100 and US$1 000 per cycle, depending on the stage which the cancer has reached, according to a local oncologist.

A patient may need a minimum of six cycles, but these can go up to 12.

Apart from treatment costs, cancer patients also have to pay admission fees if they are to be admitted, including at public hospitals such as Parirenyatwa.

But despite the debilitating effects of her illness, Munemo takes time to work through pain to supplement her husband’s salary so that she can help foot part of her treatment bill.

“I am a tailor by profession and tailoring has always been my source of income. Although the amount that I currently earn is not much as I cannot work long hours at the moment, every little bit helps,” she said.

Cancer Association of Zimbabwe Information, Research and Evaluation manager Lovemore Makurirofa said cancer patients face many other hidden costs other than the expensive treatment.

In Zimbabwe, where the majority of people live on less than US$1 a day, cancer — a non-communicable disease — is treated at only two public health institutions, Parirenyatwa in Harare and Mpilo Central Hospital in Bulawayo. Many people therefore travel long distances to access treatment, in many cases, distances which are even longer than what Munemo has to travel.
“Most patients have to travel long distances to get treatment and face high transport, food and accommodation costs as some do not have relatives in Harare or Bulawayo. It is however commendable that cervical cancer screening is now decentralised and most provincial hospitals are now screening,” said Makurirofa.

After screening, patients are then transferred to Parirenyatwa or Mpilo hospitals for treatment.

Other than costs, cancer patients are also disadvantaged by drug shortages which have resulted in costs ballooning.

A fortnight ago Health minister David Parirenyatwa said most district and provincial hospitals were currently operating at below 60% capacity due to shortage of drugs, but the situation was even worse for cancer drugs, as well as psychiatric medication.

A cancer patient in Harare, who preferred anonymity, said some pharmacies are cashing in on the drug shortage.

“I had to buy cisplatin (cancer drug) in Bulawayo as I could not find it in any of the pharmacies in Harare. I bought it for US$20 in Bulawayo, but three weeks ago I was forced to buy the same drug for US$100 in the capital because there was a shortage,” said the patient.

In Zimbabwe, cancer has become more deadly than the HIV/Aids epidemic, but the perception is that not enough is being done to prevent or treat it, especially when compared to efforts expended in curbing the spread of HIV.
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 of the disease without being diagnosed or treated due to ignorance or failure to access medication because of the high costs of cancer drugs and treatment, as the country’s health system remains in a parlous state following a prolonged economic crisis.

According to the World Health organisation Zimbabwe report, cancer accounted for 138 000 deaths in 2014 alone.
The statistics also show that the number of HIV related deaths in 2014 (63 853) and 2013 (61 476) is less than the cancer deaths even when combined. This suggests more must be done in diagnosing and treating the disease.

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.

However, Makurirofa said the statistics do not paint a true picture of the ravages of cancer as many people with cancer go undiagnosed.

“Cancer cases are on the increase and statistics are an underestimation of the situation on the ground. It is not everyone who can afford to get screened or diagnosed and yet statistics are based on those who would have been diagnosed or screened,” he said.

In Zimbabwe, breast cancer affects one in every 10 women and one in every 100 men has to battle prostate cancer mostly affecting males above 50 years
.
According to the last survey done by national cancer registry, the total number of new cancer cases recorded among Zimbabweans in 2012 was 6 107, comprising 2 621 (42,9%) males and 3 486 (57,1%) females.

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