May 09, 2016
By Uwemedimbuk Ekanem, MD, MPH
University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
As someone who grew up, resides in, and works in Akwa Ibom State (AKS), in Nigeria, I have come full circle in my awareness of the health challenges facing my people. Since 1992, I have worked in AKS as a community physician, thereby gaining significant exposure to the issues surrounding cancer control both in the State and in Nigeria on the whole. I have often looked forward to a time when we could improve cancer control in this region and make it a public health priority. In that sense, participating in ASCO’s Cancer Control in Primary Care Courses (CCPC) in Uyo, AKS, was a home-coming for me. I felt elated that my dream of cancer prevention in AKS and Nigeria as a whole was gradually being fulfilled.
Truly, when the presentations kicked off, the discussions and questions confirmed most of the thoughts I had about cancer care in Nigeria. The poor awareness of the risk factors of cancers among the general population and, surprisingly, even among health professionals; the poor understanding of the burden of cancer among policy makers and health care providers alike; the unavailability of comprehensive cancer treatment centers in the state and country; the high cost of cancer treatment in the state and nation; the cultural belief system that affects the perception of the disease and the help-seeking habits of the people; and the difficulties, challenges, and barriers in the health system that makes access to treatment and care a nightmare for cancer patients.
When I led a discussion session, which focused on “your experience with cancer,” I learned even more (as did the audience) about the scope of the problem of cancer in Nigeria. First, the account of Nse Inyang, a survivor of breast cancer survivor who now runs a local NGO (Seabas Cancer Initiative), provided wonderful insight into the benefits of early detection of cancer. Ms. Inyang also shared her experience with the challenge of the high cost of treatment and non-availability of some treatments in the state and country. As a widow, she had to sell her properties to enable her to pay for treatment and care in South Africa. We also heard the account of a female doctor whose relative was diagnosed with breast cancer, who spoke about the great resource of family support, which is available in Akwa Ibom State, Nigeria, and probably in most of Africa. In her story, the doctor reported the difficulties that her relative encountered in accessing cancer care in the State and even in Abuja, the Federal Capital Territory. In response to these difficulties, the doctor convened a family meeting to discuss the problem and the situation. She succeeded in mobilizing funds from the family members, which enabled the patient to go to India for treatment.
Another revealing experience was shared by a female physician. She recounted the story of her friend who lived in denial after being diagnosed with breast cancer. The friend believed cancer to be a “spiritual attack” and declined medical therapy. While she was seeking “spiritual healing” from prayer houses, the disease metastasized. It is unfortunate that the friend is currently raising funds to access medical treatment.
Overall, I think the CCPC was successful; more than 90% of the participants agreed to change their practice to include health education messages on cancer prevention. It can be said that awareness of cancer among primary healthcare workers in the State has increased; thus more people will be encouraged to modify their lifestyles to prevent cancers and to go for cancer screening so that unapparent disease can be detected early.
At the end of the training, participants issued a communique. This communique is presently used by the Medical Women’s Association of Nigeria (MWAN), Akwa Ibom State Branch, for advocacy to policy makers and other stakeholders, to garner support for a policy on cancer control in Akwa Ibom State. This is already yielding positive results.
It was encouraging to hear that even in the unfortunate situation of advanced cancer disease, our local health professionals are able to provide useful treatment with good results. Isaac Udo, MD, a general surgeon who has developed great interest in breast cancer care, reported some successes that he had in situations that he initially thought were hopeless. One such instance was a case where a very poor woman presented to the hospital with an advanced breast cancer disease. Rather than give up in despair and do nothing, he did the best he could in the face of the several constraints that the patient had, and miraculously, the woman improved remarkably.
As the 2014 Avon Foundation Global Breast Cancer Clinical Scholar from Nigeria and Africa, I spent 5 weeks at Boston Medical Center (BMC) under the mentorship of Tracy Battaglia, MD. Comparing cancer care at BMC and home is like comparing night and day, but the good news is that prevention is possible. Though mammography can only be done in one government-owned health facility in the entire Akwa Ibom State, and at a cost that most people cannot afford, the good old breast self-examination is still readily available and affordable to everyone. If the health workers in primary care settings keep to the promise that they made at the CCPC training to modify their practice to include cancer prevention, then very soon the trend of cancer disease in the state, and by extension Nigeria, will change positively. However, at this point there is a great need to adapt the national cancer control policy in Akwa Ibom State, to plan and implement cancer control, and to also establish a comprehensive cancer treatment center in the State.
I thank ASCO for supporting the Medical Women’s Association of Nigeria (MWAN) to conduct the CCPC in Uyo, and for giving me the opportunity to participate in the course.