One death is a tragedy, a million deaths, a statistic


February 4 was World Cancer Day.

Cancer is a BIG problem…and big problems are difficult to communicate. There is a popular adage on the difficulty in arousing emotion in public health work – one death is a tragedy, a million deaths, a statistic.

We have been struggling on how to appropriately communicate the circumstances of Nigerians that find themselves with a diagnosis of cancer in our Nigeria. Luckily our dilemma was solved when we stumbled on this article below written by Tony Can in the Guardian on Monday February 8 reproduced here with his kind permission

We could not have said it any better and this piece demonstrates the complexity of the challenges we face.Its a must read!

C for Cancer

By Toni Kan

MY brother, Charles Emeka Onwordi, (February 2, 1968 – December 21, 2009) would have been 42 today as I write this tribute to his short but eventful life. Trained as a Fine Artist at the Ahmadu Bello University, Zaria, we graduated the same year even though there was an almost four-year age difference between us and schooling together in close proximity, I at Jos and he in Zaria, meant that we soon became more of peers than older and younger brother but no matter how close we got, he still remained Broda to me.
My brother had been ill for close to a year for what was diagnosed as pile or Haemorrhoids. He fluctuated between periods of wellness and illness but it never went beyond a stomach ache or diarrhea. Then on December 19, 2009, he called me to say he was vomiting blood and I asked him to go see my doctor immediately. He drove there himself and was admitted but when I saw him the next day at the hospital, I experienced a sudden and inexplicable panic attack; my brother was at death’s door.
The thought came to me without a diagnosis; the mere sight of my brother with his distended stomach and emaciated frame left me in tears and I remember walking downstairs blinded by my tears as I bawled like a baby. The last time I saw him was a mere 12 days earlier and in that short span of time my brother had undergone some severe depreciation. I hadn’t yet gotten a grip of myself when I re-entered his room and one look at me and he said “You are crying for me, abi? So, what do you want me to do?”
Things moved pretty fast in the next few days. My doctor, a thorough and methodical man, who had seen him about three months earlier was upset that my brother never came back for the test he had asked him to undergo, didn’t have a good prognosis. I recall his exact words: “I suspect he has a growth in his stomach which is causing a blockage. I just hope it is not malignant. You know what malignant is?” I know what malignant is but what is a man without hope. My brother underwent a CT Scan on Monday and by the time I walked into the hospital that Monday evening and was summoned to the doctor’s consulting room, I suddenly realised that my life was about to change in a way I had never imagined.

The doctor showed me an x-ray film that had been placed against a light box. It turned out that he, not being an oncologist, had placed it wrongly. But the full picture would emerge a short while later when we were joined by another doctor, a surgeon who had been summoned from Lagos University Teaching Hospital (LUTH). The diagnosis was dire. My brother had Cancer of the Colon. It had spread or metastized from the Colon to the liver and latched on to a bone. The large intestine was completely gone so he could no longer pass waste. The immediate imperative was to open him up, drain the waste, perform a colonoscopy and drill a hole through his tummy from where he would pass waste. My brother’s life was changing irreversibly too.
“How bad is this?” I asked sweeping aside all the arcane medical terms.
“Sit down,” the doctor said and I did. My doctor for about nine years now, I have always trusted his judgement.
And so he told me what to expect. He said Cancer is a disease that destroys and impoverishes families and there is scant chance of the person getting better. He also said that right now, aside from Malaria and Road accidents, Cancer has become the third highest killer of young people in Nigeria. But he did add a caveat, “We are doctors, but we can never rule out miracles.”
I left them and walked outside into the gathering dusk, tottering like a drunk. I was confused and depressed. My brother was just 41. He had a wife and three kids. The eldest, like mine, was just six going on seven. He was by every definition of the term, a young man.
I walked the length of the street, then sat on a slab and cried like a baby, the second doctor’s words echoing in my head: “what we can talk about now is quality of life not quantity of life.” The sub-text was clear, there was a shroud hanging over my brother’s head; he was living on borrowed time. How much time, was what no one could say. My parents were upstairs and in the dark with regard to the diagnosis but I told the doctor I needed my brother to know. The doctors wanted to know if I was sure and I told them that my brother is a fighter and if he knows he will fight for his life the way a horse would; with all his strength.
So, we went upstairs, asked everyone to leave and told him. He was calm and his only question was: “When is the surgery? Tonight?” He didn’t sleep that night. The pain and anxiety kept him awake and by 6am, he was already in the theatre. It lasted all of three hours and my brother was out looking rested, relieved and relaxed for the first time since he checked into that hospital. But it was a mirage. The cancer had done serious damage. I remember the surgeon wringing his hands as he spoke to me after the surgery. He was almost in tears. His eyes were red and he kept saying “Ah, he should have come earlier. He should have come earlier.”
My brother’s blood and system had been poisoned by the waste that had burst in his stomach. He was given powerful antibiotics and we were told that the next 24 hours were critical. His liver had also been damaged by the cancer which had spread all the way up and as we all know, we have only one liver. There is no spare unlike the kidney. He slept. He rested and we even spoke but by 7 p.m., everything went down hill as he went into what they call extremities. His blood pressure was fluctuating like a yoyo as his system began shutting down from Acute Septicemia or blood poisoning. It was heartbreaking to watch him expire in degrees. He cried, begging for water, as his lips caked over from dehydration. And for the first time since he took ill, I saw my brother show fear as he watched the doctors and nurses scurrying about looking for what to do to stabilise him. And as I watched them, I leaned close to him and said “Broda, you have fought this thing. Just pray and rest.”
He died hours later in the intensive care unit of our hospital in Surulere. And his death threw up many issue
s for us. First, is the quality of health care in Nigeria and the parlous state of our health care system. A qualified doctor had treated him for over one year for pile while the actual disease, Cancer of the Colon ravaged his body, running wild and destroying healthy cells. It makes you wonder whether we now train butchers instead of life-savers.

Secondly, at about 8pm, the surgeon had suggested that we move him to another hospital where they had better Intensive Care equipment. There were two options. LUTH and a private hospital in Apapa. Calls were made. LUTH was available but there was no light. So, we were left with the private hospital option. They demanded a one million naira deposit. When we said we could afford it, another call was placed explaining his situation at which point, the hospital said they wouldn’t accept him because the prognosis didn’t look good and they didn’t want to appear fraudulent.

The President can fly to Saudi Arabia, at our expense, where there are Intensive Care units every mile and the light never blinks. But how many of us hapless tax payers can walk into a government hospital and come out with an analgesic? That, not my brother’s untimely and avoidable death, is the real tragedy. Happy 42nd birthday, Broda and rest in peace.

Kan, a writer and company executive, lives in Lagos

p/s Read about  Seun Adebiyi. He just graduated from Yale Law School and is training to become the first Nigerian to compete in the Winter Olympics. You may have seen my story recently on the Today Show, CNN, the Huffington Post, NPR, the Yale Daily News. He has leukemia and my only chance for survival is to have a stem cell transplant.  Stem cell transplants are usually done using bone marrow cells from a healthy donor. His best chance in life might be finding you Read his sorry.

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

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