October was Breast Cancer Awareness Month. You may have noticed the pink fests in many Nigerian cities. Yet, beyond all the pink is deep anxiety, that if one does get cancer in Nigeria, your chances are indeed very bleak. With all the pink in town, we saw or heard very little in terms of concrete steps that will change the situation in Nigeria.
Cancer. It is a dreaded word that strikes fear into the heart of people. The World Health Organization (WHO) reported about 14 million new cases and 8.2 million deaths in 2012 related to cancer. It is the second most common cause of death in developed countries and among the three leading causes of death in developing countries. In Nigeria, it is estimated that over 71,000 people die each year from cancer related causes, with about 102,000 new cases diagnosed each year.
A neglected arena of public health in Nigeria
Faced with the second highest burden of HIV in the world, an increasing incidence of tuberculosis, a health care system that is unable to provide primary care, cancer has not been high on the list of priorities in Nigeria. Very little is being done on prevention and even less on establishing excellent treatment centers that can cater to the growing number of cancer cases in the country. There are a few treatment centers for cancer and cancer related illnesses but they are always in the news for the wrong reasons – a failure of their radiotherapy infrastructure.
In a country of over 170 million people there are only nine radiotherapy facilities, and right now (October 2015) the only functioning machine is at National Hospital, Abuja. The effect of such poor cancer services is expensive medical “tourism” for those who can afford to get care outside the country, or turning to private hospitals, traditional healers and religious leaders, for the many Nigerians who cannot afford to travel. By and large, cancer treatment and care in Nigeria is sorely inadequate.
Cancer treatment is expensive. With the fragmented nature of private medical care, we are mainly reliant mainly on provision of care services by government facilities. These currently lack the funding, support and management capacity needed to bring consistent, high quality care to the average Nigerian cancer patient.
Changing the cancer treatment story in Nigeria
When government fails, as is so often the case in Nigeria, the private sector steps in. There are a few examples of groups that finding innovative approaches to the provision of care. We have highlighted a few in the past such as “Kidney Solutions” providing renal care and D&TEC providing endoscopy services, both in Lagos. One new organization that is passionate about changing the situation with cancer in Nigeria is the Lakeshore Cancer Center in Lagos. It is taking a series of steps to become the most comprehensive cancer care and treatment center in Nigeria.
The center began in July 2014, and is the dream-child of Dr. Chumy Nwogu, a U.S. trained Thoracic Surgical Oncologist. Nwogu began his journey at the University of Nigeria Nsukka (UNN), and still works part-time at the Roswell Park Cancer Institute in Buffalo, New York, when he is not in Nigeria.
Nigeria Health Watch recently visited Lakeshore Cancer Center, to talk to some of its pioneering staff. We met with Dr. Oge Ilegbune, the Center’s in-house general practitioner, to discuss the ways in which the Center is working to improve the access to quality cancer care services in Nigeria. Ilegbune, who herself returned to Nigeria in September 2014, said Nwogu wanted a “comprehensive cancer center in Nigeria because he found that cancer care was being done in patches. It was a case of trying to get cancer care under one roof, a bit like what Roswell Park does.”
The need for such a comprehensive center is obvious, Ilegbune asserts. “In Nigeria, you have a lot of private hospitals that do sporadic chemotherapy and some even invite oncologists to come in to manage the odd patient. Some teaching hospitals have their oncology departments, but it is one of several services,” she said. “Until now, there hasn’t been this sort of coordinated care, where you are doing not only cancer treatment and chemotherapy, but also cancer education and awareness and prevention all under one roof.”
Lakeshore services include cancer consultations, chemotherapy, as well as palliative care for cancer related illnesses. “If a patient goes to India for treatment and returns to Nigeria, and needs to continue their regimen, we care for that patient,” Ilegbune said, adding that “It’s expensive and emotionally draining for someone to leave their country and go to another country to stay for an extended time while getting treatment. There are financial and emotional implications, many patients cannot afford to be away for too long, so when they return, they need a place to go. In the long term, we hope that there will be no need for them to go at all, as we hope to be able to provide for all their care”. And this is what Lakeshore offers. A place for those dealing with the complex and difficult care and treatment of cancer to go to, here in Nigeria, and receive world class care from concerned and expert staff.
Since June of this year, Roswell Park is officially affiliated to the Lakeshore Cancer Center. Roswell Park Cancer Institute is one of the most renowned cancer research and treatment centres in the world. “Dr. Nwogu is here in Lagos every six to eight weeks, and when he is here he carries out surgeries and provides specialist care,” Ilegbune said, adding that, “We have an affiliation with other specialties at Roswell Park, who are available when patients request a second opinion from a known cancer institute.”
The Center recently hosted a team from Roswell Park, who spent a week doing in-house training for staff as well as training nurses at LUTH and UCH Ibadan. The Center has also held a Continuous Medical Education (CME) course with LUTH and Pathcare. Ilegbune says continuous development is part and parcel of Lakeshore’s vision. “We do not just want to achieve excellence in our centre, but to support those working in other centres, especially the public sector.”
Beyond cancer treatment alone
Besides treatment, Lakeshore offers prevention services such as cervical cancer screening. Early detection is an important part of reducing cancer prevalence in Nigeria. Ilegbune said her team is advocating for cancer screening to be covered under the insurance packages of Health Maintenance Organisations in Nigeria. “We are in the process of getting advocacy groups to recognise that lots of HMOs in this country do not have cancer screening on offer, which leads to a situation where patients end up paying a lot more in the long term for care. She said a “nationally recognized screening program” for certain cancers will help bring down the incidence of cancer in Nigeria. “In the UK or US, women get a letter when they turn 40 to come in for their mammograms, and it’s the same thing with a pap smear, when at 25, and subsequently every three years to come in for cervical screening. It’s already built into the system,” she said.
She adds that Lakeshore hopes to “set up a directory that anyone who passes through us for any type of screening can be reminded at the appropriate time to come for subsequent screening appointments.”
She notes that government support is key, as well as private investment, if Nigeria is going to one day be known for excellent cancer treatment centers. “At the end of the day, it’s going to have to be a collaborative effort,” she says, adding, “It can’t be the public sector alone, it can’t be the private sector, there’s got to be some sort of merge, some sort of relationship between the two, to get it going.”
See photos from Nigeria Health Watch’s visit to Lakeshore Cancer Center