The cancer threat to Malawi

It is lunch hour and the corridors of Ward 2A at Queen Elizabeth Central Hospital (QECH), currently hosting the Oncology Department, are full of people.

None of the patients wants to go for lunch, thinking that they may miss their chance to consult the doctor.

Nurses are busy putting drips on patients, administering medication and flipping through patient files.

Dr Leo Masamba, the country’s only oncologist and his assistant, Dr Ntabeni Jemu is equally busy.

They cannot even think of having a soda because doing so will mean knocking off late or sending some patients back for the next day, a thing which they do not want to do.

“On average, we attend to 50 patients a day. These are just a few of the many patients that are in need of cancer treatment in the country,” says Masamba, adding he has never been on leave since the establishment of the department in 2009 due to pressure of work.

The department is congested with cancer patients at Ward 2 A. One of the beds in the side ward, which has four beds, serves as a consultation room.

‘Consultation bed’

In this case, one bed is used as a consultation bed while three are left for admitted patients. Although all the beds are demarcated by thick curtains, the admitted patients can hear what transpires in the consultation ‘room’.

“There is no privacy because patients who are resting hear everything that other patients tell me,” notes the oncologist.

Outside the ward-cum-consultation room, the patients with different types of cancers are seated on hard chairs regardless of the pain they are going through as they wait for their turn to see the doctor.

Those who have already seen the doctor are seen being put on drip while seated at the waiting bay, some getting injections while others receive medicine in full view of other patients and guardians.

Masamba recommends that government should build a purpose-built facility for cancer since patients on cancer treatment need to be put in isolation where no one except relations (wearing masks), nurses and doctors would visit.

He says the main side effects of chemotherapy include severe vomiting, diarrhoea, hair loss and the decline of one’s immune system.

“These patients may not respond to treatment as expected because of the environment,” says Masamba.

At the moment, the Oncology Department has four nurses and two doctors. The nurses have never been on cancer management training, but have only had on-the-job training.

“A unit such as this is supposed to have at least three medical officers, three clinical officers and nurses. In this case, we have no snack break because of the many patients we have to attend to,” says Jemu.

It is clear that cancer treatment at QECH is a challenge both to the doctors and the patients, considering that this is the only hospital in the country that has an Oncology Department.

Shortage of drugs

The shortage of drugs makes it worse. Patients would come from other districts when they are due for a check-up, only to find that the type of drug they need is not available. If they are lucky enough to afford it, they will procure the expensive medication from a private pharmacy, but most cannot afford it and they simply return home.

Dr Jemu notes that some patients do not come for scheduled treatment for lack of transport money to reach Blantyre for treatment.

One of the nurses in the department, Elluby Mankhoma, says many patients have given up on their medication because they cannot afford transport to the hospital as required.

After noting these problems, the Cancer Association of Malawi raised funds for the renovation of Ward 4A at QECH to make it a full cancer ward.

Chairperson for the association Chifundo Chogawana is quoted in the media as having said the demand for cancer treatment has increased since the onset of a temporaly oncology department at Ward 2A.

He noted that the state of Ward 2A is not conducive for cancer patients.

Dr Masamba says Ward 4A has 22 beds and four isolation wards, but that it will need appropriate furniture, floor, ventilation and other equipment.

The association is, therefore, appealing to wellwishers to help in fast-tracking the renovation of ward 4A to ease the congestion problem at ward 2A.

Director of clinical services in the Ministry of Health, Dr Chithope Mwale, says plans to build a cancer centre at Kamuzu Central Hospital are in the pipeline.

He says the feasibility report is complete and that the plan will be submitted to International Atomic Agency (IAA) in Vienna, Austria for approval; afterwhich construction will start, to be ready by 2014.

“This will help in reducing congestion at QECH’s ward 2A and cancer patients will be treated in a conducive environment,” he says.

The IAA will fund the project.

Cancer policy

Mwale says the centre will house the first-ever radiotherapy machine in the country.

At the moment, the country does not have a cancer policy which activists say could address cancer issues at different levels such as early detection, prevention, screening treatment and palliative care.

Again, resource allocation in the national budget to cancer is minimal compared to other diseases such as malaria, tuberculosis and HIV and Aids.

Programme of Action for Cancer Therapy (Pact) website indicates that the world is facing a global cancer crisis which is often considered a ‘rich world’ disease.

“Cancer is quickly becoming a public health catastrophe for developing countries. If urgent action is not taken, 84 million people will die from cancer in the next 10 years,” reads the information in part.

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