Taiwo Alimi examines Nigeria’s soaring medical/economical loss to Ghana, via cancer treatment.
The first time breast cancer survivor Senanu Ladipo, 49, went to the ever-busy Lagos University Teaching Hospital (LUTH) Cancer Centre, she begged her husband to take her elsewhere for treatment.
“There were hundreds of patients at different stages of cancer waiting to be enrolled for treatment. Some had been coming for many days. I felt many could die even before they were attended to. That put me off,” she recalled.
Her own condition at the time was cancer stage 1 and she eager to start treatment. Instinctively, the couple made inquiries for alternatives in Nigeria but found little comfort in that venture.
“We were told we could go to Abuja or Enugu.But upon our investigation, we found both were worse than LUTH,” the banker said.
This was in February 2020 and LUTH had just acquired new Radiotherapy (RT) machines in partnership with the Nigeria Sovereign Investment Authority (NSIA), about a year earlier, making the centre the best option for any Nigerians seeking cancer treatment in the public sector.
Structured under a Public-Private Partnership (PPP) arrangement, the project cost NSIA $11 million in investment to be recouped after 10 years of ownership.
So, it had the newest radiotherapy machines and chemotherapy services in government hospitals in the country.
Mr. and Mrs. Ladipo got to know that patients even come to the centre from Abuja and Enugu, as well as from other states in the country for treatment, hence the influx they witnessed.
Radiotherapy is vital during cancer treatment as 70 percent of cancer patients have multiple sessions in the process of cure.
They also learned that in the whole of Nigeria, only three public radiotherapy machines are working at full capacity.
The others, scattered, in the 20 university teaching hospitals in the 36 states of the country, including Federal Capital Territory (FCT Abuja), are either obsolete or in comatose.
“A couple of private hospitals in the coun try have serviceable radiotherapy machines but they are beyond the reach of average Nigerians. Only the super-rich can afford their services,” Yinka argued.
Dr. Jafaru Momoh, the Chief Medical Director of the National Hospital, Abuja, said that aside from his hospital, which has two Linac radiotherapy machines, only LUTH, has two of the machines.
Dr. Habeeb Muhammad, the head of the Radiotherapy Department, LUTH, confirming Dr. Momoh’s claim, explained that their machines can attend to about 120 patients every day.
Yinka, who regularly accompanied his wife to LUTH, said he observed that patients and their loved ones come from the North, East, and South of Nigeria, for treatment in LUTH.
MORE TALES OF WOES
Swatkasa Gimba, 33, is also alive to tell her story. She described her two-year treatment in Abuja National Hospital (ANH) as an eye opener.
“In Abuja (ANH), the number of people waiting to use the radiotherapy machine was overwhelming. I was to use the machine for 25 days, but there was such a long waiting line that I kept going back and forth for one month before I was enrolled for the programme. Because of the pressure put on it and its age, the machine kept breaking down.”
Gimba believed that sometimes such delays can kill patients. “Cancer spreads and becomes deadly when patients don’t get treated quickly,” she added.
“That is the major reason Nigerians go on medical tourism to other countries, Senanu said.
Sidi Rabi,35, is one of the unfortunate ones to have lost the breast cancer battle because her treatment was delayed.
The late Bauchi resident was diagnosed with breast cancer in 2019. On getting to the Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, she was told that the radiotherapy machine there had not been functional for some years, and was subsequently referred to the Usmanu Dan Fodio University Teaching Hospital, Sokoto, about 726 kilometres away.
Rabiatu, Sidi’s daughter, said in her ill-health condition, she had to travel the rough terrain for 11 hours to Sokoto only to meet another brick wall: the hospital’s radiotherapy was down. Thereafter, she was referred to ABU Teaching Hospital Kaduna.
“In Kaduna, we met many patients waiting to see an oncologist. There were more names on the waiting list. After one week we were informed that the linear accelerator had bro ken down. My mother was then referred to ANH,” Rabiatu said.
Two months after,Rabi was dead. Her condition worsened as she was already in stage 3 before she knew her medical travail was caused by cancer. Failure to get medical attention did her in.
Rabi’s experience is akin to that of many cancer patients in Nigeria who die in the process of being tossed from one medical facility to another.
Dr. Demola Adewusi, Medical Director at Broadland Hospitals in Ogun State, said the poor system is killing more patients than the ailment.
“This is a result of not being able to access medical attention on time,” he said.
Based on the recommendations of the International Atomic Energy Management Agency, one radiotherapy machine is supposed to serve a community of 250, 000 people. Metropolitans like Kano and Lagos states with a combined estimated population of over 30million people (World Population Review 2022) are supposed to have no fewer than 120 radiotherapy machines.
“There are only three functional radiotherapy machines to cater for Nigeria’s population of over 200 million. Isn’t that absurd?” Dr. Adewusi asked.
The Ghana option
Faced with the delay factor, Senanu and Yinka probed for an affordable solution outside the country. “All the experts, including my doctor, recommended Ghana, where, they said, many Nigerians now go for treatment.”
They were seriously considering the possi bility when the COVID-19 induced lockdown thwarted their plan.
“That was when a global lockdown was put in place, which stopped us from accessing treatment outside Nigeria. That was how we were condemned to go through the horrific experience of LUTH. If not for the lockdown I would have taken my wife to Ghana for treatment.” Mr. Ladipo added.
Dr. Bankole Adebambo, a cancer consultant ,said the disease has become a severe issue for the government to prioritize.
According to the Nigeria National Cancer Prevention and Control Plan (2018-2022), cancer is responsible for 72,000 deaths with an estimated 102,000 new cases annually.
In 2018, a five-year National Cancer Control Plan was launched by the federal government (FG) to reduce the incidence and prevalence of cancer.
Part of the plan is the establishment of a cancer treatment centre in each geopolitical zone. Five years on, that pledge has not been fulfilled.
“Truth is that we don’t have adequate equipment to cater for the enormous cases we come across daily. It is overwhelming because even if you have your money, you will still need to wait for your time. The alternative is to seek a better option for your loved ones,” Dr. Adebambo said.
Destination Ghana
Ghana,according to him, offers a comforting option for Nigerians who can afford it.
Thousands of Nigerians now go on medical tourism to Ghana annually for treatment, especially for breast cancer.
Cancer survivor Mrs. King was cured in a Ghana specialist centre. She joined the Ghana train five years ago, citing undue rescheduling in Nigerian hospitals as the chief cause of her decision.
The 55-year-old narrated her journey from Abuja to Accra. “I felt a lump in my breast in 2017 and went for a check-up. A further test proved it was cancerous and they proceeded to search for more. Another one turned up on my hand.”
The Abuja-based was to start treatment immediately but one month after; she was still on the waiting list for radiation.
“At a point, the machine broke down and that was the beginning of my search for treatment elsewhere.
“My doctor recommended I go to India or England but the cost was way above what the family could handle.Then he mentioned a place in Ghana. I researched on the hospital and we made contact and that was it.”
Mrs. King spent the first three months as an in-house patient in the hospital and returned to Nigeria. Subsequently, she would go on appointments. “I had radiation sessions there and spent some days there whenever I had to take chemotherapy drugs.”
She was certified cancer-free about a year later.
Asked to hazard a guess as to the number of Nigerians heading to Ghana yearly for cancer treatment ,she said: “I expect that a couple of thousands go to Ghana.”
Mrs. King may just be right going by the rising cases of cancer in Nigeria.
Dr. Adebambo noted that Mrs. King’s claim is not impossible. “When you observe the number of people on a waiting list and the numbers that go on medical tourism yearly, then it is appropriate to say that if they can get treatment in Ghana, they will go there.
“That, however, does not mean that Nigeria lacks the expertise. We have qualified oncologists and surgeons. I consult for Gbagada General Hospital, Lagos and in a week I perform successfully, at least, two mastectomies. I could have done more if not for the power and personnel challenges I face often. You cannot work alone, you need nurses and in government hospitals, you have to plead, cajole and rub their egos for them to cooperate with you.”
Mrs. King described the Ghana treatment as ‘less stressful.’
Ghana’s population is only 31.07million (World Bank 2020) but boasts of better cancer facilities than Nigeria.
While Lagos, with a population of 15.3 million (World Population Review 2022),half of Ghana’s, have two accessible radiotherapy machines (there are more in private clinics well beyond the reach of the majority of Nigerians), Accra,the capital of Ghana and with a population of 4 million, boasts of three.
This is made possible by Ghana’s success story in the area of medical and management partnerships with high-flying conglomerates.
Ghana’s government provides an enabling environment and space for the multinationals to build world-class cancer centres to cater to, not just the locals, but patients from across the rest of West Africa.
And Ghana keeps sustaining this initiative and attracting even more foreign investors.
The reality is that Ghana is doing more than Nigeria, whose population is about half of West Africa combined, to create accessible caregivers for cancer patients, even though, Nigeria with its huge population produces more sufferers every year.
Senanu said she was enticed by the information provided by the Sweden Ghana Medical Centre (SGMC)’s on its website including facility and treatment options.
Located in East Legion Hills, Greater Accra, the hospital is a joint Ghanaian-Swedish venture with Elektra and Swedfund (GMI-Global Medical Investment) as part owners. It has become Nigeria’s number one destination for medical tourism.
According to Yinka, SGMC came highly recommended when they were seeking an alternative for his wife.
Its bills are settled in dollars.
But Dr. Adebambo said it is an open secret that cancer treatment does not come cheap.
He put the full cost of cancer treatment in Nigeria at between N4.5milion and N10million depending on the complexity of the case.
“Cancer care is extremely expensive, even in government hospitals,” he said.
Continuing, he said: : Averagely, to do mastectomy (breast removal) in a not-too-big Nigerian hospital is about N500,000. If you want to do chemotherapy, conservatively, the cheapest drug goes for about N100,000 per session and it may take a minimum of six sessions.
“At times it may be more. I’ve seen patients that took 18 sessions. If a patient is taking expensive drugs it would be up to N450,000 per session.
“In between chemo, PCV will drop and you will need to give blood, or Y Cell drops and you have to boost it. Then, we come to radiotherapy, and in government hospitals, the cost is about N700,000 and N900,000.
“When you sum this up you already have a cost of N3million for a simple, straightforward case. And that is not the end.
“After evaluation, a patient can be told to take a drug called adsetris and a full dosage is 18. One comes for 350,000 and imagine having to take 18 doses. In seven out of 10 cases, it is not straightforward.So roughly, a patient will spend between N4.5milion and N5 million, on average. The cost can be up to N10millon.”
Mrs. Ladipo said that at LUTH, “to do only radiotherapy is N1 million. To consult with a doctor at the LUTH is N70, 000 for a start.
As high as this may look, it is nowhere near what is obtained in Ghana and other countries Nigerians go to in the name of medical tourism.
“It does not matter. Some Nigerians can afford it all they want is to be given the best of attention and expertise and on time,” Dr. Adebambo said.
For example, In the UK, private consultation with a cancer specialist will cost around £300 per visit, and each chemotherapy cycle will cost £2000.
In the USA, radiation therapy can cost between $10,000 and $50,000 or more, depending on the type of cancer, the number of treatments (radiotherapy fractions), and especially the type of radiation used.
In Canada, the average cost for breast cancer radiotherapy treatments ranges between $5,500 and $14,500.
In India, the cost of three-dimensional conformal radiation therapy (DCRT), stereotactic body radiation therapy (SBRT), and intensity-modulated radiation therapy (IMRT) lies between $800 and $1500 per fraction cycle of treatment.
In Ghana cancer treatment is not cheap either.
Mrs. King said her treatment cost over $15,000. “Even in Nigeria, I would have spent like N10million so what is $15,000. I did not add the smaller bills, including accommodation, travels, and feeding.”
If the non-medical bills are added, we should be looking at $20,000, give or take.
SGMC does not give exact detail of its total cancer bills online but compares them to what is obtainable in the UK, U.S, India, and Canada.
So, on average a Nigerian patient will be spending no less than $20, 000 (including travel, accommodation, and feeding costs) for breast cancer treatment in Ghana.
A chartered accountant working in the pharmaceutical field , Sola Ogunwale,estimated that Nigerians spend on average $50million (N21billion) yearly on medical tourism to Ghana with breast cancer topping the list.
His words: “Though this is a fraction of the $1.2 billion (N576billion) medical tourism projected figure released in 2021 by the National Association of Resident Doctors (NARD), my point is that Ghana is getting new income in-road and Nigeria is paying for it.
“From what Ghana is doing in the area of the healthcare system, monies that could have been invested in the development of Nigeria’s health care system now go to Ghana and they are employing it judiciously.
A PriceWaterhouse Coopers (2016) report states that Nigerians spend $1 billion annually on medical tourism with 60 percent of it on four key specialties : oncology, orthopedics, nephrology, and cardiology.”
Finance Minister Zainab Ahmed, couldn’t agree more.
She noted: “Wealthy Nigerians are compelled to travel outside our shores for healthcare due to the dearth of professional healthcare facilities and management in Nigeria.”
Then, the Central Bank of Nigeria’s (CBN) balance of payment data released in the 3rd quarter of 2021 indicated that Nigerians have spent the sum of $11.01 billion on health-related services abroad in 10 years.
Going by The Nation’s findings, medical tourism to Ghana will swell in years to come and Nigeria’s loss to Ghana will double unless the trend is arrested.
“While Ghana is busy building on its successes and investing more in healthcare, Nigeria is losing more ground by not investing in the sector. In five years, Nigeria would have lost N100 billion to boost Ghana’s health and in extension, economy.
Aside from SGMC, which was birthed in 2012, other facilities have sprung up with the support of foreign investors and encouragement from Ghana’s government to develop Ghana into West Africa’s modern healthcare hub.
In 1997, Ghana commenced the process with a National Centre of Radiotherapy and Nuclear Medicine, Korle Bu, in collaboration with the International Atomic Energy Agency (IAEA) to provide care for cancer patients from Ghana, Togo, Benin, Côte d’Ivoire, Burkina Faso, Liberia, Sierra Leone, and Nigeria.
In quick succession came Immanu-el Cancer Help Centre/ Goshen Biomedical Centre, African Cancer Organisation, Pappis Cervical Cancer Initiative, Peace And Love Hospital Breast care International, Korle Bu Teaching Hospital, and the latest, HopeXchange Medical Center, a joint venture between U.S and Ghana governments.
The Women’s Cancer Center, including a new Clinical Pathology Laboratory and Sur gical Suite, which, officially took off in 2021, was largely funded by the American people through the United States Agency for International Development (USAID).
Yet, another gigantic health project, Eco Medical Hospital birthed in Accra-Ghana in 2017. The 500-ward accommodating 1,100 beds is the result of a $300 million financial deal between a Ghanaian investment firm, Eco Medical Village Limited, and a New York-based private equity firm, Milost Global Inc, under the Mesa Fund 1, a global opportunity fund.
With sustained collaboration with western governments, Ghana has made sufficient strides to position itself as a health and medical tourism destination in Africa.
This became evident in 2019 when Covid-19 became a global health emergency. Many Nigerians, who could not go to UK and U.S, due to the partial lockdown, proceeded to Ghana, where they did not need an entry visa.
Yet, Ghana has not stopped building. In August 2021, Ghana President Nana Addo Dankwa Akufo-Addo announced the commencement of Agenda 111 hospital projects across the country.
The project includes 101 district hospitals, six regional hospitals in the newly created regions, two specialized hospitals in the middle and northern belts, as well as a regional hospital in the Western Region, and the renovation of the Effia-Nkwanta Regional Hospital.
The ultra-modern health and medical infrastructure proposition is potentially the largest healthcare project in West Africa. And it will be achieved with major funds coming from investors in the U.S, Europe, and some African countries including Nigeria.
Verifiable sources have confirmed that Nigerian investors are rushing more than NI billion into the project.
When completed, it will triple the capacity of Ghana to take in more health tourists from Nigeria.
Cancer’s alarming spread in Nigeria
Sadly, Nigeria is not doing much to arrest the situation.
Uche Orji, Managing Director and Chief Executive Officer of NSIA, said the FG should see cancer care as part of a broader investment strategy.
“Our strategy is to target areas that have been subject to medical tourism, where we believe Nigeria should be able to handle domestically,” he said.
“Oncology is one of them, cardiology, renal care, and more lately, high-end surgeries. These are the four areas where you see Nigerians spend money going abroad for treatment.”
The NSIA began its foray into cancer care investment with a partnership with the LUTH. They took over LUTH’s oncology department, rebuilt it, and expanded it as part of a “build, operate and transfer” partnership model.
“As it stands today, we own it 100 percent, but the idea is when we’ve earned back our capital and returns we will transfer it back to LUTH.
“So, it’s a way for us to provide the necessary input for us to develop the oncology department at LUTH, train people who are at LUTH, and then be able to expand from there.
“To have this type of centre, for me, is important because then people can go somewhere. And it’s not just about affordability. Some people can afford it but can’t get a visa. Some people can afford it and get a visa but can’t afford to go with a family member to look after them and cook for them. So that’s why we built it here and we think it has impacted. The fact is that there is no need to go to India, no need to go to Germany, the United Kingdom, Israel, or Dubai. There is nothing they have in those places, we do not have here.”
Ogunwale added that it does not cost a fortune to install a radiotherapy machine. “It costs between $3m to $4m to install one RT. It is not too much if we prioritize health care.”
Until the FG can think along this line, the like of Mrs. King, Ladipos, and thousands of cancer sufferers in the country will continue to look up to Ghana for treatment.
