Prof. Remi Ajekigbe is a consultant at the Department of Radiotherapy, Radiodiagnosis and Radiography at the College of Medicine, University of Lagos (CMUL) and Lagos University Teaching Hospital (LUTH), Idi-Araba. In this interview, he tells OYEYEMI GBENGA-MUSTAPHA some of the steps that can be taken to stem the cancer tide ravaging the country.
hat have you discovered over the decades in the treatment of cancer?
I have learnt in close to 40 years that the management of cancer and its care treatment have not changed. We still see cancer patients coming late to the hospital. I remember we have written papers, talked at seminars and made recommendations on what the positive difference of early presentation can make in the overall treatment of cancer patients. And till date, we still have patients coming in at very late stages.This is traceable to our cultural belief that these diseases are caused by human beings in form of ‘enemies’, ‘the other woman’, as a form of attack through diabolical means.The hospital, unfortunately, is not the first place of call by these sufferers, except for few highly educated ones, who come in early. Even those ones, how early in the real sense do they come? So, we are tasked with educating people on cancer.
Why did you say that?
It appears that the government is not too serious about cancer treatment in Nigeria. As of today, I can say categorically that cancer has become an epidemic in Nigeria. I do not know when the government will be convinced that cancer is now an epidemic. We haven’t got enough facilities to treat cancer to international acceptable standard. And the manpower is not enough. Virtually all the cancer machines across the country are down. When we were being trained abroad, we were told that we are doctors of the future in Africa and the future is now here. Africa, especially Nigeria, is not prepared for cancer treatment. When we talk of Africa here, I mean the Sub-Sahara black Africa. North and South Africa are ok. Why Sub-Sahara Africa is not prepared for cancer treatment is still a puzzle. I do not know. Nigeria is the future of the black man. I hope Nigeria will take up the challenge.
Cancer rate is that it is an epidemic. There is no Nigerian family that would say it does not know or have somebody affected by cancer. The reality is that everybody is a potential cancer victim.This disease does not have respect for age, creed, gender, wealth, and position. Everybody should avoid it. For instance, prostate cancer is becoming at par with cancer of the breast. Virtually all men, who come to the hospital have cancer of the prostate. Some argued that it is due to awareness. That is, men report themselves to the clinics. The rate is on the increase, not only caused by ageing factor, for we now see 42-year-old patients.
What do you think are the causes?
For cancer, the genetic factor is there, social factor is there. Total environmental factors are there as well. Frightening enough, we are becoming less and less Africans except in our complexion. We are becoming more westernised. Cancer with other non communicable diseases are the supreme prize.
What is the way out?
Cancer education should be done in all nooks and crannies of the country. Every state should have a cancer centre. This is possible because more manpower should be trained in cancer care and treatment.The ones trained some years ago are already ageing and close to retirement, and will ease out of the system. The younger ones are not showing much interest because it is not a lucrative part of medicine. Many medics are moving across the country now with titles like ‘I’m an oncologist’, because cancer is now ravaging. If the government wants to ensure that cancer, as an epidemic, is arrested in the country, it must as a matter of urgency allocate an oil bloc to cancer. That will create more cancer centres across the country. It will train more manpower that can be deployed in all parts of the country as cancer specialists. That will stop people from travelling from one part of the nation to another in search of treatment.
Imagine somebody living in Maiduguri coming to Lagos, or from Calabar to Abuja. Every state will have cancer centres with the necessary machines. At least, two machines so that when one breaks down, the other gets people treated while the former is being repaired. The situation is so bad that patients are requesting to be transferred to Ghana. That is an insult to the country. Even referrals to India is insulting. We have qualified hands here, but lack facilities.
Are there other ways out of this epidemic?
We should just encourage more doctors into the field of oncology. And those trainees should forget about the lucrative part of medicine and come to cancer management. Naturally, such trainees will have milk of kindness. People with cancer are really suffering. Many do not even know that cancer is a bone-seeking disease. It can affect any part or bone of the body except hair, teeth and nail, leading to severe pains. If you see a male cancer patient crying, you will be dejected knowing that ordinarily men don’t usually cry. I see all these and I do not feel comfortable with them and that is why I am appealing to those, who matter in government, to please listen to what we are saying on cancer management.
What about drugs availability?
The drugs that really work in cancer cases are very expensive, especially the ones called Monoclonal antibodies (mAbs). These drugs are effective. Monoclonal antibodies (mAbs) with a chemotherapy drug or a radioactive particle are called conjugated monoclonal antibodies.The mAb is used as a homing device to take one of these substances directly to the cancer cells.The mAb circulates throughout the body until it can find and hook onto the target antigen. A Federal Government civil servant with cancer of the breast was a patient here. The breast cancer dictated the drugs it needed and they are Monoclonal antibodies (mAbs). We cost it and arrived at N18.6million. There was no way she could raise the money being a junior civil servant. If all she has, along with friends and co-workers are put up as bazaar, all cannot amount to that amount. I had to write to the Executive Secretary of the National Health Insurance Scheme (NHIS) that the patient was too young to die, appealing that he should use his offices to assist a Federal Government civil servant.
After many attempts, he listened and approved the drugs. He gave a condition: that the drugs would be procured but first doses given at a Federal hospital in Abuja and others in Lagos, to be absolutely sure. The lady and I complied and she was sent to Abuja for the first cause of chemotherapy and the Monoclonal antibodies (mAbs). She is cancer free now. That is an isolated case. How many have gone because they could not afford the drugs – males, females, even children, and cannot be helped; the list is endless. Another was the wife of a soldier. She too could not afford the drugs and I cited the isolated case because I know her as a civil servant working in LUTH. That if the couple can follow same by requesting the Chief Commandant to write such a letter, who knows? They did and the woman is also ok.
What lessons did you draw from those experiences?
I will strongly recommend that the NHIS include the coverage of cancer treatment to, at least, an extent. For instance, take a look at children with cancer, otherwise called childhood cancers. When these children are in pains, no matter how strong you are,you will break down; something will give way in you. Each time I see them in that ward – I ask, what is the government doing for its citizens? This is not a game-blaming situation. The poor have many children and when those children fall sick with cancer, you cannot but see their raw sufferings. There are no charity organisations that give out drugs, no government, so the children suffer. Government really needs to help cancer patients.
The Federal Ministry of Health recently took some steps on cancer care nationwide, do you see them working?
I think the Federal Ministry of Health is the only ministry that does not bring in money to the coffer of the government. It is ever spending. So, in budget allocation in spite of the World Health Organisation’s recommendation, the country is way far back. Health is wealth. If Nigerians are healthy, they will work and increase the gross domestic product. More investment should be done in the health sector.
What are to be done to avoid developing cancer?
Nigerians should re-embrace organic foods. Enough of this western diet – fast food, fizzy drinks, noodles, pasta, white bread, over processed food, can food, smoked/burnt food etc. Nigeria is yet to see what the future is like because these noodles-eating generations by the time they grow up, without being a pessimist, we will be recording more colorectal, and gastro-urinary cancers. This is the time to go back to our natural foods. Most Nigerian staple foods have fibres that help to ease digestion and passage of faeces.Women should avoid expired or inferior cosmetics. Some of those ingredients – lead, mercury etc are carcinogenic. They can lead to cancers of the skin, breast, even leukemia (cancer of the blood), among others. Also, the moderate use of roll-on is good. Most Nigerians are right handed, so when they apply roll-ons, they apply much on the left side, hence higher cases of left cancer of the breast. The nation is paying a lot of price for civilisation.
