CANCER PATIENTS IN POOR AND RICH COUNTRIES

By Okot Nyormoi, editor, cell biologist, author of the novel, Burden of Failure

M.D. Anderson Cancer CenterI was touched by an article about two cancer patients, published in the November second 2022, Daily Nation, Nairobi, Kenya, titled, “Waiting to die: The pain of being a poor cancer patient”. I am a cancer patient myself that is why the story resonated with me. Though our cancers are different, one of the two patients in the story and I were diagnosed at about the same time in November 2021. The experience of the two women in the story answered questions or confirmed what I always think about whenever I go for treatment at M.D. Anderson Cancer Center (MDACC), one of the top cancer centers in the world. In fact, I recently learned that  a former Ugandan Minister of State for the Environment died at the same hospital where she was brought for specialized treatment.

First, the Cancer Center is huge with many multistory buildings and employs about 26,000 people. The physical facilities are luxurious. Some of the waiting rooms are like high class hotel lounges or VIP airport lounges, adorned with carpets and comfortable chairs and tables. Walls are decorated with all kinds of art works. Clean restrooms are everywhere on each floor near every waiting room. Restaurants are available for employees, patients, care givers and visitors to the hospital. Different floors are accessed by escalators and multiple elevators while separate buildings can be accessed via connecting skywalk provided with go carts or by shuttle buses.

There are organ specific cancer departments such as Genitourinary Medical Oncology, Breast Medical Oncology, Hematology Medical Oncology, etc. There are specialized diagnostic centers equipped with MRI, CT, PET/CT and PSMA scanning machines, blood and urine analysis laboratories, and histological diagnostic laboratories. Some of the machines are so efficient that results of blood analysis can be available almost immediately. Likewise, there are many specialized treatment centers such as surgery, radiation, chemotherapy, immunotherapy,  stem cell therapy, etc. There are experts for every type of cancer known to man. Unlike many general hospitals, this hospital has just about everything a cancer patient needs. Of course, this does not guarantee a positive outcome, but it makes patients feel hopeful for better prognosis than if they have no access to even the most basic treatment.

However, all these cancer facilities, service employees (doctors, nurses, technicians, receptionists, security agents, janitors, etc.) come at a hefty cost. A single procedure or treatment may cost thousands or even tens of thousands of US dollars. The only way ordinary people can afford the treatment is by having health insurance. Even so, the patient is still responsible for what they call out-of-pocket and deductible payments which can amount to many thousands of dollars a year beyond which the insurance will pay completely. How much the patient pays depends on what the insurance covers.   

Whenever I go for treatment as an outpatient, I keep wondering how on earth hospitals in poor countries would have, even a tiny portion, of what this Cancer Center has. How on earth would cancer patients in poor countries afford the treatment they need? It is a grotesque difference between what I saw on my visit to a paltry national Cancer Center in one developing country and what I know exists in the hospital where I am treated.

No wonder, I found the story of the two women simply gut wrenching. Unfortunately, some people will simply scoff at the story by saying, “So what! Everybody will die one day regardless of one’s status in life: rich, poor, powerless, powerful, religious devotee, agnostic, atheist, etc.). The horror of the story of the two women and many other people in similar situations is not about death as such. While everybody is going to die one day, it is just horrible that poor cancer patients in poor countries spend the rest of their lives waiting literally to die. The horror is about how they die due to their inability to get a second chance to survive their illness and live even just a little longer. Otherwise, we have to ask why high government officials spend huge sums of public money to go to Europe, India, North America, South Africa, etc. seeking better medical treatment.

Is it any wonder that citizens who cannot even afford to access the little cancer treatment available in their own countries feel abandoned by their governments when they see high government officials spend so much public funds in search of better healthcare outside their own countries. A case in point was when the late Speaker of Ugandan Parliament was flown half way across the world in a whole jet only to pass on soon thereafter. Yet, officials feel entitled to such expenditures. However, for the sake of equity in medical services, the perks public servants deserve to get should not be abused, as it is often done, at the expense of the public.

To paraphrase Einstein, after about 60 years of “independence”, a country like Uganda, should have learned not to do the same thing over and over and expect different results. Instead of spending money year after year on medical treatment overseas with nothing to show for, why not spend it on improving the national health system where every citizen can feel comfortable to go for treatment, exceptional cases notwithstanding. Obviously, this will require improving the quality of multiple interconnected key institutions including education, judiciary, security, transportation, and others. Otherwise, the country will continue to lose funds necessary for national development through corruption, abuse of power, brain drain, and others.

Can the deplorable situation exemplified by the story of the two Kenyan cancer patients be improved? Of course, it can be improved. Though it seems like an impossibility, we must imagine that change is possible and then commit doggedly to doing what needs to be done to actualize the change we envision for the future. More importantly, it will require critical thinking to ensure that the process is not derailed by leaders who regard their nations as their private property. In any case, though it may take a long time, change will come if we believe in it and work on it.