Wednesday, December 5, 2012

BBC News - Cancer: Not only a rich-world disease

Dr Jackson Orem is on the front line of the change. He directs the Uganda Cancer Institute - the only dedicated cancer treatment facility in a country of 33 million people.

He's a busy man, but he makes time to see patients like Musa Settimba.

Settimba is in for a check-up. He has something called Gist, a type of gastrointestinal cancer that is often fatal, even in the West.

Orem has arranged for Settimba to get a very effective and costly new cancer drug free of charge, courtesy of the manufacturer. There's paperwork involved, and drugs for only a few cancers are available this way. It's a godsend for Settimba, who has been doing very well.

"You are getting one of the best treatments for this disease," a smiling Orem tells his patient.

Unfortunately, Settimba is the rare exception.

The survival rate for patients who make it to the Uganda Cancer Institute is astonishingly low. It treats about 22,000 patients a year, and of those, 20,000 die within a year.

Orem says most Ugandans don't have a real concept of cancer as a set of diseases that can be diagnosed and treated. In some tribal languages, there is no word for it. "They don't have early diagnosis. They don't actually even know that they have cancer," he says.

And most don't see the value of seeking care. "Once you are diagnosed with cancer, they think that it's already a death sentence."

They're partly right. Most people don't see a doctor until the very last stages of cancer. At that point, no hospital anywhere could do much for them.

Orem studied oncology in the US and returned to Uganda to head the government-owned cancer institute in 2004. For several years, he was the only oncologist in the country.

Orem doesn't complain about the hard work, but some things make him cringe. One of them is a comment he's heard expressed by people from developed countries - that cancer doesn't hit poor people.

"People think that malaria kills [and] other diseases are killing people from a low socio-economic status. But cancer is the same," he says. "The truth of the matter is that cancer is a disease of the African person just like any other person elsewhere in the world."

The misconception affects funding. "When you ask for funding for cancer, nobody is going to give [it to] you," Orem says. "But if you ask for funding for these other diseases, they say, 'All right, your priority is correct, we are going to give you some funds.'"

There is also a perception that cancer is too expensive to treat, and treatment is too hi-tech to be done in poor countries. Orem says that's not necessarily true - surgery and chemotherapy, for example, don't require million-dollar machines.

The result is that the amount of money available for cancer care in the developing world is only a fraction of the sums spent on HIV, TB and malaria.

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