World Cancer Day 2022: Close the care gap

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By Michelle C Madzudzo
AS we commemorate World Cancer Day 2022, I wish I could be very proud of my achievements and efforts as a radiation therapist making strides against cancer in a country where cancer seems to be the untold story.

I will not relent in the fight against cancer as one of the 31 radiation therapists left on Zimbabwean soil!

Organised every February 4 by UICC, World Cancer Day is a global initiative that aims to inspire greater awareness of cancer and action in preventing, detecting and treating the disease. World Cancer Day 2022 marks the first year of a new three-year campaign centred on the issue of equity.

The campaign theme Close the care gap recognises the power of knowledge and challenges assumptions. The first year of this campaign raises awareness about equity in cancer care and explains barriers that exist for many people in accessing the services and receiving the care that they need and how those barriers potentially reduce a person’s chances of surviving cancer.

Where you live, who you are, where you come from, what you do, are the social determinants of health that represent the many factors that may lead to inequalities, they can unfairly stand between you and cancer prevention, diagnosis and treatment.

People with cancer have important life decisions to make, and they should not include whether they have enough money to pay for the treatment or care, let alone are the services even available to them.

As a passionate cancer advocate, I call for a united front against cancer in Zimbabwe as we endeavour to close the care gap. We can make this day the start of a revitalised focus, the kick-off of a close the care gap campaign to ensure that radiotherapy services are available to the patient in Binga and the one in Borrowdale, the five-year-old and the 50-year-old, the white farmer and the black vendor. Simply put, every Zimbabwean deserves access to radiotherapy services. Closing the care gap is about providing everyone with equal resources and making sure that everyone has equitable access to lifesaving services.

Radiotherapy is given by high energy machines known as linear accelerators found at Parirenyatwa and Mpilo hospitals, and at Oncocare, a private centre in Newlands, Harare. However, most cancer patients throughout the country struggle to get radiation treatment given the frequent breakdowns of the radiotherapy machines.

The country acquired five state-of-the-art radiotherapy machines in the past, however, it is very rare for these machines to function simultaneously.

In most cases, one or two machines will be operational mainly in Harare, leaving many cancer patients stranded waiting for their turn in a usually long waiting list.

Multiple faults reported for these machines have halted their operation, which resulted in  prolonged downtime of some machines especially at Mpilo radiotherapy centre. This has caused patients from Bulawayo and other parts of the country to migrate to Harare seeking an opportunity on the already overloaded machines if by any chance they will be functioning.

As a radiation therapist, I find it worrisome that while patients are waiting for their turn to get treatment, the disease continues to grow and metastasise. Eventually, patients are cornered to seek alternatives like getting treatment outside the country such as neighbouring South Africa which is very costly.

Sometimes they get treatment from the private centre in Newlands, Harare, but the charges are too high compared to government centres. Let’s close the care gap and revive our radiotherapy centres.

When it comes to radiotherapy, it is consistency and timely treatment which yields more favourable outcomes. Failure to stick to time-conscious treatment protocols consequentially exposes cancer patients to metastasis and or recurrences.

Ideally, a radiotherapy treatment course should not be skipped if its intended effectiveness is to be achieved. However, that is not often the case as a result of operational hiccups.

The international atomic energy agency (IAEA) recommends that for every 500 000 to a million of the population there should be at least one to two cancer treatment machines.

Accordingly, a country like Zimbabwe requires between 14 and 28 machines for an adequate cover of the entire population. This means every city should have at least one machine taking advantage of established referral and central hospitals.

Scattering these machines around the country would help to decongest Mpilo and Harare radiotherapy centres while promoting the decentralisation of cancer management. Careful planning can help cancer patients especially those from rural areas who usually struggle to find a place to stay in town since hospital accommodation can only cater for a handful of these patients.

Without the assistance from their relatives staying in town, their medical expenses would be too much for them since they have to pay for accommodation. Daily travel also adds to their expenses since radiation treatment is usually given on a daily basis. We need to close this care gap, the corporate world and other stakeholders can come in and work together with our government for a good cause.

Early detection and early treatment of cancer is known to improve survival rates of patients diagnosed with this dreadful disease.

Even after cancer has been diagnosed early, it is disheartening that patients do not always receive early treatment given the costs related to its management and the above-mentioned machine-related issues.

Cancer radiotherapy treatment should be administered without any interruptions or extension of treatment time, over the prescribed period, some of the patients end up receiving half their treatment courses or the course is extended beyond the prescribed period.

This may have adverse effects on the treatment outcome. Delay in instituting appropriate cancer management has made our cancer awareness programmes futile.

Amid the COVID-19 pandemic, which has taken the centre stage, it is important not to starve cancer of the attention it deserves.

Despite some short-term measures taken by the government to fund then repair of radiotherapy machines, there is a need to prioritise cancer treatment, otherwise control of the disease remains a pipe dream.

Having a service contract with the manufacturers of radiotherapy machines may help in ensuring the machines  are required in time.

Definitely, this will bring great relief for cancer patients who have been deprived of this life-saving treatment.

Solutions for those breakdowns must be sought through implementation of strategies which help to eliminate or prevent such circumstances.

The life of a cancer patient depends on radiotherapy machines, their functionality and availability is a ray of hope for them! Let us all join hands in the fight against cancer and close the care gap! Let’s revive radiotherapy services!