REPUBLIC OF KENYA

Reducing esophageal cancer burden, one stent at a time

       

The story of 49-year-old Sabina Moraa Omoti living with esophageal cancer began 18 months ago. She first experienced difficulty in swallowing and frequent bouts of what she described as heartburn and stomach pains. At the time, the mother of three believed she had an infection that would subside in a couple of days with adequate rest and pain relievers.

However, after a couple of days, her self-diagnosis seemed erroneous. The ‘minor’ throat irritation, chest pain and stomach ache turned out to be a major problem.

I was trying to eat ‘ugali’ but my throat was painful, drinking was also a challenge, I was vomiting every time I tried to eat. I also experienced bouts of hunger and stomach aches,” narrated Sabina of her first brush with the fourth leading cause of cancer death in the country. “I stayed for hours without eating to avoid the pain from swallowing” she recounted.

It was then that she opted to seek medical attention. The year was 2020, the month was October. The world was in the midst of the COVID-19 pandemic. She walked into a hospital in her home county of Nyamira. At the hospital, several tests were conducted, the history of her symptoms recorded and she was referred to a hospital in Kericho for further investigation.

It was the same script at the hospital in Kericho. Her symptoms were recorded and additional tests conducted including an x-ray. The test results were confirmed. She had esophageal cancer and needed to begin treatment. The immediate problem was to figure out a way to have her eat without vomiting and eliminate the pain. She had lost weight due to poor nutrition and she could only start treatment if she was able to eat.

Stent placement offers a ray of hope

 The answer to her eating dilemma would come when she walked through the doors of Tenwek faith-based hospital in Bomet. She had been referred to the facility which specializes in management of esophageal cancer.

“At Tenwek hospital, it was confirmed I had stage 2 esophageal cancer and needed to be fitted with a pipe inside my throat to aid in eating. I did not have money to pay for the stent. It came as relief when I was told the Ministry of Health had donated stents to the hospital and I would get it fitted for free.’’ Said Moraa.

On February 2nd this year, she underwent a 30-minute esophageal stent placement procedure. A tube was inserted in her esophagus to keep the blocked area open and help in swallowing. This marked a new chapter in her treatment journey after more than one year of excruciating eating episodes and numerous hospital visits.

Dr. Michael Mwachiro, Director Endoscopy Department at Tenwek hospital, said the hospital was happy to have received a donation of stents from the Ministry of Health to assist needy cancer patients.

“We fit an average of 600 stents per year. The stent project by government has removed the cost of buying stents for patients which has increased access to cancer treatment. We received 200 stents from the National Cancer Control program and fitted 160 stents by end of February.” Explained Dr. Mwachiro.

Additionally, he revealed they had partnered with government to ease the cancer burden. He explained some of the strategies in place included; enhanced surveillance, public sensitization and training of healthcare personnel in six high burden counties namely; Bomet, Uasin Gishu, Kisumu, Kakamega, Meru, Kilifi and Garissa.

“We are monitoring to ensure those found to have the slightest symptoms such as assumption of heart burn get tested. We are training health care workers on early detection, screening and what to do if a patient exhibits symptoms such as difficulty in swallowing, pain in the chest and abdomen. We are also training them on placement of stents. Esophageal cancer is treatable with early diagnosis”. He explained.

Esophageal cancer burden

Esophageal cancer which is detected in the throat, is listed as the fourth leading cause of death among cancer patients in Kenya after breast cancer, cervical cancer and prostate cancer. According to the Head of the National Cancer Control Program Dr. Mary Nyangasi, of the 2,974 new cases reported annually, 2,743 patients die translating to a 95% death rate.

It is these statistics that triggered the Ministry of Health through the National Cancer Control Program to strategize on ways to reduce the impact of the disease such as provision of stents to patients to improve nutrition and increase chances of treatment.

“When we looked at the market costs, one stent goes for between 40,000 to 50,000 shillings. Not many Kenyans can afford this. A majority of them go back home, give up and die. We decided to procure about 300 stents in the last financial year and approached Tenwek hospital to support a program where the patients will not be charged for the stents and have them fixed for free” remarked Dr. Nyangasi.

The program which started in October last year has transformed the lives of more than 200 patients who have had the stents fitted for free. By the end of February this year 160 patients aged between 21 to 91 years had been fitted with a free stent donated by the government.

“Patients who would have died of starvation are now able to swallow, their nutrition is improved. Nutrition is important when you want to start treatment for cancer. We hope the mortality rate will now reduce.” stated the head of the national cancer control program.

The Ministry plans to track the progress of the 300 patients who benefit from the stents to inform future management of the disease and reduce the mortality rate.

Among other strategies adopted by government to reduce esophageal cancer deaths include a plan to have stents listed under essential commodities by KEMSA which will drastically reduce the cost and increase access, increase diagnostic equipment in hospitals, build capacity of healthcare workers to enhance their index of suspicion when patients present with esophageal cancer symptoms. Already discussions are ongoing with the Japanese government to give a grant of endoscopic equipment to 7 county referral hospitals in Machakos, Mombasa, Tenwek in Bomet, Kenyatta National Hospital, Bungoma, Kakamega, and Meru county referral hospitals.

Esophageal risk factors are similar to those of other forms of cancer such as; smoking cigarettes, alcohol consumption, consuming unhealthy foods among others.

“The high mortality from the disease is due to the fact that one cannot swallow food or drink. The stent improves nutrition of patients to withstand treatment” observed Dr. Nyangasi.

Focusing on the future

Moraa has begun treatment after her nutrition improved following the insertion of the stent. She undergoes chemotherapy sessions on a weekly basis at Kenyatta National Hospital in Nairobi.

She is undergoing treatment at a subsidized cost courtesy of her National Health Insurance Fund (NHIF) card. She has already undergone five of the eleven scheduled sessions and the cost of treatment continues to decrease with each session.

To raise awareness on this form of cancer during the esophageal cancer awareness month commemorated in April, Moraa has a word of encouragement to others presenting with similar symptoms.

“I would like to tell others cancer is not witchcraft, if you feel unwell go to hospital early and the doctors will be able to assist you.” She advises.