Only two radiotherapy machines working in Nigeria

Following complains by cancer patients across the country in accessing treatment, there is the need to ascertain the availability and functionality of radiation machines at some designated hospitals in the country, as the machines, used in treating sufferers, are said to be working either at half capacity or have packed up.

About half of all cancer patients receive some type of radiation therapy during the course of their treatment, whereby high-energy radiation is used to shrink tumors and kill cancer cells through X-rays, gamma rays and charged particles.

The radiation may be delivered by a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy, also called brachytherapy).

Systemic radiation therapy uses radioactive substances, such as radioactive iodine that travel in the blood to kill cancer cells.

Consequently, however, Dr Mohammed Habeebu, a Consultant Oncologist and Radiotherapist at the Lagos University Teaching Hospital (LUTH), Idi- Araba, Lagos, said the radiotherapy machine at the hospital broke down as a result of overuse.

Habeebu, who was reacting to the allegation that the radiotherapy machine at the teaching hospital was faulty, confirmed to the News Agency of Nigeria (NAN) in Lagos that “as I speak to you now, the machine is faulty, but our machine is not the only one faulty, others in the country are also faulty and only two are functional out of the about seven we have in the country.

“We have six government-owned and one privately-owned designated hospitals with radiation machines . The private one is operational and one other in the government hospital is functioning.

“In LUTH’s case, we are trying to repair the machine, but the clinic is on, where we treat patients every day. There are many modalities to the treatment of cancer. Cancer treatment is not just about radiotherapy; there are other forms of treatment too.’’

The consultant oncologist also said that radiotherapy machine was highly technical and required specialised handling, adding that “the machine can breakdown if the workload is too much. However, in most cases outside the country, they provide back-up in case the one being used is faulty; they don’t rely on one machine.

“Here in the country, we have only one per centre because of the cost of the machine, and that one is being over stretched. We need to have more than one of such machine in every centre. The workload is huge on the machine; we need a back-up to support it.’’

Habeebu, who, however, reiterated the commitment of the hospital to provide quality treatment to cancer patients, advised people to always present themselves early and stop attributing spiritual attachment to it, stressing that “LUTH will always be in the forefront of cancer treatment even though most patients come to the hospital when it is late due to many reasons.

“One reason is the culture, where people attribute it to spiritual attacks; people believe cancer is a spiritual disease and because of that, they go for spiritual solution and secondly is that most Nigerians are not financially buoyant and cancer treatment is expensive and people may not be able to afford it.

“We really need awareness on this issue to educate our spiritualists to send cancer patients to hospital as there is no any approved traditional medicine for the treatment of cancer known to the medical world.’’

On her part, Dr Abia Nzelu, the Executive Secretary, Community Encouraging Corporate Philanthropy (CECP-Nigeria) said Nigeria needed to have comprehensive data and mobile cancer treatment centres.

Nzelu, also an oncologist, said “the country cannot only rely on limited number of radiotherapy machines; we have about six machines in the country and most of them are not working. At a given time, we only have only one functioning.

“When one of my patients was referred to LUTH for radiotherapy and was told that the machine was down, I felt bad. That is what we are going through in Nigeria. LUTH as a teaching hospital is not the kind of place where you can just put only one machine. Putting only one there would make the machine over-worked.

She said “all types of cancer cases such as breast, cervical, prostate, colon and others are accessing only one machine and that calls for great concern. To solve this, we need mobile cancer centres.

“Also, there are more high-tech machines that can facilitate the treatment of cancer better than the radiography machine. The new one takes care of both cancer cells and normal cells.’’
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Meanwhile, some patients at LUTH expressed worry over their inability to access the machine and urged relevant authorities to expedite action in repairing it.

Mrs Gift Augustine, an indigene of Imo, who brought her mother to LUTH said only the X-ray machine was functioning and that they had not been able to access the radiotherapy machine.

She said “my mother has cancer and the doctors are trying their best but the machine is not functioning.

Another helper who brought a cancer patient, Mr Layeni Bodunde, said “even the X-ray machine is only working manually not automatic.’’

The story is the same at the University College Hospital (UCH) Ibadan, but Prof. Temitope Alonge, the Chief Medical Director, told NAN that the hospital had bought a radiation machine for the treatment of cancer “and the Cobalt 60 radiation machine, which costs N10 million, will be delivered to the hospital before the end of November.

He explained that the machine was purchased from Panacea Biotec Company of India, and would be ferried to Nigeria within the next few weeks.

He added that “panacea is one of the three largest biotech companies in India involved in research, manufacturing and marketing of pharmaceutical formations, vaccines and natural products.

“The company is responsible for installation of the machine, and radiotherapy technicians, maintenance engineers and mould room technicians who would all be trained in the management of this equipment.

“We opted for the Co-60 because it is now used medically for radiation therapy as implants and as external source of radiation exposure in cancer patients.’’

Also, Dr Theresa Elumelu-Kupoliyi, a Consultant Radiation Oncologist and Head of Department of Radiotherapy, UCH, said when the machine was eventually delivered, more cancer patients would be successfully treated.

She then urged the Federal Government to provide the machine in more hospitals in order to cater for the increasing cases of cancer among Nigerians.

A female nurse who spoke to NAN under anonymity said the department had not given radiotherapy treatment to any cancer patient since January 2015.

She said patients stopped coming when the machine “packed up’’ and they had to seek help from other hospitals that had the facility, noting, however, that with the UCH arrangement to buy a new one, there was hope for cancer patients who attend the hospital.

Elsewher at University of Benin Teaching Hospital, (UBTH), the CMD, Prof. Michael Ibadin, said the faulty cancer treatment machine would be fixed before the end of 2015.

He told NAN in Benin that the cancer treatment machine, which was acquired five years ago at the cost of N2 billion, broke down recently and patients were being referred to the National Hospital in Abuja to enable them to access treatment.

He added that “the control board in the machine is faulty and it is not easily available in the country. We wanted to repair it, but we were told that the machine is old and needs a replacement.’’

However, Dr Malami Gandi, a Consultant Oncologist at Usmanu Danfodiyo University Teaching Hospital, Sokoto, said that the machine was still in good shape but the burden was high.

Gandi, who is the Head of Oncology and Radiotherapy Department of the hospital, told NAN that with increased prevalence of cancer cases across the nation, there was the need to have more of such machines in more hospitals to take care of patients.

He listed some of the cancer types mostly presented to the hospital to include breast cancer, cervical cancer, prostate, colorectal, brain, lung, as well as that of head and neck.

He added that between January this year to date, the hospital recorded 150 breast cancer and 110 cervical cancer cases, which were the commonest.

While maintaining that there was no immediate known cause of cancer, the consultant oncologist, who was trained in South Africa, enumerated some of the predisposing factors of cancer in Nigeria to include the Human Papiloma Virus (HPV).

He said “the pandemic is also precipitated by seeming lack of personal and environmental hygiene. In the same vein, cancer cases are increasingly caused by the suppression of immunity in some of the patients.

“This could be due to multiple sexual partners, as the HPV is harbored by men, but HPV infects women, leaving the men as mere carriers,’’ he lamented.

The consultant noted that apart from the radiotherapy machine, the hospital also has functional computer tumography stimulator machine and has no fewer than 24 cancer specialists, among others.

The specialists, he added include mould room technicians, oncology nurses, clinical oncologists and medical physicists, among others.

On the cost of cancer treatment, Gandi said 95 per cent of the patients are indigent, while only five per cent can go out of Nigeria, with four per cent using public funds for treatment.

“The treatment of cancer is capital intensive and we can treat between 45 to 50 patients daily with the linear machine for radiation. We are trying to upgrade it to be able to treat 100 patients per day, when the latest technology from Electa, UK is acquired.

“The bractherapy machine which complements treatment of cervical cancer patients is non-existent in Nigeria,’’ he lamented and urged the Federal Government to establish additional centres for treatment across the country.

“NHIS should also include oncology services in its activities to alleviate the sufferings of cancer patients who are largely indigent, while its treatment is expensive.’’

The CMD of the hospital, Dr Yakubu Ahmed, disclosed that all arrangements had been concluded to start the use of nuclear medicine, with the training of three specialist doctors abroad.

“Patients from across Nigeria are accessing treatment here and our efforts will be sustained, with priority on training and re-training,’’ he promised.

“We are also discussing with NHIS that gave the machine, while JNCI Ltd, a company based in Lagos will provide funds to balance what is needed to buy the new machine.

“We will, however, continue to provide highly subsidised services to the people, to alleviate the sufferings of patients.’’

The mother of a three-year-old cancer patient, Faith Ayodele, Mrs Odutola Omowunmi, said her daughter was afflicted with retinoblastoma since 2014, an infection which had debilitated her left eye.

“I came from Lagos down to UDUTH Sokoto for the treatment of my daughter and the radiotherapy treatment is working steadily for her.

“The Federal Government should provide more machines, while there should be more awareness.’’

At the Ahmadu Bello University Teaching Hospital (ABUTH) where the cancer machine was also functional, the CMD, Prof. Lawal Khalid, however, complained that it was installed in 2005 and now old and obsolete, as many places no longer use it because the factory that produced it are already folding-up.

He suggested a replacement with the latest cancer treatment machine which he said was faster and convenient and its parts easily available.

Also, Dr Adamu Abdullahi of Clinical and Radiation Oncology, ABUTH, advocated a Public Private Partnership to procure the linear accelerators and position them in each of the six geopolitical zones of the country with a view to assisting the cancer patients.

He also appealed to multinational corporations to assist in procuring the machine as part of their corporate social responsibility.

NAN