When doctors at the Nakuru County Teaching and Referral Hospital told Nancy Kipkemoi in 2019 that her seven-year-old daughter had nephroblastoma, a kidney cancer that affects children, she accepted the prospects of not having much time with her. But then Covid-19 shortened that time further. The little girl, Fancy Chepkoech, died six months after doctors tried removing one of the kidneys and growth that needed surgery.
The process took longer than expected because of stretched facilities, besides a directive from the Ministry of Health that categorised surgeries like Fancy’s as “elective” operations, meaning they could wait.
As the pandemic escalated, the ministry canceled elective surgeries, hoping to conserve resources, including healthcare workers. “There is a need to direct all our available resources towards combating the further spread and prepare for intensive management of patients who may need critical care,” read a March 25, 2020 memo from then-Acting Health Director-General Patrick Amoth to all hospitals.
The directive read further: “This letter is therefore requesting you to cancel all elective surgical procedures, except obstetric cases, at your facilities to redirect resources towards combating this disease.”
Covid 19 Time Series
To ration the much-needed personal protective equipment, the government cancelled surgeries for early-stage cancer, joint replacements, and other considered non-emergency were cancelled to keep hospital beds open, and to protect patients from the virus.
Little Fancy, from Neissuit in Njoro, found herself battling cancer in this mix-up as her medical review took three weeks in Nakuru alone.
Fancy was referred to Kenyatta National Hospital and started on chemotherapy a month after admission, but died on October 17, 2020. Ms Kipkemoi was heartbroken.
Dr Festus Njuguna, in charge of the pediatric oncology unit at Moi Teaching and Referral Hospital in Eldoret, explains that not all elective surgeries are non-urgent, and not all are minor. Some delayed surgeries, though, may cause harm, especially in aggressive forms of cancers.
Harm is also in delayed diagnosis. Marian Wangui, from Githunguri in Kiambu County, found a lump under her breast. In fear, the 41-year-old sought medical advice and was instructed to go for tests in July 2020. She got a breast ultrasound at the Kiambu Level 5 Hospital, but it took months for the results to return. The anguish of waiting was unbearable as “I feared that if it was cancer, and that it would spread,” recalled Wangui adding that she had no choice but to refer herself to the Kenyatta National Hospital on December 2, 2020. A month later, results revealed she had Stage Two breast cancer. Chemotherapy was scheduled right away.
Such delays in diagnosis are what builds up to the ghastly statistics on cancer in Kenya. The World Health Organisation reported that as of September 2018, Kenya recorded 32,987 cancer deaths a year. This is two in five of all the deaths in East Africa.
Normally there is poor medical seeking behaviour, but the pandemic added to the delay in diagnosis as oncology services were greatly affected due to the curfews, lockdowns, and hike in transport.
“At the beginning of the pandemic, matatus imposed high charges, and cancer patients also feared contracting the virus,” said Dr Njuguna.
Cancer is a complex set of diseases whose move from one stage to another is influenced by the timing of diagnosis. Generally, patients who receive treatment earlier survive and have a better outcome after treatment.
Health Cabinet Secretary Mutahi Kagwe decried the decline in the number of patients visiting health facilities after the lockdowns. The cancers that were missed during the pandemic still came to light eventually, but at a later stage and with worse prognoses.
Andrew Odhiambo, an oncologist and lecturer at the University of Nairobi, said after the lockdown was lifted, he was losing patients at an abnormal rate due to delayed care, besides “the hiked fares, loss of jobs, and decline in fundraising for patients.”
Dr Odhiambo added that telemedicine helped “but patients should be checked, and also undergo surgeries, services that cannot be done on the internet or phone.”
Medics’ contracting of coronavirus also disrupted oncology services, as was the case in Longisa Hospital in Bomet County, where a majority of esophageal cancer patients seek care. Most are often very sick, sometimes unable to chew or swallow food.
Dr Stephen Omondi, an oncology pharmacist at the facility, said most patients were referred to the faith-based Tenwek Mission Hospital, which was already on its knees dealing with cases from all over the country.