After a long day’s work at a law firm in Nigeria’s capital, Abuja, 35-year-old Comfort Daniel returned to her apartment one cold evening in December 2014 and began to undress for a bath. She was halfway done when she felt a lump on her left breast. A pang of apprehension surged through her. She ran her hand over her breast and the lump became more visible.
But Daniel didn’t go to hospital for screening immediately. Instead she consulted a South African-based physician who visited her church after Sunday service. The physician gave her some drugs for 17,000 naira (£44) and told her that she would have a discharge from her nipple then she would be healed.
Trusting the physician’s assurance, Daniel didn’t visit the hospital for screening. Two weeks after the treatment, a brownish discharge came from her nipple, but she became more uncomfortable. Shortly afterwards she was watching TV when a health programme came on and a doctor advised women to go for screenings whenever they noticed any abnormalities on their breasts. “That was all I needed to go to a hospital in downtown Abuja,” she says.
After several months of travelling between a private clinic and the national hospital in Abuja, and after spending most of her savings on appointments, Daniel finally learned she had cancer in March 2015. “God forbid,” she recalls yelling at the doctors. “Nobody has cancer in my family.”
Daniel was astonished. “I thought cancer was a disease for elderly, more mature people,” she says. “But all of that changed after the doctors told me I had stage two breast cancer. In fact, they even said I’d had the lump on my breast for more than a year.”
Daniel underwent a mastectomy shortly after getting her diagnosis and is now having chemotherapy. She says the healthcare system was inadequate for her needs. “When I wanted to receive initial treatment, I had to visit many hospitals … doctors were either on strike or there was no electricity to power the machines, or they weren’t responding properly. This whole process can be frustrating.”
Daniel’s experience of trying alternative treatments before approaching doctors is common in Nigeria. Professor Tajudeen Olasinde is a consultant radiation and clinical oncologist at the Ahmadu Bello University Teaching Hospital in Zaria. He says late presentation is a widespread problem. “Around 85% of cancer patients present at advanced stages of their diseases in Nigeria due to poor awareness.”
Even when people do seek treatment, the equipment and facilities needed to treat cancer are not available everywhere. “Most diagnostic and treatment equipment are available in only tertiary health institutions, which are far away from most rural dwellers,” Olasinde says. “Where only one or two radiation treatment mega-voltage machines are functioning optimally at any time, [this] is unacceptable and a national disgrace for a country of 180 million people. At least, the country needs 180 functioning machines.”
Nigeria has less than 40 trained radiation oncologists and most of the nine comprehensive cancer treatment centres in Nigeria are, according to Olasinde, either “obsolete or non-functional”.
While cancer is more prevalent in wealthier countries – rates actually rise with increasing levels of income – the mortality rate is much higher in poorer countries such as Nigeria. The World Health Organisation estimates that more than 100,000 Nigerians are diagnosed with cancer each year, and 80,000 die from the disease. In the UK, where more people develop cancer, the rate of survival is 50%.
Campaigners and politicians across Nigeria are pushing to promote the kind of cancer care seen in wealthier countries, with an emphasis on prevention, early diagnosis and screening and survivor support.
NGOs such as the Abuja-based Health and Psychological Trust Centre – known as Project Pink Blue – are bringing best practice in cancer care to the city.
Having built up an awareness-raising programme that travels to rural areas to explain the signs of cancer and tell people how to prevent it, the centre has just begun Nigeria’s first breast cancer support group, made up of nine cancer survivors.
“Until we begin to change the way our people think about cancer we cannot change late detection of cancer,” says Runcie Chidebe, executive director of the centre.
Chidebe says that many people are unaware of behavioural and dietary risks that trigger cancer, including high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use and alcohol intake.
“The only way we can change the narrative of cancer being a death sentence is to get strong voices against cancer,” he says. “Strong voices against cancer cannot even be the doctors, neither can they be me nor the media. Strong voices of cancer are strong champions – the cancer survivors themselves. We have nine survivors right now, and we are mobilising more.”
Besides awareness campaigns, the group supports cancer patients through fundraising. It was through one such fundraising event that the NGO raised around 5.5m naira (£14,000) in cash and 9m naira in drug support to enable Daniel to have her chemotherapy when her savings ran out.
“I used up all the money I saved for my schooling for treatment, and when it finished I stayed away from treatment for more than a year until Mr Runcie came to my rescue,” Daniel says.
Politicians want to capitalise on the growing understanding of how to treat cancer. Muhammadu Usman is a lawmaker in the lower chamber of Nigeria’s legislature. With colleagues, he is sponsoring a bill calling for the establishment of national agency on cancer control. The bill has passed first and second readings and is due for a public hearing soon.
“Until we establish an agency that will handle cancer there is no way Nigeria can make any process,” he says. “When you have an agency, you will able to appropriate money, you will be able to recruit staff, the agency will be given certain responsibilities on mobilisation, treatment and prevention or seek international support.”
Usman notes that none of the country’s hospitals are properly equipped to provide the necessary medication to cancer patients. Citing recommendations from the International Atomic Energy Agency, he says South Africa has 18 functional machines for cancer treatment, Japan has 611 and China has 453.
Nigeria is supposed to have around 800 machines to treat cancer, such as an external beam radiotherapy machine, but none are working properly.
For Comfort Daniel, the new ways of supporting cancer patients are as important as working machinery. “After I was diagnosed with cancer, for three days I was unable to sleep. This is why the Abuja breast cancer support group is important. Nobody can understand the pains of the patient like a survivor,” she says. “There was a day I visited the hospital and came across an elderly woman who had breast cancer and was looking so sad. She refused to eat. But after speaking to her, she cheered up and took her food. Nobody can understand the pains we pass through, not even doctors.”
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"I thought cancer was a disease for the elderly": tackling Nigeria"s 80% mortality rate
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