By Prabhat Prakash
Mumbai: Cancer has been one of the leading causes of death globally and the incidence of cancer is on the rise. With advancements in medical science cancer is no more a ‘death sentence’ but the incidence and mortality rates remain high due to unawareness, denial, not being detected timely, appropriate treatment protocols being followed, and availability and accessibility of treatment.
India’s private healthcare sector is not just known for Medical Value Travel (MVT) but also for aspiring medical experts that travel to India seeking training and education in various specialities and sub-specialities. India has eminent doctors in various specialities, cancer treatment programmes, leading innovations, and advancements in various segments of healthcare delivery with better clinical outcomes that are at par with global standards.
Interacting with ETHealthworld two doctors from The Federal Democratic Republic of Ethiopia, a landlocked country in the continent of Africa discussed the uptick in the incidence of cancer and the burden is similar to that of anywhere in the world.
The nation of Ethiopia is capable of handling the majority of surgical interventions that can be done in Ethiopia, around 70 to 80 per cent of all surgical interventions. The country has a well-developed surgical team of different levels of specialities in different disciplines. The medical oncology part of cancer which involves medical treatments like chemotherapies is accessible to the people of Ethiopia. However, there is slight accessibility for people when it comes to some newly developed drugs and therapies.
Bridging the cancer care gap
Cervical cancer, breast cancer, and lung cancer are the most common worldwide. Similarly, in Ethiopia, the first two, cervical and breast cancer are at the top. Beyond that, the nation witnesses cases of colorectal cancers, cancers of the GI tract, and prostate cancer.
Dr Henok Seife, General Surgeon, AAU-CHS while visiting India for training at the Apollo Proton Centre, Chennai shared, “This training will help with hepatobiliary surgery which includes surgeries of the liver, pancreas, and the biliary tract. We came here because we wanted to have a good idea of how this most advanced technology in radiation therapy works in the world. This is the closest area for our country to have a reference for such a treatment. We have seen how proton radiation functions, its basic indications, and the advantages and disadvantages of this mode of treatment. As professionals, we need to know where we have to advise patients to get such treatments.”
Adding further Dr Seife mentioned, “When it comes to hormone and targeted therapies, we are still really far behind. So patients may have to travel for access to such medications, or we request medications to come from abroad. But when it comes to radiation therapy, we are far behind, almost by 20-30 years. That’s a major gap we have in cancer treatment. That’s where we want to fill the gap with partnership and collaboration.”
Financing cancer treatments in Ethiopia
The insurance system is nonexistent in the country. The insurance system by the government is just starting up, which only covers the services in a government centre, where the queues are very long and the services are very limited. So patients do not benefit from any insurance system in Ethiopia.
Very few private companies can afford to cover the medical expenditure. So more than 95 per cent of patients end up paying from their pockets. Patients who cannot afford to go overseas for treatment or get treated at private centres, avail of the services at the government centres. These services can be called pre-treatments because the prices are extremely low, and the majority of the services can be delivered for free in government centres. The only challenge is the long wait time for treatment, and the quality of care is in question as well.
Commenting on the strain that the public health sector in Ethiopia faces, Dr Kibruyisfaw Zewdie, Assistant Professor, Neurosurgery, Head, Paediatric Neurosurgery Division, Vice CEO, Lancet General Hospital added, “We are a country where we have 110+ million population. A year ago we had only one COBALT radiation machine that covered those 110 million population. So you can imagine the cues that the patients had to pass through to get treated. It might take 10 months to do a basic surgery. The doctors do what they can and send the patients for radiation. So the patient cannot get even proper radiation leading to recurrence.”
“We have five LINAC machines for a population of 110 million plus. So the patients have to wait for six months to a year, which makes them miss the golden period to have the radiation. Our economic situation is very bad, and very few people can afford to get treated from abroad,” informed Dr Zewdie.
Commenting on how Ethiopia is establishing a collaboration with Apollo Proto Centre, Dr Zewdie stated, “We are going to see the physicians and the provisionals available here so we can give the right recommendations based on the multidisciplinary team efforts that we witnessed here. We can also continue the care here at Apollo as we can directly communicate with the physicians here and be involved in the treatment. Additionally, we can send surgeons and clinical oncologists to receive their basic training here in India. Recently, three oncologists from Ethiopia were staying here for their training. They had lab sessions and visited the centre to get a glimpse of how the treatment is given at a standard level.”
Cancer treatments in government-funded hospitals
Addis Ababa, the capital city of Ethiopia has around 11 hospitals that are funded by the government. Two of the hospitals are tertiary level, and only one of them is capable of providing radiation oncology treatment. Most of the hospitals led by the city administration don’t have radiation treatment. These hospitals are capable of providing just provide basic clinical oncology services such as chemotherapy or diagnosis. The installation of five LINAC machines in different parts of the country has enabled radiation treatment in those parts of the country. However, problems in maintaining preventive maintenance of the machines persist.
“We have five regional speciality hospitals in Ethiopia which deliver services which are almost equivalent to speciality service. In the last year, we are developing radiation therapy as well. So the hospitals generally have a higher level of trained professionals, including specialists and subspecialties. So it is the system that does not help the hospital to perform as expected. So in all the private hospitals in Addis Ababa, the majority of the high-end practice and expertise is coming from the government teaching hospitals. So these experts from government hospitals are seeing more than 700 patients a day, and doing 15-20 procedures a day. These are all complicated bigger surgeries including brain tumour surgeries, spinal fixations, liver resections, pancreatic resections, and cardiothoracic surgeries. But we still are limited by the medical oncology service. We don’t have radiation therapy. So any patient that requires radiation therapy will generally be advised to travel for additional care.”
Prolonged waiting periods affecting success outcomes
The Ethiopian Health Ministry is engaging a lot of physicians and floating a roadmap for both speciality and sub-speciality programmes. Through this roadmap, the ministry is considering three important core points. First is personnel, which will include training individuals from different specialities and sub-speciality. The other major problem that the nation faces are instruments and infrastructure, for which the government plans to build good referral hospitals in different parts of the country. Finally, the government is also considering professionals from different societies.
Commenting on the current scenario in the country, Dr Seife mentioned, “The scenario is such that majority will end up not getting the radiation because, at the end of one year, most patients will have recurrence or far advanced malignancies, where radiation at the end will not help in the treatment. So even if they get the treatment, their quality of life will never be what it used to be or they may not survive the entire treatment therapy.”
“It is globally understood that base quality services, high-end specialised services in healthcare are inevitably provided by private sectors. Especially in countries like Ethiopia, India, or even Turkey, the government allows private centres to develop by not being able to provide such services themselves. This is more in the support of private centres to grow and come up with quality care because the government cannot afford to deliver high-end speciality services. That’s why the majority of Ethiopian doctors are collaborating to come up with a better healthcare facility, and trying to cope with the roadmap laid by the government,” shared Dr Seife.
The government has been trying to ease access to radiation as there is a lot of agony and misery in patients of oncology. There are also initiatives in trauma. The nation has a lot of patients with trauma and road traffic accidents. There is also a huge burden of infectious diseases. To tackle these medical issues, projects of up to $2 billion are being done in the bigger hospitals. New fully furnished hospitals are also being built for the same reason. So there are a lot of initiatives being undertaken by the government, and even though it’s not enough, the future seems promising.
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