Jun 01 2012
By Rondi Kauffman, MD
Vanderbilt University: Department of General Surgery
Being diagnosed with a malignancy in Kenya is a very different thing than being diagnosed with a malignancy in the United States. CT scans and PET scans as means to evaluate for metastases are not locally available. A patient must travel to Nairobi, and frequently, these imaging studies are too expensive for most patients to afford. Furthermore, many malignancies are very advanced when they first come to the attention of a physician. Patients may delay being evaluated because of the cost, because of the distance required to get to a clinic, or because they must choose between obtaining health care and their family eating. Finally, chemotherapy and radiation therapy have limited availability. At the private hospitals, the costs are prohibitive for many patients which means that the queue to access the limited government sponsored facilities is exceedingly long making access to treatment all the more difficult. As a result, all of the procedures I have done in my first week in Kenya on patients with malignancies have been palliative in nature. This is emotionally challenging for clinicians who are accustomed to being able to offer surgery for cure. Still, it is a way by which to provide improved quality of life for whatever time a patient may have left, and that is certainly valuable to both the individual and their family.
It has struck me though, the number of malignancies I have seen here. I have been surprised- having expected rather to see more infectious diseases. I wonder if public health campaigns to provide mosquito nets, community education projects to teach about modes of transmission of HIV, and global health programs to provide free immunizations haven’t started to lead to some progress in the battle against communicable diseases in the developing world. Not that there isn’t still work to be done, but perhaps we are getting somewhere. Maybe it is time to bring the fight against cancer to the forefront of the global health platform. There is clearly a need.