March 9 — Cancer Care in Zimbabwe

I’ve paid extra attention to the subject of cancer care during this visit to Zimbabwe. Economic conditions have improved in the country since my 2009 visit. The economy has stabilized somewhat, the shops have food for those with the U.S. dollars to purchase it, and there are many cars, many new cars, on the roads. Yet, power cuts are common; fuel can be difficult to find; Harare’s water remains unsafe to drink, and some suburbs are not being supplied; and unemployment runs above 90 percent, leaving many people, particularly in rural areas, without cash for food, school fees, and other necessities.

So, how does cancer care fit into this situation?

First, a broad picture for government and mission hospitals as I have pieced it together (I have no information on private clinics, except that conditions are said to be generally better):

  • There are two national referral centers for radiotherapy, chemotherapy, and specialized surgery, Parirenyatwa Hospital in Harare, and Mopelo Teaching Hospital in Bulawayo.
  • There are three oncologists remaining in the nation, with two more to be certified in June.
  • One doctor noted that two curable cancers in the country are cervical cancer and lymphoma, and that it is possible to identify those who are curable, but the cost of drugs is a problem.
  • Radiation therapy is available mainly at the referral hospital in Harare, but it is very limited, expensive, and patients may wait many months for treatment.
  • Chemotherapy is limited. Patients or families must purchase the drugs themselves and bring them to the doctor. Only a few drugs are available, and 90 percent of the patients can’t afford them, or they may purchase enough for one course of therapy when several courses are needed.
  • Morphine is used for pain control, but supplies are erratic and the drug is sometimes unavailable.
  • Health workers feel overwhelmed because they have few resources, and patients keep returning as their cancer progresses. As one doctor put it, “They keep seeing patients who don’t get well. It is not easy.”
  • Programs are needed for education, screening, and early detection. This is particularly true for cervical cancer, which is detectible at an early and curable stage (the incidence of this cervical cancer is also increasing due to HIV infection). Breast cancer is often detectable early, and its early removal can improve quality of life and extend life.

Here is what I learned at the local level:

  • One mission hospital is using telemedicine to diagnose cervical cancer and other malignancies. They biopsy a mass, cut thin sections from the biopsy and stain the sections, scan these under a microscope, and transmit the digital image to colleagues in Switzerland for diagnosis.
  • Pap smears for early detection of cervical cancer are not done because hospitals lack reagents for the involved staining process.
  • Cervical cancer occurs in women aged 35 to 60, and it is usually advanced at diagnosis. The younger women are generally HIV-positive.
  • When a woman is told she has cervical cancer and that her uterus must be removed, she will say she must confer with her family and then return to the hospital. But some women don’t return for three to six months. Some wait two years. “When they have blood as an oozing discharge, then the woman is frightened and she returns.”
  • Women with breast cancer are usually aged 55 to 65, though some are in their 30s. The women arrive at the hospital “with a wound that has not healed. These patients are referred to Harare Hospital for mastectomy, but they are scheduled for surgery one or two years in the future, and some die in the meantime.” (Many rural patients who are referred to Harare do not go because they lack even the money for transport.)
  • When a woman is told she will lose her breast, she is likely to go to a “prophet” or a traditional healer who will use magic and say that she is cured. But when the wound worsens, the she will return to the mission hospital hoping for help. “But all we can do is provide some morphine for the pain and give her a dressing that helps with the bad odor.”

If anyone has ideas for how we can work together to ease the suffering caused by cancer in Zimbabwe, please pass them along.  Thanks, and I hope all is well. Darrell