Will the much-heralded Universal Health Coverage (UHC), a major plank of President Uhuru Kenyatta’s Big Four Agenda, extend its benefits to cancer patients?
That is the question on the lips of patients, survivors, lobby groups and the leaders of organisations involved in the treatment and care of one of the most dreaded non-communicable diseases (NCDs), thanks to its costly nature.
Cancer survivor and founder of community organisation Breast Cancer Kenya Josephine Sitawa is categorical: “Cancer should be declared a national disaster.”
In a 30-minute telephone interview on Friday, Ms Sitawa, 35, discussed the economic cost of a disease that tends to be limited to its debilitating physical impact and the pain it causes patients.
Xeloda — the brand name for an anti-cancer-chemotherapy drug Capecitabine — has to be administered every two to three weeks at a cost of between Sh30,000 and 40,000, Ms Sitawa says.
“Remember, this is a woman with no money. She has been relieved of her duties and most likely parted with her husband and her family because of the stigma associated with disease. Patients would rather stay hungry in the house, where they are perceived to be doomed to die, than seek help to buy food,” she says of a disease with great psychological and physical impacts.
Another chemo drug, Herceptin (Trastuzumab) costs between Sh150,000 and Sh250,000 per cycle of three to four weeks, “depending on the supplier and the economic situation in the country”. Most patients, Ms Sitawa says, “give up and wait to die”.
Breast Cancer Kenya is seeking a memorandum of understanding with the National Hospital Insurance Fund (NHIF), irrespective of whether or not the President’s UHC will cover cancer.
And not just for breast cancer. Cervical cancer, which causes continuous bleeding, requires two packets of sanitary pads daily, which is way beyond the means of an already vulnerable lot.
The prohibitive cost of cancer has heightened the clamour to declare it a national disaster, as Laikipia Woman Representative Catherine Waruguru did when she filed a Motion in Parliament to that effect on March 21.
She also called for the establishment of a cancer fund to cater for patients’ treatment and care, noting that cancer causes more deaths than HIV, TB and malaria combined.
Dr Alfred Karagu, acting CEO at the National Cancer Institute (NCI), disclosed that an estimated Sh10 billion is spent annually by people seeking medical attention abroad, 50 to 60 percent are for cancer-related services. He described it as “a huge drain on the economy”.
He is for declaring cancer a national disaster because, “Whenever something is declared a national disaster, it makes everyone invest in it”.
He, too, referred this writer to the office of the Cabinet secretary, which is responsible for appointing boards to statutory organisations, for a comment on why the NCI has operated for a whole year without a board.
During a telephone interview with the Executive Director of the Kenya Hospices and Palliative Care Association (Kehpca), Dr Zipporah Ali, she backed the call to declare cancer a national disaster.
Kehpca, a grouping of 70 hospices, also has 17 palliative outlets in 35 counties, catering for cancer patients and those afflicted by NCDs.
Cancer is harder to treat, and more expensive, yet there is a shortage of treatment centres, she says.
“Patients and their families want cancer declared a national disaster and accorded the same importance HIV/Aids was given,” Dr Ali said, adding that HIV/Aids received more attention after it was declared a national disaster.
She challenged donors to also support NCDs, as “cancer does not come alone; a cancer patient can also have HIV or other NCDs”.
The doctor was concerned that the UHC programme does not seem to address palliative care, which, she says, should be part of the package.
Palliative care is important in addressing non-curable diseases that are often accompanied by distressing symptoms, which can be physical, psychological, emotional and spiritual.
It is holistic and extends to the entire family. Coughs, diarrhoea, and pain, “which can be very frustrating”, are among the afflictions terminally-ill patients face.
The Kenya Network of Cancer Organisations (Kenco) also noted frequent shortages and drug stock-outs, which were particularly bad this year in public facilities, including Kenyatta National Hospital. When the drugs were available, they were quite costly.
Its 2018 scorecard dated November 27, which the chairperson, Mr David Makumi, made available to this writer, shows that some patients cannot afford even Sh200 for a monthly dose of Tamoxifen.
The 25-member group blames shortages and the high cost of drugs on procurement hitches, which put patients at risk of disease progression.
“The cost of chemotherapy and supportive drugs is prohibitively high,” it says, urging the Ministry of Health to ensure that Kemsa [Kenya Medical Supplies Authority] stocks all chemotherapy drugs and avoid parallel procurement mechanisms in public hospitals.
“It is unacceptable that 55 years after independence, Kenyatta National Hospital is the only public hospital with radiotherapy facilities,” Kenco says in its scorecard.
Public officers above 58 years and with pre-existing conditions told to work from home: The Standard
Head of Public Service Joseph Kinyua. [File, Standard]
In a document from Head of Public Service, Joseph Kinyua new measure have been outlined to curb the bulging spread of covid-19. Public officers with underlying health conditions and those who are over 58 years -a group that experts have classified as most vulnerable to the virus will be required to execute their duties from home.
However, the new rule excluded personnel in the security sector and other critical and essential services.
“All State and public officers with pre-existing medical conditions and/or aged 58 years and above serving in CSG5 (job group ‘S’) and below or their equivalents should forthwith work from home,” read the document,” read the document.
To ensure that those working from home deliver, the Public Service directs that there be clear assignments and targets tasked for the period designated and a clear reporting line to monitor and review work done.
SEE ALSO: Thinking inside the cardboard box for post-lockdown work stations
Others measures outlined in the document include the provision of personal protective equipment to staff, provision of sanitizers and access to washing facilities fitted with soap and water, temperature checks for all staff and clients entering public offices regular fumigation of office premises and vehicles and minimizing of visitors except by prior appointments.
Officers who contract the virus and come back to work after quarantine or isolation period will be required to follow specific directives such as obtaining clearance from the isolation facility certified by the designated persons indicating that the public officer is free and safe from Covid-19. The officer will also be required to stay away from duty station for a period of seven days after the date of medical certification.
“The period a public officer spends in quarantine or isolation due to Covid-19, shall be treated as sick leave and shall be subject to the Provisions of the Human Resource Policy and procedures Manual for the Public Service(May,2016),” read the document.
The service has also made discrimination and stigmatization an offence and has guaranteed those affected with the virus to receive adequate access to mental health and psychosocial supported offered by the government.
The new directives targeting the Public Services come at a time when Kenyans have increasingly shown lack of strict observance of the issued guidelines even as the number of positive Covid-19 cases skyrocket to 13,771 and leaving 238 dead as of today.
SEE ALSO: Working from home could be blessing in disguise for persons with disabilities
Principal Secretaries/ Accounting Officers will be personally responsible for effective enforcement and compliance of the current guidelines and any future directives issued to mitigate the spread of Covid-19.
Uhuru convenes summit to review rising Covid-19 cases: The Standard
President Uhuru Kenyatta (pictured) will on Friday, July 24, meet governors following the ballooning Covid-19 infections in recent days.
The session will among other things review the efficacy of the containment measures in place and review the impact of the phased easing of the restrictions, State House said in a statement.
This story is being updated.
SEE ALSO: Sakaja resigns from Covid-19 Senate committee, in court tomorrow
Drastic life changes affecting mental health
Kenya has been ranked 6th among African countries with the highest cases of depression, this has triggered anxiety by the World Health Organization (WHO), with 1.9 million people suffering from a form of mental conditions such as depression, substance abuse.
Globally, one in four people is affected by mental or neurological disorders at some point in their lives, this is according to the WHO.
Currently, around 450 million people suffer from such conditions, placing mental disorders among the leading causes of ill-health and disability worldwide.
The pandemic has also been known to cause significant distress, mostly affecting the state of one’s mental well-being.
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With the spread of the COVID-19 pandemic attributed to the novel Coronavirus disease, millions have been affected globally with over 14 million infections and half a million deaths as to date. This has brought about uncertainty coupled with difficult situations, including job loss and the risk of contracting the deadly virus.
In Kenya the first Coronavirus case was reported in Nairobi by the Ministry of Health on the 12th March 2020. It was not until the government put in place precautionary measures including a curfew and lockdown (the latter having being lifted) due to an increase in the number of infections that people began feeling its effect both economically and socially.
A study by Dr. Habil Otanga, a Lecturer at the University of Nairobi, Department of Psychology says that such measures can in turn lead to surge in mental related illnesses including depression, feelings of confusion, anger and fear, and even substance abuse. It also brings with it a sense of boredom, loneliness, anger, isolation and frustration. In the post-quarantine/isolation period, loss of employment due to the depressed economy and the stigma around the disease are also likely to lead to mental health problems.
The Kenya National Bureau of Statistics (KNBS) states that at least 300,000 Kenyans have lost their jobs due to the Coronavirus pandemic between the period of January and March this year.
KNBC noted that the number of employed Kenyans plunged to 17.8 million as of March from 18.1 million people as compared to last year in December. The Report states that the unemployment rate in Kenya stands at 13.7 per cent as of March this year while it stood 12.4 per cent in December 2019.
Mama T (not her real name) is among millions of Kenyans who have been affected by containment measures put in place to curb the spread of the virus, either by losing their source of income or having to work under tough guidelines put in place by the MOH.
As young mother and an event organizer, she has found it hard to explain to her children why they cannot go to school or socialize freely with their peers as before.
“Sometimes it gets difficult as they do not understand what is happening due to their age, this at times becomes hard on me as they often think I am punishing them,”
Her contract was put on hold as no event or public gatherings can take place due to the pandemic. This has brought other challenges along with it, as she has to find means of fending for her family expenditures that including rent and food.
“I often wake up in the middle of the night with worries about my next move as the pandemic does not exhibit any signs of easing up,” she says. She adds that she has been forced to sort for manual jobs to keep her family afloat.
Ms. Mary Wahome, a Counseling Psychologist and Programs Director at ‘The Reason to Hope,’ in Karen, Nairobi says that such kind of drastic life changes have an adverse effect on one’s mental status including their family members and if not addressed early can lead to depression among other issues.
“We have had cases of people indulging in substance abuse to deal with the uncertainty and stress brought about by the pandemic, this in turn leads to dependence and also domestic abuse,”
Sam Njoroge , a waiter at a local hotel in Kiambu, has found himself indulging in substance abuse due to challenges he is facing after the hotel he was working in was closed down as it has not yet met the standards required by the MOH to open.
“My day starts at 6am where I go to a local pub, here I can get a drink for as little as Sh30, It makes me suppress the frustration I feel.” he says.
Sam is among the many who have found themselves in the same predicament and resulted to substance abuse finding ways to beat strict measures put in place by the government on the sale of alcohol so as to cope.
Mary says, situations like Sam’s are dangerous and if not addressed early can lead to serious complications, including addiction and dependency, violent behavior and also early death due to health complications.
She has, however, lauded the government for encouraging mental wellness and also launching the Psychological First Aid (PFA) guide in the wake of the virus putting emphasis on the three action principal of look, listen and link. “When we follow this it will be easy to identify an individual in distress and also offer assistance”.
Mary has urged anyone feeling the weight of the virus taking a toll on them not to hesitate but look for someone to talk to.
“You should not only seek help from a specialist but also talk to a friend, let them know what you are undergoing and how you feel, this will help ease their emotional stress and also find ways of dealing with the situation they are facing,” She added
Mary continued to stress on the need to perform frequent body exercises as a form of stress relief, reading and also taking advantage of this unfortunate COVID-19 period to engage in hobbies and talent development.
“Let people take this as an opportunity to kip fit, get in touch with one’s inner self and also engage in reading that would help expand their knowledge.