Image courtesy of rjones0856
Co-written with Matthew de la Hey
African presidents keep disappearing. Mysterious trips abroad are commonplace, fuelling rumour and speculation about their causes. Whether of secret international meetings to lavish taxpayer funded holidays, the stories are everything from conspiratorial to ridiculous. The reality usually turns out to be much less glamorous. Presidents are flying across the world to seek medical treatment.
Zimbabwe's aged leader Robert Mugabe's destination of choice seems to be Singapore; Ethiopia's late President Hailemariam Desalegn died, after a curious disappearance, in a Belgian hospital; Zambia's Edgar Lungu is said to have flown to China to seek throat cancer treatment. In countries with limited healthcare infrastructure, which includes much of sub-Saharan Africa, elites jetting off to receive 'world-class' medical treatment is the norm. The vast majority of the populations left behind won't have that option.
Patients suffering from non-communicable diseases, and cancer especially, are in a particularly dire position. Domestic treatment options are scarce, with vital skills sorely lacking. Tanzania, for instance, does not have a single trained surgical oncologist. In 2013, The Lancet found that radiotherapy was available in just 23 of 53 African countries, mostly concentrated in the wealthier northern and southern regions. Some variants of the disease that could be avoided through vaccination, like cervical cancer, claim hundreds of thousands of lives. The problem is further complicated, as Kenya's First Lady Margaret Kenyatta remarked in 2014, by the fact that "seventy per cent of cancers in sub-Saharan Africa are discovered at a time when the disease is at an advanced stage, when it's too late for a cure".
Those diagnosed with cancer in Africa therefore face a harrowing choice: between extensive, costly treatments in foreign private healthcare establishments (beyond the reach of most), and an often slow, hopeless death. Unsurprisingly, it's not just Presidents that take the former path - many still spend huge sums trying to access treatment abroad: in Kenya for example, where cancer is the third highest cause of mortality, James Macharia, the Health Secretary, is reported to have stated that over 10,000 patients spend KSh 11.28billion (c.US$ 110m) annually on treatments overseas.
The global toll of cancer is set to rise and by 2020 it is widely suggested that there will be 16 million new cases annually. Afrox, a leading cancer charity, says that 70% of these will be in developing countries, an ominous statistic for an ill-prepared continent. However, the increasing urgency of the problem isn't lost on African leaders. Uhuru Kenyatta announced in July last year that Kenya would set up four "specialized cancer treatment centres" which, "in the spirit of African brotherhood... will be open to the people of the region and the continent". Rwanda is building a new 100-bed paediatric cancer centre, set to open in 2017. Uganda's President Museveni has pledged to build a specialist cancer hospital in Mbale, a city to the East of the country. As encouraging as these initiatives are, more can be done.
In a context of limited resources and huge, sparsely populated areas, a sensible approach would be the development of regional hubs, strategically located to serve the maximum number of potential patients. A good example of such an initiative is the proposed Rutakwabyera International Cancer centre in Tanzania. It would be built in Bukoba, on the Western bank of Lake Victoria, close to Rwanda, Burundi, Uganda and the DRC. If developed, its situation will allow it to become a nexus of cancer care in the Great Lakes region, catering not only for Tanzania but also to other patients in East Africa.
Pooling facilities in this way will offer governments more resources and companies bigger markets, too. As The Economist's Intelligence Unit suggested in its 2012 Healthcare in Africa Report, "better collaboration between both the public and private sectors will be crucial to improving healthcare provision in Africa". Regional hubs could provide a focus for this collaboration. Foreign aid also has a part to play, with a need for both investment and medical expertise. But whilst the potential rewards for those who pioneer new solutions on the continent are great, nations must be careful to ensure that provision is made for those least able to access quality care, and be certain that capacity across public and private sectors is efficiently utilised. It's not enough to have new hospitals and equipment; there must be people to perform the operations and run the hospitals, and attracting skilled oncologists and experienced administrators will require serious work, and serious money. The biggest mistake, at this stage, would be to underestimate the scale of the challenge ahead.
Waging an effective battle against cancer in Africa is not going to be easy, or cheap. If success is to be found the state and private sector must work together in a coordinated, cross-border attempt to alter the cancer treatment landscape. With increased provision for care, the statistics will improve. But statistics hide the grim reality of the problem; undignified and indiscriminate, cancer is biting hard in Africa. There is no time to waste.
Matthew de la Hey grew up in South Africa and read for an MSc in African Studies at Oxford University as a Weidenfeld Scholar. He now runs WorkMatch, a start-up company based in London.