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Africa's looming cancer epidemic

By 2020, it is predicted that Africa will be facing a cancer epidemic. Claudia Hammond reports from Ghana, where efforts are being made to transform cancer care before it is too late.

Kumasi
Kumasi has one of only two cancer treatment centres in the country

When I first walked into the room labelled brachytherapy in the hospital in Ghana's second city, Kumasi, it seemed fairly empty.

There was just one nurse sitting at a wooden desk.

But she was watching a black-and-white monitor, and there on the screen was a woman lying very still on a bed in a cell-like room.

Broad tubes emerged near her feet from under the crumpled sheets.

For the safety of staff, she was separated from them by several heavy, lead doors while she had the radioactive treatment.

Still a young woman, she has cervical cancer, the most common form of cancer in Ghana.

'Distinctly uncomfortable'

This hospital is one of just two with cancer centres, and between them they serve a country with a population of 23 million.

Map of Ghana
But this treatment - low dose brachytherapy - is not pleasant.

Radioactive material is inserted into the cervix via tubes, which are held in place with metal gynaecological devices.

The doctor showed me the equipment and it looked distinctly uncomfortable.

There are just five cancer specialists in the whole country, treating tumours of a size doctors in the West rarely see
But it was worse than I thought.

For this treatment the patient must stay alone in this room for 50 consecutive hours.

There was a TV, but little else to distract her.

Fear of surgery

Like many cancer patients in Ghana, the disease was not diagnosed until it was already at a late stage.

There are just five cancer specialists in the whole country, treating tumours of a size that doctors in the West rarely see.

A combination of a lack of awareness of the symptoms, combined with a fear of surgery and the stigma of cancer, leads people to seek help late.

Doctors have resorted to recruiting ex-patients who have survived to help them to convince people to have surgery
In rural areas, the first port of call is often a traditional healer and the tumours tend to be treated with herbal remedies more suited to boils.

Then there is the belief that cancer always leads to death.

It is not unusual here to know someone who has had a mastectomy for breast cancer that was at such a late stage that they later died.

So in many people's minds their deaths are linked with the operation.

Recruiting ex-patients

Sharon
Sharon helps other cancer patients see the benefits of treatment
Doctors have resorted to recruiting ex-patients who have survived to help them to convince people to have surgery.

Sharon, who has lost two cousins and a sister to cancer, was diagnosed with breast cancer 19 years ago and had a double mastectomy.

She told me women are afraid to have mastectomies in case their in-laws persuade their husbands to leave them.

Her approach is blunt. Whenever she is going to the hospital to meet a woman reluctant to have the surgery, she gets dressed up so that she is looking her best, draws the curtains around the hospital cubicle and then quickly undoes her blouse.

"One woman almost fainted," she told me.

And then she spells it out to them: "If you don't do it, you will die."

Charitable organisation

But in rural areas, even the option of treatment is not always available.

A new charitable organisation called Afrox - led by a team from Oxford University - has ambitious plans to transform cancer care across Africa before the predicted epidemic starts, and it is beginning its work in Ghana.

The proposals cover the prevention and early detection of cancer as well as treatment and palliative care.

This is an area where a lot of people miss out.

Protocol seems to dictate that no decisions are made during the meetings themselves, so by the end very little appears to have been achieved
Although the number of terminally ill patients is on the rise, there are no hospices and for some there are not even adequate painkillers.

Sharon told me about a woman she used to visit who was dying from breast cancer.

Her family saved what little money they had to give her a good funeral, rather than spend it on pain relief for her final days. They said she was going to die anyway, so why waste money on treatment?

Ministerial meetings

For two days I sat in on the meetings Afrox had with health ministers and other officials.

It was an insight into the way ministerial meetings work.

Protocol seems to dictate that no decisions are made during the meetings themselves, so by the end very little appears to have been achieved.

What does take place is a great deal of business-card swapping.

There is even an etiquette for the timing of the handing over of the card.

People introduce themselves, set out their stall, get some kind of response and then out come the cards. It is easy to get 20 in a day.

Then everyone shakes hands, and with nothing agreed the meeting is over. Yet somehow this is how policies are formed and things do get done.

As well as going to meetings in the two days since I had seen the patient having brachytherapy, I had recorded lots of interviews, had two lunches, two suppers and two nights' sleep.

But all along I knew that she was still there, lying with that equipment inside her, all alone in that little room.

And it turns out that after all that, this treatment is not even aimed at curing her. She just might live a little longer.

From Our Own Correspondent was broadcast on Thursday 12 June, 2008 at 1100 BST on BBC Radio 4. Please check the programme schedules for World Service transmission times.

SEE ALSO
Country profile: Ghana
06 Feb 08 |  Country profiles
Timeline: Ghana
06 Feb 08 |  Country profiles
Ghana hosts 50th birthday party
06 Mar 07 |  Africa

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