Grappling With Rising Cases of Cancer

Jacob Ng'etich
From an obscure and insignificant disease that was known to affect a few old or rich people, cancer has now risen to become one of the leading causes of death in Kenya.
Studies by the Kenya Medical Research Institute indicate that cancer is the third cause of death after infectious diseases and cardiovascular diseases.
The disease has claimed the high and mighty, and the poor in the country.
Its latest victim is the celebrated environmentalist and Nobel Peace Prize winner, Prof Wangari Maathai, who died of ovarian cancer on Sunday night at Nairobi Hospital.
The increase in cancer cases has been attributed to, among other reasons, changing lifestyles.
Medical Services minister Prof Anyang' Nyong'o, himself a cancer survivor, says the disease accounts for seven percent of Kenya's total mortality every year.
The minister says every year, over 28,500 new cases of cancer are diagnosed. The country loses 22,100 people to the disease each year.
"It is sad because over 60 percent of those affected are below the age of 70. In Kenya, the risk of getting cancer before the age of 75 years has increased significantly over the years," said Prof Nyongo in an interview with the Saturday Nation.
However, the vice-chairman of Kenya Cancer Association, Mr David Mukami, gives a higher figure of new cases recorded annually.
"There are 18,000 deaths of cancer in the country annually, based on the ministry's statistics, though the figures are very modest given that there are no proper records on the disease.
"Even the 82,000 figure for new cases annually is modest because it does not include cases from rural areas," says Mr Mukami.
His assertion is supported by the Global Medicine (2011) report, which repeatedly states that the incidents of cancer in Kenya are on the rise, with over 82,000 new cases reported annually.
"Based on 2002 data from the Nairobi Cancer Registry, of all the cancers registered, breast cancer accounted for 23.3 percent, cervical cancer for 20 percent and prostate cancer for 9.4 percent. In 2006, around 2,354 women were diagnosed with cervical cancer and 65 percent died," says Prof Nyongo.
The 2010 study by KEMRI found that of the 2,292 cancer-related deaths recorded in Nairobi during a two-year period, oral tumours claimed the biggest percentage of victims.
According a policy brief on the analysis of cancer in Kenya, prepared by Parliament's department of research, cancer now ranks third as one of the most common diseases causing death in the country.
The report identifies the most common forms of cancer as breast and cervical cancer among women. Men are affected by cancer of the oesophagus, neck and prostate.
In children, the commonest cancers are blood (leukemia) and lymphomas. Dr Paul Wangai, a consultant physician and a doctor at Aga Khan, says the eating habits of Kenyans, especially in urban areas, exposes them to cancer.
"Cases of the rich-man-disease (the consumption of too much sugar and fats) are alarming. More people are complaining of diabetes and cardiovascular diseases. The trend is worrying. It causes a lot of problems, including cancer," says Dr Wangai.
Former Kenyatta National Hospital chief executive officer, Dr Jotham Micheni, agrees that there is a serious increase in non-communicable diseases related to lifestyle.
Dr Micheni says KNH received between 120,000 to 140,000 new cases related to lifestyle diseases per week. "There is a worrying trend," says Dr Micheni.
"Most of the cancer cases are related to what we consume. For instance, the over-consumption of red meat has increased cases of cancer of the oesophagus, intestines, stomach," he says.
The KEMRI study notes that cancer treatment is improving in the developed world.
Unfortunately, in Kenya, these advances are yet to be realised due to lack of resources and trained personnel, the prohibitive cost of chemotherapy drugs and the advanced stage of a majority of the cancer cases at the time of presentation.
The parliamentary report recommends that the government, through Parliament, must fast-track policy measures to address the rising cases of cancer.
Among others, the report suggests that at least one hospital in each county, if not constituency, should be equipped with facilities and specialists to handle cancer cases.
Prof Nyong'o says over 40 percent of cancer cases can be prevented through cost-effective interventions based on reduction in exposure to risk factors.
He says this can be achieved through the implementation of comprehensive tobacco control programmes.
"Other interventions include the promotion of healthy diets, physical activity and control of alcohol abuse," says Prof Nyong'o.
"Environmental risk reduction includes identification and removal of hazardous occupational and environmental exposures like asbestos and chemical effluents from industries," he adds.
"The prevention of other infectious diseases that are associated with cancers, such as immunisation against the human papilloma virus, which causes cervical cancer, and hepatitis B, which causes liver cancer, will also go a long way."
There are very few public facilities that cater for cancer cases. At the moment, Kenyatta National Hospital, according to the Global Medicine (2011) study, is the public institution that hosts most of the cancer experts and technology in Kenya.
The country's referral national hospital is currently overwhelmed with inpatient and outpatient cases and cannot cope.
The report notes that the government ought to give cancer the same weight it gives malaria and HIV since more than 70 percent of cancer cases are preventable through a healthy lifestyle.
Kenya does not have a cancer registry and surveillance to help determine the cancer burden.
The parliamentary report called for the establishment of a government medical centre, incorporating a cancer institute, in Nairobi, which could be an autonomous centre for research, diagnosis and treatment of cancer.
Dr Sridar Susheela, a consultant oncologist at Healthcare Global Enterprise in India, says the cost of diagnostic services such as CT scans, MRI, ultrasound and radio-isotopes scans in the country was exorbitant compared to India and other Asian countries.
"In Kenya, a CT scan costs up to Sh50,000 while it costs about Sh14,000 in India. A consultant would easily charge Sh6,000 in Kenya, while patients pay Sh400 to Sh500 for the same consultation in India," said Dr Susheela.
Kenya needs to train more specialised manpower to meet the demands of rising cases of cancer.
According to the Kenyatta National Hospital's Cancer Unit's Report (2011), there are only five clinical oncologists, four medical oncologists and about eight oncologists, in Kenya.
The reports states that 95 percent of the oncologists practice in Nairobi. Training one clinical oncologist is estimated to cost at least Sh8 million.
The parliamentary report blames the rise of cancer cases to the presence of pollutants, carcinogens, lack of information, consumption of roast meat and the consumption of tobacco products.

Boom Boom Burst!

Fraud, high mortgage interest rates, and the resultant inflated housing prices may soon burst the property bubble enjoyed by developers in the past 10 years.
This alarming realisation comes in the wake of the recent demolitions of houses in Syokimau and Lang’ata over fraudulent land deals and the skyrocketing bank interest rates as a result of a weak shilling.
The demolitions exposed the extent of the rot in the local land sector, where cartels of land officers, lawyers, real estate agents, and brokers have conspired to dupe investors into buying fraudulently acquired pieces of land.
As a result, most of those who were in the process of acquiring land in Nairobi, the centre of the property boom, have retreated to re-examine the authenticity of their deals.
Mr Peter Rono, an accountant with an international non-governmental organisation in Nairobi, was about to seal a deal on the purchase of a piece of land in Ruai when bulldozers roared into Syokimau.
He says that, having worked in Nairobi for eight years, he felt that it was the right time for him to build his own house.
However, property prices near the city were too high, so he decided to settle for the cheaper Ruai neighbourhood.
“My goal has always been to own a house in the city so that I stop this business of paying rent every month and concentrate on paying school fees for my children,” said Mr Rono.
However, after the demolition of the houses in Syokimau and the emergence of details of the rot in the lands sector, Mr Rono has halted his plans.
“I saw what happened and I don’t want to pour my money down the drain,” he said. “I’d rather just have the money lying in the bank or buy an agricultural piece of land upcountry.”
Mr Rono, a father-of-two, represents a group of Kenyans who, horrified by the events of the past two weeks, have started pulling their money from the property market. Their decision, players in the industry say, can only spell doom for the sector.
Ms Jane Karia, a director with Aviton Enterprises Limited, says the fact that these investors are not pumping money into the system means little growth will be witnessed in the industry and that, if the trend continues, it is likely to bring down the prices of property in the city.
“Given the rampant land fraud in the country and the fear of being conned, buyers will reduce to a trickle and the resultant low demand will bring down the current rates,” Ms Karia said.
And it is not only local investors who are likely to hold on to their money.
Those living in the diaspora, a segment that has contributed immensely to the growth of the local market, will start giving real estate a second thought.
Foreign Affairs assistant minister Richard Onyonka indicated that part of what created the current bubble was the large remittances from the West, which in good years surpassed the Sh100 billion mark.
“These people (Kenyans in the diaspora) are investing heavily in the sector and have made the property market vibrant,” Mr Onyonka said. “They view investment in property as relatively riskless.”
However, Mr Momanyi Ogwera, a Kenyan in the diaspora, says the news coming from home is likely to serve as a deterrent to potential investors.
“With these Tom and Jerry games on the land issue, Kenyans will now be apprehensive when investing in property because there seems to be a lot of fraud in the business. No one knows what they are buying,” said Mr Ogwera from Bolton University, US.
According to market players, the mad rush to invest in property has also been aided by relatively low bank interest rates that allowed people to borrow in order to invest.
However, recent happenings at the Central Bank of Kenya may reverse the trend.
Pushed to the limit by a weakening shilling and sky-high inflation, the government raised interest rates to an all-time high, which caused banks to adjust their base lending rates to almost 25 per cent.
Mr Martin Owuor, a trade economist for the Advisory Centre for Trade and Investment Policy, wonders whether the high property prices were even ever dictated by market forces in the first place.
“Is it that Nairobi now has better infrastructure and a population growth so high as to warrant the increase in demand for houses?” he asks. “Have construction costs shot through the roof or has Kenya suddenly gained international status, resulting in mass migrations into the country. What could be the cause?”
Mr Owuor said what was happening was a result of dangerous speculation where private investors rushed into the property market with borrowed money in a self-serving mass movement.
“The government should have regulated the real estate industry and stopped the massive domestic borrowing. A disaster looms over the real estate industry and although banks may not go under when developers default on loan repayments, a number will be bruised in the process,” said Mr Owuor.
He said the revised mortgages rates, which now stand 10 percentage points higher than before the revision by CBK, were way beyond the reach of ordinary Kenyans.
Mr Owuor compared the situation in Kenya with that in Dubai two years ago.
The Emirates nation was for a long time praised as the world’s fastest growing city before the real estate sector went bust and left the city littered with incomplete projects.
“The government has stopped further construction in the city, mortgage prices have fallen, yet no investors are willing to buy into these projects, not even after the Dubai Emir directed developers to sell their properties and offset their loans,” said Mr Owuor.
In post-9/11 US, Federal Reserve chairman Alan Greenspan earned accolades for bringing down interest rates on loans.
But analysts warned that the resultant heavy borrowing was not viable for the country. No one heeded this advice.
All it took to bring the economy to its knees was Lehman Brothers and Merill Lynch, the two companies that precipitated the worst economic recession America has seen in decades. The bubble had burst.
Mr Owuor says it is wrong that, at a time when the property market threatens Kenya’s economic strength, the Central Bank, like the Federal Reserve in the US, is doing little, if anything, to correct the situation.
The other factor that has lately gnawed at the property market is the Kenyan army’s incursion into Somalia, which has curtailed the flow of piracy money into the country.
Earlier reports had indicated that Kenya had become an investment hub for piracy kingpins, who also controlled a massive smuggling network.
Mr Kenneth Kaniu, a manager at Stanbic Investment Management Services, in an interview with the Daily Nation last year, explained that the owners of the illegally acquired millions of dollars from ransom payments did not care how much a property cost and had, thus, distorted the market.
“There was no reason why the price of land should suddenly go up by 500 per cent,” Mr Kaniu said. “This situation is likely to correct itself once the inflow of piracy dollars is stopped.”
Although the precise extent of ransom money channelled to Kenya’s property market has remained unknown, Mr Kaniu said discussions with property management agents indicate that there are immense levels of investment.