It takes about 15 minutes, walking under low rusty roofs and jumping over raw sewage in Mathare slums, to reach Rosemary Awuor’s work place.
It is a dark, shanty made of rusty iron sheets. It’s here that Rosemary sells locally-made brew.
A year ago, Rosemary, 52, felt a lump in her left breast. “I had started feeling pain on my shoulder about a year earlier and with time I felt a swelling on my breast,” says Rosemary, who lives in a one-roomed mabati house deep in the slum.
She visited a local clinician who injected her breast and sucked out pus then assured her that it was just a boil which would disappear after a minor operation.
They set a date for the procedure, and she paid a deposit of Sh9,000.
Rosemary’s daughter, Victoria Atieno, accompanied her on the day of the surgery. Upon reaching the clinic in Dandora, Victoria advised Rosemary to cancel the procedure. “It was a shady clinic which my daughter hated at first sight,” she said.
Rosemary returned home and for the next month managed the pain with pain relievers until she was advised by locals to seek treatment from a proper hospital. “I went to St Mary’s, a missionary hospital in Nairobi where tests were done but nothing was detected.”
The doctor advised her to take a second biopsy, which showed she had breast cancer. “I could not believe it, and I decided to seek a third opinion which also was positive,” she says.
Rosemary went home and cried most of the time for about two weeks. “I think the moment one is told has cancer, the situation gets worse. I was in pain all through. I was always absent minded. I cried myself to sleep every night, something I still do to date,” she said.
She went to Kenyatta National Hospital but the earliest appointment for treatment she could get was for late 2017.
She had to seek other opinions. “I knew if I had to wait for next year, I would die along the way,” says Rosemary, resting on her back to ease her pain.
For the next two months, Rosemary would save money and in September last year she went to a private hospital, where she was advised to undergo chemotherapy.
“It has been very expensive for me. God should not give poor people these diseases. I now have to survive on loans and donations from well wishers,” she said.
Rosemary has been paying Sh20,000 for a chemotherapy session at Upperhill Medical Centre compared to the Sh6,000 patients pay at KNH. “The last session was done on credit, and now doctors have recommended six more sessions,” she says, adding that the breast is too heavy to walk around with.
Rosemary, who is in constant pain, says she was told she has stage four cancer, which is chronic and often terminal. The doctor has advised against having a mastectomy. “My right breast is swollen and very stiff,” she said. “The doctor said it cannot be cut at the moment.”
Her other breast is also swollen and she is worried it could also be infected.
Even after the chemotherapy, Rosemary says she feels worse than when she started. “Every time I take those drugs, I don’t leave my bed for at least two weeks. It’s a very painful experience. See what it has done to my hair,” she says, taking off her head covering to show her shiny bald head.
Rosemary is a mother of three and takes care of six others who are orphans. “I am a bread winner to nine children, and I educate all of them. I really need to live for this, if not anything else,” says Rosemary, who is also diabetic.
About two kilometres from her place of work is Kabethi Gathongo’s home. Kabethi is 72 years old and was diagnosed with prostate cancer four years ago but only had an operation done last year. “They cut off my private parts, I don’t have anything,” he said, adding that the wound is healed but the pain from within is unbearable.
He tells us the previous day he had gone for his usual clinics at KNH but was told the doctor was not available. He is hopeful that one day he will be completely healed.
Cancer and HIV patients mostly spend their last days of life in severe pain mostly lacking the much needed palliative care. This care is mostly given to terminally ill patients where strong painkillers are administered along with symptom management, counseling and comfort for the patient. Rosemary says she has been taking diclofenac and panadols to ease her pain. But they are relatively weak painkillers considering the magnitude of cancer pain.
Palliative care nurse at Nairobi Hospice Joyce Wangari says they mostly get patients with stage four cancer.
“At this stage, patients need opiods and we mostly administer morphine,” she said. They also offer comfort and counseling to the patients. “If a patient is referred to us with stage four liver cancer which is as a result of alcoholism, we don’t tell them to stop drinking, we let the guy enjoy his drink since the damage is already done and in any case the withdraw will kill him even before the disease. That is why we say palliative care is about comfort,” she explained.
According to Zipporah Ali, head of the Kenya Hospices and Palliative Care Association, only 10 per cent of people who need palliative care receive it in the country. Zipporah says medics fear prescribing opiods, which are strong pain reliever for fear of addiction and due to strict policies. “If a medic is found guilty of prescribing a drug like morphine wrongly, such person can be jailed for up to 10 years,” she said, adding that most medics avoid taking such risks.
Zipporah said that Kehpca is working closely with the government to ensure palliative care is incorporated in all government hospitals.
She adds that Kenya requires 400kgs of morphine but only 47kgs was bought by the government last year. “Even if those patients eventually die, they should die in dignity,” she said.
Dr Esther Munyoro, head of palliative care unit at KNH, says the unit is doing awareness at the hospital and training nurses on pain management. “Morphine is a wonder drug. We are encouraging medics at the accident and emergency unit to send patients in pain to the palliative care unit where they are offered pain relievers as they wait to see the doctors,” she said. Munyoro said they want to make KNH a ‘pain-free hospital’. “Pain is important, it helps us make diagnosis but at the same time, it kills, especially in cancer and HIV patients,” said Munyoro.
Early this month, the overworked radiotherapy machine at KNH broke down, forcing the hospital to send away cancer patients. Kenyatta is the only public hospital that treats cancer charging Sh500 per radiotherapy session while private hospital charge between Sh5,000 and Sh10,000.
According to Kenya Cancer Association, 80 Kenyans die of cancer each day. The NGO says 40,000 people are diagnosed with the disease out of whom 30,000 die. Chairman Ann Korir said the number of deaths and diagnoses may be higher as the figures only reflect cases reported to and recorded in hospitals. “The majority of those diagnosed with cancer are are women aged between 30 and 49 and men aged between 45 and 50,” she said.
Breast cancer is the most common cause of cancer death in women in both developing and developed countries. It is the most prevalent cancer among Kenyan women and constitutes a major public health problem. Although definite prevalence and incidence studies are lacking for Kenya, some estimates indicate that breast cancer accounts for about 23 per cent of all cancers while cervical and prostate cancer represents about 20 per cent.