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Thandeka Moyo-Ndlovu, Health Reporter
IT’S been 41 months since Mpilo Central Hospital in Bulawayo opened its cancer unit for members of the public in the southern region to access treatment for one of the leading causes of deaths in Zimbabwe.
Sadly, the state-of-the-art radiotherapy machines in the unit have been down more than they have been operational.
When the unit was officially opened on April 7, 2017 – 17 years after its closure, the public was guaranteed – or so they thought – that the additional treatment costs they incurred travelling out of Bulawayo would be over.
Three months down the line, the only functional radiotherapy machine broke down, and that has been the story ever since.
Radiotherapy treatment uses high doses of radiation to kill cancer cells and shrink tumours and it also damages the DNA within cancer cells.
Health experts say radiotherapy is the only effective way to treat cervical cancer which accounts for more than a third of cancers from the southern region which covers Bulawayo, Masvingo, Midlands, Matabeleland North and Matabeleland South provinces.
Cervical cancer is fast overtaking HIV as a killer disease and more than three quarters of women who present at Mpilo have stage three cancers.
At this stage, the cancer would have advanced so much that it is virtually incurable.
Stage three and four cancers require palliative treatment which is only meant to treat symptoms or ease pain until the patient dies. If diagnosed early, at stage one or two, there are chances of complete recovery.
Cancer patients should access treatment regularly to stop the cells from multiplying which often leads to difficulties in treatment or deaths.
From 2017, the radiotherapy machine has been regularly down which has left hundreds stranded.
In 2018, a second machine was installed but it broke down twice and took authorities more than a year to fix.
Part of the major causes of the breakdowns were linked to power outages which led the Ministry of Health and Child Care to install uninterrupted power supply (UPS) batteries.
The UPS project took more than a year to complete which increased the risk of cancer patients developing advanced cancers.
Meanwhile, those who could afford opted for chemotherapy which cost about US$300 per cycle. Some were even forced to travel out of Zimbabwe to seek services in South Africa, India and other countries.
The machine was fixed last year in November and ran for 10 months continuously for the first time ever before breaking down again on August 15 this year.
With Covid-19 wreaking havoc and forcing countries to impose lockdowns, ordinary Zimbabweans have been left without hope.
The head of Mpilo radiotherapy department Dr Tatenda Chingonzoh says all this back and forth health predicament could be solved by securing a service contract for the cancer unit.
According to her, a service contract which lasts up to three years could possibly cost the Ministry a once off US$300 000.
This fee will guarantee the servicing of the machines any time they break down and ensure that they are fixed within reasonable time, a week, compared to the reality on the ground.
“When we opened the radiotherapy department, the machines worked for only three months and broke down. Then, the problem of continuous breakdown was power outages, but the biggest issue is that we do not have a service contract,” she says.
“These machines like cars need regular servicing and unfortunately it can be done by engineers from South Africa as these experts are not locally available.”
From 2017, the Government has had to fork out about €55 000 for a single trip so that the South Africa-based engineers come down to fix broken down machines or service them.
The trip only occurs after a cash payment of the fees and the whole process takes about four months. “We had our last treatment on August 14 in the morning and that was it. We have small issues that need to be fixed and we are now waiting for engineers to come and fix them after they receive their payment from head office,” says Dr Chingonzoh.
She adds that despite people presenting late with cancer, a lot could have been done to improve their quality of life had both radiotherapy machines been working continuously. “Even if this disease is advanced, with radiotherapy there is something that we can do. Sometimes we shrink the tumor, improving the quality of life for that woman with cervical cancer,” says Dr Chingonzoh.
“This cancer produces this foul stinking discharge and easily makes this woman an outcast even in her own home as it will be difficult to stay with her. With radiotherapy we can actually palliate that and the smell disappears.”
Dr Chingonzoh adds that due to the constant breakdowns, some patients have been prescribed chemotherapy which is not always the best method to treat certain types of cancer.
“The commonest cancer in Zimbabwe is cervical cancer and this doesn’t only affect the rich but it’s very prevalent even in our poor patients. So, the majority of women who present to the radiotherapy are mothers, wives, basically the caretakers of homes. Without radiotherapy we cannot manage cervical cancer. Even those with advanced cancers there is a lot we can do with radiotherapy,” says Dr Chingonzoh.
According to her it is dangerous to start a treatment and then fail to finish it due to machine breakdowns. “The biggest challenge with cancer treatment is it’s better not to treat at all than start a treatment you cannot finish. We have seen that giving the radiotherapy and then stopping makes the cancer more aggressive,” she says.
“You want to be able to treat it fully, so this patient treatment breaks are really detrimental so you rather not start at all than start and break. Because of that a patient who would have had a good outcome, ends up with a compromised quality of life.”
Dr Chingonzoh appealed to women to be in sync with their bodies so that they present early whenever they suspect any changes in their bodies.
She says Covid-19 had also greatly impacted cancer treatment at Mpilo as they only serve about 25 people a day.
Due to staff shortages, the available personnel would treat until 3PM so that they are in time to catch the available bus back home. Now with the machine down, some patients are accessing the services at Parirenyatwa in Harare at a cost ranging between $60 000 and $100 000.
A majority of patients at Mpilo Central Hospital were being treated free of charge because they cannot afford to pay.
She says unlike in Bulawayo where there is a hostel for cancer patients who do not live within, those who go to Harare need to have extra money for food, accommodation and daily bus fare to Parirenyatwa. “We have those parents who cannot afford to go to Harare, some we try to alter their treatment to maybe chemotherapy which is not really the standard right thing but we try to make do with the bad situation. The rest we have to wait for the machine to come up and hope that the cancer will not be spreading,” she adds.
Community Working Group on Health director Mr Itai Rusike says cancer prevention and control requires an integrated and cohesive approach. “To address the rising cancer burden facing the country and the current challenges of antiquated and obsolete cancer machines that are frequently breaking down, we advocate for adequate funding and support for the comprehensive cancer control policy and programme,” he says.
“This calls for strong political, technical, and practical leadership as well as significant investment in terms of infrastructure and equipment, human resources, technologies, medicines and vaccines.”
Appropriate investment will ensure that patients accessing cancer services in Zimbabwe are assured of their right to receive quality treatment and care regardless of who and where they are from.
“The cancer treatment services should also be decentralised to all the provinces and districts to reduce the out of pocket costs for the cancer patients such as transport costs, accommodation and food,” he says. — @thamamoe
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