A silent killer is on the loose
by Tebogo Toteng
22.04.2007 1:12:57 P

Last week, I joined a family at the bedside of a sick relative at Nyangabgwe Referral Hospital. The mother, an elderly woman, was lost in thought as she held the hands of the pitiful figure that had become her son. The silence of the relatives was occasionally broken by heavy sighs – as if to suggest that the end was near.

Two days later, one of the relatives called. Our patient did not make it.

The man, in his late 40s, is another statistic in a long list of victims who succumb to the rising incidences of cancer.

Two weeks earlier, I had attended the funeral of another middle-aged man – yet another casualty of a cancerous complication that had initially manifested itself in one of the legs.

These are not isolated cases. Medical records suggest that many people are dying from cancer everyday in Botswana. In the words of one health worker, while the nation’s attention is focused on HIV/AIDS, cancer has made inroads – unnoticed and unmarked.

The head of the Oncology Department at Princess Marina Hospital, Dr Alexander von Paleske, confirmed the worst fears of a health system already overwhelmed by HIV/AIDS. Cancer is on the rise, and on a massive scale.

“I cannot say it has reached epidemic levels but there has been a massive increase in the cases of cancer,” he says.

The rise in cancer in Botswana is largely attributed to the high incidence of HIV/AIDS.

Kaposi sarcoma, an HIV-related cancer, has overtaken other types of cancers in its prevalence in Botswana. It is common in both men and women. Among the womenfolk, cervical cancer is another threat.

Paleske estimates that over 40 percent of cancer patients are HIV positive, and he told FPN that the situation could have been worse if there were no Anti Retroviral (ARV) drugs.

In a previous interview, Paleske stated that the chances of getting cancer, in this era of HIV/AIDS, are now 10 000 times higher than before.
“I have only four patients who have cancer and are HIV negative and hundreds more who are positive. There are cancers that are as a result of HIV and others that become more aggressive because of HIV,” he said.

Interestingly, the rise of cancer in Botswana has even been noticed by the outside world. Last year, the French news agency Agence France-Presse (AFP) reported that incidents of cancer had more than doubled in the previous four years.

Health professionals say the country is headed for a huge challenge. The health system is already overstretched. There is a shortage of medical doctors and nurses in the public health system. There is very little public information being disseminated about cancer. In 2002, Princess Marina Hospital’s oncology department saw 2 050 outpatient visits. The number has since skyrocketed to over 5 600. The doctors are presently seeing 20 – 30 patients each day, and they have been forced to work a seven-day week.

The Cancer Association of Botswana (CAB), a voluntary NGO founded in 1998, has stepped in to mitigate the problem. CAB currently runs three cancer-related programmes: public awareness, access to health services, as well as support and counseling.

The association also runs an interim home for cancer patients in Gaborone, while they receive treatment at any of the hospitals in town. The patients are transported to and from the hospitals on a daily basis for treatment, and they are provided with all meals during their stay at the interim home.

A common misconception is that cancer affects the elderly. A health worker tells FPN that while advanced age is a risk factor with some cancers, anyone can get cancer, regardless of age.

The rise of cancer appears to be a global phenomenon. The United Nation’s World Cancer Report predicts that cancer rates could further increase by 50 percent to 15 million new cases in the year 2020. Currently, more than one million cases of breast cancer are reported to occur worldwide annually, with some 580,000 cases occurring in developed countries.

The prevalence of cancer in developed countries is attributed to the western lifestyle which is characterized by a highly caloric diet, rich in fat, refined carbohydrates and animal protein, combined with low physical activity, resulting in an overall energy imbalance. The change in lifestyle is also blamed for the rise in cancer in Botswana.
“Habits such as smoking and drinking have increased the number of cancer cases in Botswana,” Paleske confirms.

Medical journals say there are over 250 types of cancers, which affect every body tissue. However, what affects one body tissue might not affect another. Global trends indicate that bladder, breast, colon and rectal, and lung cancers make it into the Top 10 type of cancers that are responsible for many cancer deaths.

The World Health Organization (WHO) states that reduction of tobacco consumption can prevent a third of cancer cases. The WHO emphasises a healthy lifestyle and diet. Doctors and dieticians prescribe a healthy dose of fruit and vegetables, physical activity. Early detection through screening can make a difference, particularly for cervical and breast cancers, which would allow for prevention and successful cure.

(FPN)