At the annual dinner of the Cancer Association of Botswana (CAB) three weeks back, former President Ketumile Masire sketched a broad outline of the face of cancer in Botswana.
It looked like this. Since 1998 when active surveillance started, more than 14 000 cases have been reported to date, and about 11 000 of them continue to live with the disease. Though about 90 percent of the population lives within 8km radius of a health care facility, this is not the case for cancer care and control as the disease’s care facilities in Botswana are only accessed in two referral centres in Francistown and Gaborone, while radiation therapy is offered only at Gaborone Private Hospital. In a country with a population of two million, there are only two oncologists based in the two government-run public health centres, two pathologists and less than five gynaecologists to handle cases of cervical cancer, which currently is the leading cancer-related problem in women. Patients continue to travel long distances to access both diagnostic and curative care for cancer.
This is the picture that has moved members of a local newly formed health and fitness group, Tshwaragano Adventure Trust, to undertake an expedition to Africa’s highest peak, Mount Kilimanjaro, on a two-pronged mission: to solicit funds for CAB, as well as raise awareness about the disease.
Tshwaragano Adventure Trust’s chairman, Tawana Gaolathe, explains that the group feels that the growing problem of cancer in Botswana makes it imperative to make the disease a topical subject in the same way that the nation got to engage with other challenges such as HIV/AIDS.
“Our campaign, which basically complements the efforts of CAB, is to encourage people to make a habit of visiting health facilities for routine check-up at least once a year to know the status of their health even if they are not sick, as well as to adopt a healthy lifestyle,” Gaolathe says. “We also want to see more people make physical exercise a habit.”
Tshwaragano Adventure Trust was formed by eight men and two women who share a passion for rigorous physical exercise. The members routinely participate in activities such as long distance road running, cycling, and hiking.
The Botswana National Cancer Registry indicates that of the 14, 668 cancer cases registered between 1998 and last year, 4079 (28 percent) have succumbed to the disease during the same time period. Among the registered cases, mortality is higher in males (53 percent) than in females (47 percent) even though the most affected are females (55 percent) compared to males (45 percent). Though cancer has been diagnosed in children, it is more common in the age group 19 years and above.
The ten most common cancers in the female population in Botswana affect the: cervix (2 062), skin (1 480), breasts (1 331), eyes (341), lymph nodes (302), uterus (239), oesophagus (234), blood (206), ovaries (193) and liver (188).
In men, the most affected organs are: skin (1946), oesophagus (620), prostate (412), bronchus (332), liver (325), lymph nodes (301), mouth (289), eye (277), blood (230) and glottis (212).
Cancer is counted among the non-communicable diseases that are causing disquiet among public health professionals in Botswana. The others are heart diseases, diabetes and chronic respiratory diseases (asthma). Health minister Dr. John Seakgosing indicates that these diseases share four common risk factors of tobacco use, alcohol abuse, lack of physical exercise, and unhealthy diets.
“Of much concern is that the signs and symptoms of these diseases take a long time to manifest. As a result, most of us do not take action to prevent them or intervene early enough,” Seakgosing indicated in a speech at the CAB dinner. “In Botswana, different studies and surveys have shown an increasing trend of non-communicable diseases and that a lot of people are involved in risky behaviours.”
Seakgosing indicates that the morbidity and mortality due to non-communicable diseases are common among the economically productive populations which impact on the social and economic development of the nation. This is as a result of people spending more time in health facilities to seek treatment, absenteeism due to illness which results in reduced productivity and escalating health costs.
Despite the challenge that the disease increasingly poses, it appears many countries still have no policies and programmes in place to effectively address the cancer problem holistically. As Masire noted, even though Botswana has for the last 10 years successfully managed a registry availing statistics that show the burden of the disease, the country still has not established national cancer control programmes.
“Lack of a comprehensive and systematic approach in many instances leads to poor priority setting, inefficient resource utilization and all the related administrative inconsistencies,” Masire stated in advocating for a programme that would promote public health education and vaccination of those at risk; secondary prevention through effective and systematic screening, early diagnosis and treatment; efficient use of medication to achieve long time remission and return to ordinary life; as well as palliative care for those at the terminal stage of the disease.
It is a view that the former president shares with many volunteers who are in the battle trenches, such as “the good Samaritans” ÔÇô as he termed them ÔÇô at CAB and other organisations who work to restore the hope of those affected by the disease.
