The one-size-fits-all Covid-19 containment strategy fails to factor in the special needs of citizens made vulnerable by compromised immunity, who need continuous and intensive medical care.
The few cancer facilities are open for a few hours a day, fewer patients are seen and specialised cancer healthcare workers are in short supply. The lockdowns had no provision for patients who needed to travel for treatment.
Cancer is the third-leading cause of death in Kenya, accounting for roughly seven per cent of deaths. But there are very few cancer facilities in urban areas and, of the few hospitals in the rural areas, where 72 per cent of the population lives, barely any. Rural patients have to travel to the towns and cities for treatment, which can be intermittent and takes long.
Poverty, poor roads, packed cancer wards and lack of accommodation deprive many seriously ill patients timely and appropriate treatment. And complex drug regimens have side-effects that lower immunity, making them more vulnerable to infections, including Covid-19.
Covid-19 has become highly stigmatised. People have little information about how to protect themselves and police beat up those caught up in the curfew. The dead are buried hurriedly at night with those close to an infected person likely to be victimised.
Cancer, like Covid-19, is also stigmatised. Besides the fear of being infected on the way to a medical facility, in hospital, in their lodgings away from home, they also risk ostracisation in their communities. Given their coronavirus risk, it would not be strange to hear that oncology nurses are afraid of treating them.
Oncology specialists are faced with questions around how best to take care of cancer patients, ensuring they get timely anti-tumour treatment as well as alleviating side-effects and other distressing symptoms while preventing exposure to the virus. The interim guidelines developed by the Ministry of Health recommend postponement of elective surgeries where Covid-19 demands on personnel and supplies strain service provision.
They are vague on the treatment of gynaecological cancers and do not advise on the management of cancer patients. In contrast, the Kenya Society of Hematology and Oncology called for cancer surgery resumption for new and ongoing patients.
Private hospitals in cities have, hence, developed their own protocols and initiated patient teleconsultations, which primarily attend to the middle class.
The lack of guidelines has left impoverished patients at a heightened risk, particularly those receiving or recently received chemo- or radiation therapy or require bone marrow or cell transplants.
The crisis could be an opportunity to integrate cancer care services into primary care services, particularly at the county level. For the long term, the government ought to implement the National Cancer Control Strategy 2017-2022, which would decentralise services and improve cancer surveillance.