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The Shifting Burden

The Crippling Cost of Breast Cancer in Kenya

In Kenya, both the privileged and the poor struggle to pay for breast cancer treatment. As part of our series “The Shifting Burden,” we look at the slow progress toward accessible care in a country where a mammogram costs more than an average month’s salary.

Written by Hannah McNeish Published on Read time Approx. 4 minutes
A nurse prepares to administer chemotherapy to a cancer patient. In Kenya, breast cancer treatment is so expensive that even wealthy patients often have to sell their belongings to pay for it. AP/Gerry Broome

NAIROBI, Kenya – It took Gladys Muthoni five months to go and get her swollen and painful breast checked by a doctor.

When a mammogram showed that the 57-year-old had cancerous cells, she refused to accept it.

“I stayed for a long time without treatment. Because I denied it. I thought it was just swelling,” she says.

It took three sessions with a hospital counselor to persuade Muthoni, speaking from her hospital bed in short sentences due to ongoing chest problems, to accept treatment for a condition that many people in Kenya are keen to keep denying.

“You find that you have a breast cancer. Inside you feel it is just death. So many of them keep quiet and they don’t speak. You end up dying because when you mention it in the community, they just discourage you and say that it’s just death,” she says.

Cancer is the third biggest killer in Kenya after cardiovascular and infectious diseases. Breast cancer treatment is prohibitively expensive; it is also a hard condition to diagnose. There are only a handful of mammogram machines, most of them in the capital Nairobi. And although each test costs $100, that is a huge sum of money for many women.

“Our people are really suffering,” says Alex Mutungi, chair of the Kenya Network of Cancer Organizations.

Dubbed “a rich man’s disease” in the Western world, in Kenya, he says “it’s a poverty disease.”

“Even the rich, when you get diagnosed with cancer, it’s sure that you have to sell everything … it’s going to drain you until you’re in poverty.”

For Gladys Muthoni, with a steady job at a call center, 30 years of payments into Kenya’s National Hospital Insurance Fund wasn’t enough to cover her treatment costs. It paid for her ward bed only, not even the extra blood needed to start chemotherapy. Her total bill was over 1 million Kenyan shillings (around $10,000).

She’s spent the past five years in and out of Kenya’s National Hospital, East Africa’s largest referral hospital and one of only two public hospitals in Kenya with a fully functioning oncology center. She counts herself lucky for having it on her doorstep, as many other people have to pay to be in the capital or travel long distances. She’s even luckier, she says, that she has an understanding employer who has kept her on when many others would dismiss staff with so many weeks of sick leave.

Muthoni raised the money to pay for radiotherapy, six cycles of chemotherapy and surgery to remove her right breast thanks to her community doing a “harambee,” a collection for people to donate to her cause. They raised 800,000 shillings ($8,000), while her family borrowed the rest.

“To be treated for cancer, I think many Kenyans cannot afford to be treated, and I think so many Kenyans die at home because of lack of money for treatment,” she says.

The Kenya Cancer Association estimates that around 78 people die from cancer every day in Kenya, and that 80 percent of these deaths are a result of late diagnosis and inaccessibility to treatment.

The association, whose major donor is the American Cancer Society, paid for Muthoni to get the cancer drug Herceptin that accompanies chemotherapy, as well as a prosthetic right breast two and a half years after she was cancer free. She barely left home during that time, as she was so scared of being judged.

“I could stay in bed and cry, not even knowing what to do, or what to put on, because you could see people are seeing you don’t have a breast, and you know, the way people talk, they can pull you down and make you feel like you don’t belong here,” she says.

As people pour their community’s life savings into treatment, Alex Mutungi has no idea how many women have been diagnosed with breast cancer – registers are lacking and cases go missing – or how much money the government is spending on cancer care, because the health budget puts cancer treatment alongside all other noncommunicable diseases.

“Kenya is playing a lot of catch-up,” he says. “Cancer is really eating up our people.”

He’d like the government to dedicate a part of its health budget to cancer, like it does with communicable diseases such as malaria.

Progress has been slow. The International Atomic Energy Agency (IAEA) recently announced that it would help Kenya with radiology equipment to diagnose more cancers, while Roche Pharmaceuticals says it will help the government train more oncology staff and pay for cancer drugs for breast cancer patients in public hospitals.

The government is also starting to invest in proper pain-relief drugs. “It was just recently that the government procured 50kg [110lb] of morphine,” Mutungi says.

Gladys Muthoni hopes that more can be done to make Kenyans aware of breast cancer, which some people confuse with HIV or associate with witchcraft, to catch other women early and save them and their families from so much pain, both physical and financial.

“So many people outside there, they don’t understand. They don’t know,” she says. “I wish there was a group that would bring people in and tell them about the problem they face.”

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