Afflicted with cancer, denied treatment

When the Nigeria Nuclear Regulatory Authority jacked up the licence fee of nuclear medicine centres from N250,000 per annum to N2m, it seemed not to care about the possible implications for cancer patients. OLUFEMI ATOYEBI reports that since December 2013 when the new fee regime took effect, it has been tales of woes for the sick

The Nuclear Medicine Department was established at the University College Hospital, Ibadan, Oyo State, in 2006 by the International Atomic Energy Agency based in Vienna, Austria.

The main purpose was to offer radio-active treatment at heavily subsidised rates to patients suffering from various forms of cancers. In 2008, perhaps in order to bring treatment closer to the patients, another centre was also opened by the agency at the National Hospital, Abuja.

For both hospitals to deliver this life-saving service, they owe their operations to a licence which is issued annually by the Nigeria Nuclear Regulatory Authority. Before now, each of the hospitals paid N250,000 to renew their licences annually; but in December 2013, the fee was increased by a whopping 700 per cent, translating into N2m per annum, and far beyond the reach of the hospitals’ financial capability.

 Staring death in the face

The effects of the increment are already telling on the beleaguered patients. At UCH, cancer patients were seen waiting endlessly at the lobby of the centre, with nurses, consultants and other categories of workers idling around. Our correspondent, who visited the centre, observed that many of the patients were elderly women who had visited the hospital with their relatives in anticipation of receiving the much needed treatment.

 Frustrated, intimidated physicians

The staff members were reluctant to speak on the reasons behind their refusal to attend to patients; but a senior consultant who declined giving his name said the decision of the NNRA to hike the licence fee led to the centre’s inability to import radioactive materials for cancer treatment — a situation that has resulted in the death of many cancer patients. The consultant explained that even before the new licence regime, the centre was paying a lot of money to import materials for cancer treatment and that profit was not being generated from what the patients paid.

He said, “All medical equipment used in the hospital are supported and supplied by the International Atomic Energy Agency. Even the premises we use is paid for by the agency.

“Nuclear medicine is not like the usual medical practice because we use radioactive materials. But without the licence, we cannot import the radio-pharmaceutical materials used in the treatment of cancer patients. Apart from the fee we pay to the NNRA, we also pay certain fees to be able to import the materials we use at the centre. When you import radioactive materials, you must have the licence to practice and make use of them.

“But we do not pay tariff charges on imported materials because a former president, the late Umaru Yar’Adua, intervened on behalf of the centres. However, for every consignment imported every month, we pay so much to anti-bomb personnel to escort them because the contents have radioactive agents. “The centre in Abuja even pays more because of the distance between Lagos and Abuja. With the turnout of events, therefore, the NNRA should be held responsible for the death and suffering of cancer patients in Nigeria.”

The consultant added that even before now, the department spent more than N500,000 every fortnight on materials used for cancer treatment, wondering how it would now raise N2m to pay for the licence.

He lamented, “Since December 2013, we have not been issued the licence because the agency in charge hiked the fee to N2m. This is unbelievable, considering the huge percentage increase. Where do they think we will get such money? This is not a profit-making centre but a facility set up to help people suffering from various forms of cancers.”

 Snobbish Director-General

Attempts by our correspondent to get the response of NNRA’s acting Director-General, Dr. Martin Ogharandukun, proved abortive, as his three telephone lines were not responding and there was no reply to the text messages sent to the lines.

Worse still, the physicians who volunteered to speak to our correspondent refused to have their names in print for fear of victimisation. One of such, a doctor at the Ibadan centre, decried the sharp increase, warning that if the centre was forced to make the payment, the cost of treatment would go up by as much as the percentage that the licence was increased by the NNRA.

She also revealed that attempts were made to appeal to the NNRA boss, but so far, there had been no positive response from the agency.

“Ordinarily, bone scan costs N20,000, but if we have to pay N2m to get the licence, then patients will have to pay about N60,000 for the scan. How many Nigerians will be able to afford that amount for just a diagnosis of how far a cancer has spread in their body before considering the cost of treatment?” she asked.

 Unconcerned health minister

Continuing, she said, “The hospital management has appealed to the NNRA by writing a letter to the acting Director-General, Dr. Ogharandukun, but we have yet to receive a reply. We work under the Ministry of Health, while the NNRA is under the Ministry of Petroleum Resources.

“To ensure that we exhaust all relevant avenues to resolve this and resume the treatment of our patients, we also spoke to the Minister of Health, Prof. Christian Chukwu, urging him to speak on our behalf to the Minister of Petroleum Resources, Deziani Alison-Madueke. It is very disappointing that this has also yielded no result. Our patients have been dying because of this.”

Indeed, a call placed to the mobile number of the health minister went unanswered; and, as of press time, there was no response to a text message sent to the same number.

 Waiting for Godot

According to the World Health Organisation, the main goals of a cancer diagnosis and treatment programme are to cure or considerably prolong the life of patients and to ensure the best possible quality of life to cancer survivors.

Who says, “The most effective and efficient treatment programmes are those that are provided in a sustained and equitable way; are linked to early detection; and adhere to evidence-based standards of care and a multidisciplinary approach,” all of which the Nuclear Medicine Department used to provide before the ongoing frustrating experience with the NNRA charges.

The hospital record shows that 136 patients are currently waiting for treatment. Some of them require bone scan, which is important for assessing the spread of the cancer, and which will determine the course of treatment.

The WHO notes that the first critical step in the management of cancer is to establish the diagnosis based on pathological examination. A range of tests is necessary to determine the spread of the tumour, while staging (process of determining the extent to which a cancer has spread) often requires substantial resources that can be prohibitive in low-resource settings such as this.

Avoidable deaths

On an average basis, sources said, the centre attended to 57 patients monthly for diagnosis alone before the new fee was introduced last December. On the average so far, no fewer than 400 patients who came for screening of tumour, breast cancer, prostate cancer and other cancers have been turned back since then.

On the effect of the centre’s inability to treat the patients, the consultant made reference to an old woman who died two days after being denied treatment.

“She came here panting and struggling for breath. Apparently, she was dying and we could have done something, but we were incapacitated by the situation on ground. She died two days after visiting the centre.

“Nigerians deserve to know the true state of things here. We get regular calls from Lagos for patient transfer but we just can’t help. This is why patients go to the United Kingdom, India and other countries for treatment they can get in Nigeria,” he said; adding that the NNRA should have called a stakeholders’ meeting before announcing the fee increase.

 No one cares

“Before the arbitrary increase in the fee, we should have been consulted. All stakeholders deserve to know what goes on in their industry. What we were told was that the new regulation was a direct order from the petroleum minister. People are suffering and dying, but no one cares about them,” the consultant noted.

The centre also attends to patients with thyroid cancer and those coming for follow-up every Monday; but so far, many of the patients have returned home disappointed as they were told that the hospital had yet to resolve the licence issue. Those who can have since resorted to more expensive alternative.

But even where a patient can afford it, treatment is in faraway foreign countries. One of the doctors said the nearest nuclear medicine centre was Kumasi, Ghana.

He said, “Thyroid disease is a benign cancer, but it requires quick treatment. So far, we have turned back many patients. The nearest alternative they have around is to go to Kumasi in Ghana, where a nuclear medicine centre is also located. For a patient to make use of the option, however, he or she must be prepared to spend much because he needs to go with someone, pay for accommodation, treatment and flight tickets. This is avoidable if the government can revisit the licence fee hike.

 Beyond financial capability

One of the physicians said even the few patients who had the means to travel overseas for treatment had other headaches to contend with.

“One of our patients who could afford the treatment abroad said she could not travel to the United States during the winter, adding that she had to delay the treatment till summer, which is about four months difference. By then, the cancer would have spread to other parts,” the physician warned.

The centre also treats patients suffering from blood clot in the lung, which doctors say kills fast when not quickly diagnosed.

“When we could not treat them, they went for the more invasive radiological examination which is not only more expensive but also exposes them to radiation. People are already losing confidence in us, but they need to understand our plight.”

Unfortunately for the patients, there is no provision that does not involve radioactive materials in their treatment. Some of them who spoke to our correspondent begged the Federal Government to intervene in the crisis, expressing shock that a decision on licence fee could be allowed to truncate social services.

 Young and dying

Thirty-five-year-old Mrs. Bola Adedeji is a goitre patient coming to the hospital for the first time. She said she was referred to the centre from another department in UCH.

“I have done the usual test elsewhere in UCH, but I was referred here. I have not received any treatment at all. The doctor said the hospital did not have the necessary material because the licence fee had been increased beyond imaginable level.

“If the whole of Nigeria is affected by a form of cancer or the other, does it mean that all of us will have to travel abroad for treatment that is available at home? Only God knows when I will be treated,” she moaned.

Asked if she would explore treatment outside the country, Adedeji was upfront: “It is beyond my financial ability.”

She added, “I have information that I can visit Ghana for the treatment, but where will I get the money? If I can afford it, what of millions of other patients who cannot? Would Nigerian government watch them die? It is sad; the authorities should do something about it. If the government does not rescind the decision, patients will suffer for it.”

Another patient who simply identified herself as Kemi said she was lucky to have completed treatment before the crisis began, praying not to suffer a relapse.

She said, “I am here on medical follow-up. I have been coming for the past 10 months and I have been treated. It was not easy going about with cancer knowing well that not every hospital can treat you. I was not comfortable, but I feel better now.

“I am aware that the hospital can no longer treat patients because of the hike in licence fee. Who increased the fee and why was the decision taken? I am lucky not to be affected, but what about many others? What does the government expect them to do?

“If I have a relapse now, does it mean I won’t be treated? These are questions whoever is doing this should answer. If the centre pays, it means that patients must expect high treatment fee.”

She said, “Having suffered from the disease, I know how concerned and disturbed patients waiting for treatment can be.”

She noted that even when treatments were heavily subsidised, many patients still couldn’t afford it and many have died as a result.

 Desperate, sick pensioner

Sixty-five-year-old Mrs. Cecelia Olatunji (not real name) is a pensioner. She feared that her case could worsen with the break in her treatment.

She said, “Before now, we saw the doctors and did the scan immediately. But now, the personnel no longer attend to us since December. We were told that there is a licence issue that has yet to be resolved. We come every day, hoping that the issue would be resolved. We are sickly people who cannot endure stress. I can’t walk too far with my condition but right now, I am desperate for treatment so I have to keep coming.”

In her desperation, she visited another hospital which hasn’t helped much.

“I visited a private hospital and paid N9,000 for a test, which is more expensive than what is charged in UCH. It’s a routine check which has to be done when demanded. Eventually, my money was refunded because the hospital had no equipment to conduct the test.

“I have started treatment already, but it must be consistent. The last drug that was given to me was subsidised by the centre because I had already paid certain amount, but by the time it arrived, the cost had gone up.

“I am a pensioner with very little means. The government should help us.  Some patients come from long distance, but they still cannot access treatment.”

 Risk for Nigeria

While it is not clear if the Presidency is not aware of the present situation, investigation showed that IAEA deals only with the government of a country and sets up centres through a commission that is directly under the Presidency. In Nigeria, there is Nigeria Atomic Energy Commission, which is under the Presidency. It coordinates all IAEA projects in the country.

Further investigation also revealed that there is plan by the IAEA to expand nuclear medicine facility to eight other cities in Nigeria. The Federal Government is aware of the plan because the centres are usually set up in federal hospitals. With the ongoing unresolved licence fee however, experts warn that Nigeria risks losing a major investor in its health sector.

 Senate wades in

Meanwhile, last week, the Senate directed its Committee on Health to investigate the NNRA over alleged failure to issue licences for the importation of radioactive materials for cancer treatment. It also called on the Committee on Petroleum Resources to join in the investigation of the NNRA for its refusal to issue the import licence since last December.

Deputy Leader of the House, Abdul Ningi, also raised a Point of Order on a matter of urgent public importance, calling on the Senate to investigate the licence fee increase.

He said, “Bureaucratic bottleneck has stopped the treatment of cancer patients in the country, resulting in the death of many people, which is avoidable. Since last December, no single cancer patient has been treated by the Nuclear Department of UCH and the National Hospital, Abuja, because they were not licensed.

“With this ugly development, most cancer patients in Nigeria will die because of lack of treatment, except those who can afford to travel abroad. It’s very wrong for them to review upward the licence fee because it is critical to the treatment of cancer patients.”