Improving cancer care in Nigeria

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Published: 10 Apr 2019
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Prof Ifeoma Okoye - University of Nigeria, Nsukka, Nigeria

Prof Ifeoma Okoye speaks to ecancer at the 2019 American Association for Cancer Research (AACR) meeting about Dr Zainab Shinkafi Bagudu's work in paediatric and adult cancer advocacy - which includes establishing the Medicaid Cancer Foundation.

Through her foundation, Dr Bagudu has been able to focus on issues surrounding cancer care in Nigeria, including primary prevention, vaccination, and education. However, late cancer detection is still an issue in Nigeria and needs to be urgently addressed among both urban and rural communities.

Dr Bagudu continues to work alongside both policy-makers and international collaborators to improve cancer management and control in Nigeria.


 

Dr Zainab Bagudu is a paediatric surgeon, a paediatrician, and she runs her own facility that is called Medicaid. Over the years of practice as a paediatrician she became interested in the area of paediatric cancer and then expanded into adult cancer advocacy. She founded her own foundation that is called the Medicaid Foundation and she started this well before she became the wife of the Governor of Kebbi State. So her interest goes beyond being the First Lady of the state into a personal passion for this work that she is doing.

She is going to present at the AACR meeting on Monday in order to showcase what her foundation has been doing. However, she is using her foundation in that presentation to be able to talk about the work, general work, of NGOs operating in Nigeria. Nigeria representing a low and middle income country with low resources, or mismanaged resources, as one would put it. She was able to show that mostly NGOs operate across a continuum of cancer care from prevention, which includes primary prevention or vaccination, to education, informing people, the population, and arming them with the right information to inform their choice to increase the ability for them to make use of available early detection facilities that are in the country.

One of the banes of cancer control in Nigeria in particular is the late detection. That late detection is actually defined by stigmatisation, fear of the fact that the perception that cancer is a death sentence and that death sentence perception was defined by the fact that everybody they hear that had cancer dies. Why is that? The reason being that they are detected late so late detection reduces your ability for survival. So this information is being passed through education, rural outreaches to rural communities and also urban communities as well because, no matter the level of education, the perception persists.

So the work of Her Excellency Zainab Bagudu actually spans beyond just Kebbi State into an effort in the federal capital territory to reach the rest of the country. She is doing this job in collaboration with so many international groups and she is getting a lot of support as well from her husband, the Governor of Kebbi State, his Excellency Bagudu. With her profile she is also able to muster a lot of political will because she has access to influencers, policy makers, community leaders and with that asset she’s able to reach more of the population. Over the years, I met her in 2009, she has been working consistently in this effort impacting on prevention, education, early detection that’s actually getting involved in administering screening – screening for cervical cancer, screening for breast cancer. She actually set up a diagnostic centre in order to facilitate that process. So she has done a huge amount of work over the years.

In the recent past two years she has started getting involved in also reaching out to schools. So she has a school programme to mentor young people, to influence their perception of this illness and to begin from that age group to get them to understand that prevention is part of the way to fight the cancer issue and also to imbibe the vaccination effort for cervical cancer reduction and to ensure that they also become influencers for their families, being that they are in school. Some of their parents are not educated so informing them, and children have a way of impacting older people whenever you arm them with information.

Also in the past one year she got involved in improving data, the ability for Nigeria to have better data records. So she got involved in getting a cancer registry running in her state and working with other stakeholders, the Federal Ministry of Health and other NGOs, to empower on that. She’s also been involved in international collaborations and she is currently a board member of the Union for International Cancer Control which she was elected into last year. In that position she is actually really sitting on an ability to be able to reach out to international collaborators to assist in looking back to Nigeria and seeing how they can assist us to better manage our cancer control measures.

So in this presentation, being that it is the American Association for Cancer Research, she wanted to bring out the fact that over those years she has been able to look back and she sees that she has a lot of visual records of what she has done. However, does she have documented records that can translate into evidence based data and which can be published and which would inform policy decisions, create more impact? Because with those policy decisions being informed by actual representation of what is happening in the country then we make the right policies and not waste scarce funding on policies that don’t have impact or policies that are not even necessary. So, more or less, what we do is we look at what other developed countries are doing and we think it’s one car fits all, there is no cultural content, inclusion of cultural content, into some of the protocols that we adapt for cancer control in the country. So she began to appreciate more over the years that it was necessary for her to get into her foundation, to get into the area of cancer research advocacy and see how she can also be an influencer in that area, both for government, influencing government policies, as well as education of healthcare providers to get more involved in research and to also look at the aspect of patient involvement in cancer research. So, because the practice now is exclusion of patients except for the fact that we look at them as older participants, however, their involvement in cancer research should go beyond just being participants. Of course, their cooperation will be improved if you can get them to understand why cancer research is important.

This morning I was actually listening to the opening ceremony and one of the statements that was made by one of the awardees was the fact that, for him, being able to keep patients alive long enough to benefit from new methods, new breakthroughs in cancer treatment, is an advantage that we should all take up. I think that is something that, in my own experience, personal experience as a physician, being trained as a doctor I found that attitude. I’m 38 years in the medical field right now so you can imagine how many years ago I’m talking about as a medical student, I found that once I said ‘cancer diagnosis’ there is an attempt to discharge the patient and counsel them that the best thing is go and put your house in order. So it was really a death sentence then. So I was curious to find out – is there no way we could improve on this. Thank God that we are now imbibing developments from outside of our country, including palliative care and all that, into the system such that our effort now is to keep people comfortable, make sure that they have a good quality of life whilst you wait and hope that maybe before the illness overwhelms the patient there might be a cure that might just come and save that person’s life. I think that makes us feel much better now about cancer care.

So this would be, more or less, her message. Then, of course, her recommendations are that international collaborations are very, very welcome for us both to improve our skills as healthcare providers, to improve what we are doing in terms of cancer advocacy, so that as we do that advocacy work we should introduce an element of research into it to be able to harness data from what we are doing that should be able to show measurable outcomes, impact, and be able to inform policy decisions going forward. We feel that if we do that the arena of cancer care in Nigeria would definitely improve. Those collaborations are important because you don’t reinvent the wheel and we would like to benefit from already existing protocols for data storage, acquisition, even data retrieval and all that. We would like to do that; we would like to improve on our cancer registry records, we would like to participate more in the clinical trial process. The clinical trial process, of course, introduces for us an ability for our patients to be involved in that clinical trial. Most times it helps patients to benefit from drugs they would not have been able to afford in the first instance. Then, of course, it improves on the healthcare infrastructure and therefore raises the standard of care for cancer patients for us as well as so many other things, including professional development for the providers that engage in this process. Then patient participation gives them hope in this research process, understanding it. It introduces hope; hope is one of the healing methods for cancer. If you can keep the hope of a cancer patient up you may be able to improve, especially with the science of epigenetics you should be able to improve their ability to survive that illness. Thank you.