Facing Cancer Is Even Tougher If The Only Radiation Machine Is Broken

Jul 9, 2017
Originally published on July 9, 2017 2:32 pm

If you happen to be a cancer patient needing radiation in Senegal, getting past the shock of the diagnosis and onto treatment is a major hardship at the moment.

The country's only radiotherapy machine — indeed for a long while the only one in French-speaking West Africa — is broken. That's the machine whose radiation is used to treat primarily breast, head and neck tumors and bone cancer.

Aristide Le Dantec teaching hospital, one of the oldest and largest in Dakar, the Senegalese capital, buzzes with activity. Dozens of mainly female patients are waiting to be seen at a cancer outpatient clinic.

It's in this department that patients would normally receive radiotherapy treatment. But that hasn't been an option in Senegal since late last year.

Dr. Mamadou Diop is charge of the cancer institute at Aristide Le Dantec Hospital. In consultation with his colleagues, Diop made the decision to switch off the Cobalt radiotherapy machine in December, after it kept breaking down. He says it had simply become too dangerous — for patients receiving treatment and technicians operating the machine.

As a young intern in his final year of medical school in 1989, Diop saw what he describes as a revolutionary radiotherapy machine then for Senegal being wheeled into the hospital. Today, it's just taking up space.

"This is the waiting room," says oncologist and radiotherapy specialist, Dr. Mamadou Moustapha Dieng, giving NPR a tour of the radiation center. "Patients come here. This is the treatment room. This is the cabin. This is the machine. You see it," he says, pointing to a huge, cream-colored and distinctly 20th-century looking machine.

The Senegalese government has promised four new radiotherapy machines for Senegal — including a replacement for this hospital – will be installed this year.

Until then, patients must travel to Morocco for treatment — at the government's expense, with help from the Senegalese Anti-Cancer League.

The League has recently refurbished Aristide Le Dantec's brightly-lit chemotherapy department, with rows of new daybeds in the ward. The chemo unit stands in sharp contrast to the dated, kaput Cobalt machine sitting in an empty treatment room in the radiotherapy unit across the way.

Michel Djery Dogue, 24, twice had surgery for a tumor on his tongue last year and has just completed chemo. He's one of dozens of Senegalese booked for radiotherapy in Morocco. Dogue winds a scarf around his head covering prominent scars from surgery on the side of his face and under his chin.

"It's a shame I can't have my radiotherapy here in Senegal," says Dogue.

Diop, head of the cancer unit, says the problem in Senegal — and elsewhere in Africa — goes much deeper than one broken radiotherapy machine. He says the government continues to spend more time and money on infectious diseases such as malaria, which affect many more people and are inexpensive to treat compared with cancer.

"I don't want to hear another word about high-cost cancer care," says an exasperated Diop, adding, "When you're talking about the effect on people's lives and families, how do you measure the cost?"

Diop says Senegal needs to fast-track training cancer specialists and set up one-stop centers where patients have access to all the treatment they need.

"We need to do more screening and record numbers and patients and which cancers are most prevalent," says Diop, stressing that the focus needs to be placed squarely on chronic diseases that are killing the Senegalese.

Senegal doesn't have good statistics on cancer numbers or deaths. Currently, Diop says, prostate cancer is thought to be the country's number one cancer. But he is convinced that breast cancer is a bigger killer in Senegal.

"How do I tell a mother of 35 or 40 that she's come too late and the diagnosis is that she may not survive, despite treatment? That disrupts an entire family, the children's education, the family's future. We must prioritize cancer in Senegal and other African countries, as well as infectious diseases."

The priority right now for widow Madeleine Sene, is her only child, Michel Djery Dogue — the tongue tumor cancer patient.

"We want him to receive radiotherapy in Morocco and return home safely to Senegal," she says. "That's what we're praying for."

Sene clutches her rosary as if for comfort as tears well up in her eyes.


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LAKSHMI SINGH, HOST:

Cancer is on the rise in Africa, yet the ability to treat it is not keeping up. With sub-Saharan Africa's population fast approaching 1 billion people, there are only about a hundred full-fledged cancer treatment centers. And many of them have old, broken or inadequate equipment, as NPR's Ofeibea Quist-Arcton has found in Senegal.

OFEIBEA QUIST-ARCTON, BYLINE: If you happen to be a cancer patient right now needing radiation in Senegal, good luck. The country's only radiotherapy machine - indeed, for a long while, the only one in French-speaking West Africa - has broken down.

UNIDENTIFIED WOMAN: (Foreign language spoken).

QUIST-ARCTON: This is Aristide Le Dantec teaching hospital, one of the oldest and largest in the Senegalese capital. Dozens of mainly women are waiting to be seen at a cancer outpatients' clinic. It's in this department that patients would normally receive radiotherapy treatment, but that hasn't been an option in Senegal since late last year. Doctor Mamadou Diop is in charge of the cancer institute at Dakar's Le Dantec hospital.

MAMADOU DIOP: (Speaking French).

QUIST-ARCTON: This cancer surgeon, in consultation with his colleagues, made the decision to switch off the cobalt radiotherapy machine in December after it kept breaking down. He says it had simply become too dangerous for patients receiving treatment and technicians operating the machine.

DIOP: (Speaking French).

QUIST-ARCTON: As a young intern in his final year of medical school in 1989, Diop saw what he called a revolutionary radiotherapy machine - for Senegal - being wheeled into the hospital. Today, it's just taking up space. Oncologist and radiotherapy specialist, Doctor Mamadou Moustapha Dieng, leads me to the treatment room.

MAMADOU MOUSTAPHA DIENG: This is a waiting room. Patients come here. This is the machine. You see it.

QUIST-ARCTON: It's eerily empty and echoey. I'm looking at a cream-colored, huge, very 20th century cobalt machine but it's kaput. The Senegalese government has promised four new radiotherapy machines for the country, including a replacement for this hospital. Until then, patients must travel to Morocco for treatment at the government's expense with help from the Senegalese Anti-Cancer League.

MICHEL DJERY DOGUE: (Foreign language spoken).

QUIST-ARCTON: Twenty-four-year-old Michel Djery Dogue twice had surgery for a tumor on his tongue last year and has just completed chemo. He's one of dozens of Senegalese booked for radiotherapy in Morocco. Dogue winds a scarf around his head, covering prominent scars from surgery on the side of his face and under his chin.

DOGUE: (Foreign language spoken).

QUIST-ARCTON: "It's a shame I can't have my radiotherapy here in Senegal," says Dogue. Doctor Diop says the problem in Senegal - and elsewhere in Africa - goes much deeper than one broken radiotherapy machine.

DIOP: (Speaking French).

QUIST-ARCTON: Diop says the Senegalese government continues to spend more time and money on infectious diseases such as malaria, which affect many more people and are comparatively inexpensive to treat than cancer.

DIOP: (Speaking French).

QUIST-ARCTON: "I don't want to hear another word about high-cost cancer care," says an exasperated Doctor Diop. Diop says Senegal needs to fast-track training cancer specialists and associated personnel and set up efficient one-stop centers, where patients have access to all the treatment they need.

MADELEINE SENE: (Speaking French).

QUIST-ARCTON: The priority right now for widow Madeleine Sene is her only child, Michel Djery Dogue, the tongue tumor cancer patient. We want him to receive radiotherapy in Morocco and return home safely to Senegal, she says. That's what we're praying for. Clutching her rosary as if for comfort, tears well up in Madame Sene's eyes. Ofeibea Quist-Arcton, NPR News, Dakar. Transcript provided by NPR, Copyright NPR.