LUNG CANCER, GANI FAWEHINMI AND THE NIGERIAN HEALTHCARE

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“With the remaining time left for me in this world, I will treasure these unusual, wonderful and unprecedented outpouring of love, support and kindness from my fellow countrymen and women…………….

I will continue to battle this deadly disease of lung cancer despite the pain and pangs it entails, with determination and courage that I can muster.”

With these words as reported by a national newspaper recently, Chief Abdul-Ganiyu Oyesola Fawehinmi encompasses the threats of an emerging disease and ominously sounded a warning that should not be ignored. Lung cancer remains the greatest killer of all cancers worldwide and its course may be brutally short. According to the WHO, in 2004, 7.4 million people died of cancer worldwide, the greater majority attributed to lung cancer.

The rate of occurrence of lung cancer has been reported to have a striking parallel to the incidence of cigarette smoking in any nation. The risk is increased by early age of commencement of smoking and the duration of smoking. Other identified risk factors include second-hand smoking, air pollution and exposure to chemicals like arsenic, randon gas (radiation) and the notorious asbestos. It is important to mention that all current smokers have a higher risk of developing this illness, regardless of the tar content of their tobacco. This is in comparison to the low rate in ex-smokers and non-smokers.

There is often an average latency period of 20 years between commencement of smoking and occurrence of disease. And a heavy smoker consuming more than 20 cigarettes per day has a 30 to 40 times higher risk of developing the illness.

Normally, the cells of living organisms divide and grow in a controlled and co-ordinated manner. However, this control mechanism is lost with the advent of cancer of any organ or part of the body. Cells continue to grow in an uncontrolled manner causing local pressure effects and damages (primary tumour) or sometimes spreading to adjacent or distant organs through the blood or lymphatic glands, producing secondaries, otherwise known as metastases.

Symptoms of lung cancer could be due to the original tumour in the lung or to secondary tumours elsewhere in the body. These symptoms include chronic cough, worsening breathlessness, persistent chest pains or pains at sites of metastases, weight loss, excessive fatigue and haemoptysis (coughing out of blood). Haemoptysis is particularly significant as it can be an early warning sign and sometimes at this stage, the cancer may still be curable.

While lung cancer remains a non- major harbinger of death in Nigeria and probably many other developing countries, worldwide, it is gaining the dubious distinction of a colossal killer, almost of an epidemic proportion. This is explained by the ever increasing addiction to tobacco or smoking. Men retain the highest incidence, but this dishonourable position is being actively challenged by women who are almost displacing men as the greatest smokers in the world. It has been reported that Nigeria and Senegal are amongst the nations with lowest incidences, estimated at less than 1 case per 100,000 population per year. Prostate cancer in men and Breast cancer in women remain the highest killers in Nigeria.

Worldwide, however, lung cancer remains the greatest cause of death. Incidence is higher in industrialised nations. Incidence is highest in the UK and Poland where it is more than 100 cases per 100,000 population per year. Before we begin to celebrate, it should be noted that Nigeria has no standardised national cancer register and detection rates remain very low in the face of inadequate facilities and the chaotic nature of our healthcare delivery. We should also not forget that the rate of smoking is rapidly increasing in our society, especially amongst our youths. This portends a future time bomb.

When examined under the microscope, there are three types of lung cancer – adenocarcinoma, squamous cell and small cell cancer. The knowledge of tumour- type could be of therapeutic significance. However diagnostic tools include chest x-ray which shows a “coin” lesion, blood tests, biopsy (taking a small chunk of the cancer for histological analysis) and what is known as Computerised Tomography (CT) scan, an advanced form of imaging technique not commonly available in Nigeria.

Treatment includes surgery, use of anti-cancer drugs (otherwise referred to as chemotherapy) and exposure to radiations (called radiotherapy). It must be said that the surgical option is often not explored as the cancer has often spread by the time of diagnosis in most patients. Also, because of the physically poor state of most patients, surgery is often not an option. Generally, it must be said that the treatment of lung cancer is generally ineffective with a resultant high death rate.

The full import of the current travail of our most respected and distinguished Chief Abdul-Ganiyu Fawehinmi are the lessons that we, as his most beloved people, can derive from it. Chief Fawehinmi has spent the greater part of his chequered existence fighting for the emancipation of the masses of this country. I am convinced that his most innate desire would be for us as a people to benefit from even this sad episode of his life. The benefit essentially lies with developing a political system that will produce credible leadership committed to the delivery of a qualitative and enhanced healthcare. This is essential to tackle the menace of an emerging disease like lung cancer and other forms of established cancers.

In the area of healthcare delivery, like many others, Nigeria is striding into the 21^st century like a nation just waking up from the slumber of the 17^th. The best strategy of all in combating the menace of these mortal diseases in a developing economy like ours is practically the preventive option. This can only be achieved via a massive, sustained and well-organised public health education programmes. These programmes should be aimed at prevention and early detection. Prevention should be aimed at discouraging young people from smoking (a growing problem in our society) and also encouraging smokers to quit. As per the latter, establishing Stop-Smoking Clinics throughout the federation would be a step in the right direction. To achieve the maximum impact, these clinics should be established at the level of local councils.

The law stipulating the display of warnings on tobacco packets is commendable but has not achieved the desired deterrent effect to date. Well-organised, goal-oriented massive public health education on the dangers of smoking will go a long way in sensitizing the populace. Additionally, it will create scarce jobs for the teeming population of jobless Nigerians. Stop-Smoking clinics will be manned by specially trained counsellors, psychologists and supporting staff, another source of employment creation.

While much can be said in favour of a healthcare system focussed primarily on prevention, the time has arrived in this country where the awareness, detection and management of the so-called “diseases of the rich” have become imperative. Ours is a complex society where poverty is struggling with exposure to western lifestyles. This apart, the lifestyle of the average Nigerian is basically unhealthy. This is in terms of food and lack of sufficient physical activities. Conditions linked to indulgent lifestyles such as obesity, heart disease and strokes are increasing in our society.

Thus, a comprehensive healthcare system that recognises the complexity of our society and focussed on achieving the maximum is what the country needs. This entails, amongst other things, the provision of well-equipped and functional hospitals massively distributed all over the country. There are many western countries with successful, efficient and functional healthcare systems. These could be under-studied in trying to develop one suitable for the Nigerian situation. A well-developed healthcare delivery system in Nigeria (which of course is long overdue) would make it unnecessary for the likes of Yar’adua or even Chief Fawehinmi to travel outside the shores of this country for treatment. Nigeria can be a truly great country if only our leaders would utilise our God-given resources to really develop the fatherland.

 In the final analysis, as regards cigarette smoking and lung cancer, perhaps the government will have the moral will to simply do the obvious – ban tobacco production in the country, put a general ban on smoking and prescribe heavy penalties for illegal importation and smoking of cigarettes. This seems to be an impossible panacea that economic consideration will not permit!

Dr Olusegun Fakoya, 

oluseguncs@yahoo.co.uk 

Robot  # 1 | 22.05.2008 02:09

LUNG CANCER, GANI FAWEHINMI AND THE NIGERIAN HEALTHCARE &...Read the full article.