In Kenya, the battle against cancer is a fight I see daily. Just last week, a young woman named Abeni arrived at my clinic, her once vibrant spirit dampened by months of misdiagnoses and unnecessary referrals. The problem had started with a small swelling in her leg, for which she had been referred from the health centre to a level 3 facility where an ultrasound was done.
She was then referred to a level 4 facility where she was seen a month later. The doctor there decided to do a biopsy. This was done two weeks later and the results came out after six weeks after which she was referred to us with a diagnosis of a sarcoma. I hope that your head is spinning a little by now after that long explanation, the only level she didn’t pass through was level 5.
As you can imagine, by the time she reached a specialist, the cancer had progressed significantly, the swelling was much bigger, and her cancer had spread to the chest and liver. Abeni's story, tragically, is not uncommon. The flawed referral system in Kenya delays critical diagnoses and treatment, stealing hope from patients like her. I have a saying I like to use, when it comes to cancer 'Time is Life'.
The battle against musculoskeletal sarcomas reveals deep flaws in our healthcare system when it relates to how we manage cancer in general. The journey of patients like Abeni, who endure months of travelling through various levels of our referral system before receiving the correct specialist care, underscores a dire need for systemic change.
If she had been seen at the health centre and referred to the specialist right away, just from the timeline we have seen, we could have saved three months, because all the tests and assessments she required could have been done in one place.
Currently, patients navigate a labyrinthine referral process that delays essential care. This inefficiency not only diminishes survival rates but also starkly contrasts with the streamlined systems in the Global North, where early diagnosis leads to survival rates as high as 70 per cent. In Kenya, the delay in diagnosis often results in survival rates falling below 50 per cent.
This situation is a profound injustice, particularly affecting our most vulnerable populations who lack immediate access to specialised care. We must overhaul this system to provide timely and expert treatment at specialised facilities like Kenyatta National Hospital and Moi Teaching and Referral Hospital through a direct referral system. This would ensure that patients like Abeni, who arrive with symptoms of sarcoma, are immediately directed to facilities equipped to manage their care effectively.
The costs of maintaining our current, inefficient system are too high, measured not in monetary terms but in human lives. Each mismanaged case signifies a potentially preventable tragedy. Investing in an efficient referral system is not merely cost-effective; it is morally imperative.
The main challenge that patients will face if we switch to a direct referral system is the logistics of travelling to these centres. Addressing transportation and accommodation challenges is crucial for ensuring that all Kenyans, regardless of their geographic location, have access to these specialised services. Partnerships with NGOs and government initiatives could provide vital support such as travel subsidies and temporary accommodations, ensuring equitable access to necessary care.
Enhanced training for healthcare providers and increased public awareness are also critical. Many sarcomas are misdiagnosed due to non-alarming symptoms, leading to dangerous delays in appropriate treatment.
A simple example is that many healthcare workers in primary care settings associate sarcoma and other forms of cancer with pain. This means that they often ignore painless lumps or swelling until it is too late. Initiatives that train healthcare workers effectively and raise public awareness about the signs of sarcomas can make a significant difference.
Our healthcare system stands at a crossroads. We can continue on a path of inefficiency and injustice or choose a new direction that offers hope and improved health outcomes. We have a moral obligation to provide timely, equitable and effective healthcare.
Let us be the generation that transforms sarcoma care in Kenya, ensuring that no other patient endures what Abeni went through. Let's commit to a healthcare system that champions efficiency, equity and compassion—a system where timely care and justice in health are guaranteed for all.
Orthopaedic surgeon and a 2024 Global Surgery Advocacy Fellow
