Waiting for Death - Woman suffering from breast cancer declares

On a mat in a cold and dark corner in her room, she gazes at the ticking clock and wishes her last breath will end with the last tick of her counts.

To exit the face of the earth is her greatest wish and if she had just little savings, she would have bargained with the angle of death to show her mercy and accept her offer, but while she has no savings to her name and cannot also afford the cheapest poison to end her nightmare, Amina Alhassan can only keep cursing poverty for her predicament.

“To die now will be more comforting to me than living with a disease that is killing me slowly and you can’t afford its treatment”, the hopeless mother of five children lamented.

For one to wish to exchange her life for death due to a treatable disease, exposes the weaknesses of the country’s health policies and social interventions.

The situation

Madam Amina has battled breast cancer on her left side breast for close to one year. She went to the Wa Hospital in the Upper West Region in 2020 but was referred to the Tamale Teaching Hospital for treatment.

“I, however, did not go because I cannot afford the cost of my transportation and living expenses let alone to afford the high cost of treating this cancer”, she said.

Amina lost her husband some years back and has since assumed the burden of her children including seeing them through basic school. Currently, all her children are adults but none of them has any meaningful source of income that could support the cost of treatment of the mother.

With the situation of her children, 72-year-old Amina knows if help does not come from above, she will have to keep wishing she dies so she could find eternal rest.

Dr Paschal Kingsley Mwin, the Wa Municipal Director of Health Services, who was shown a picture of Madam Amina’s condition, described it as very bad and one that needs urgent attention.

“Depending on the level of spread of cancer, it could get to her brain, bones, lungs, and many of the systems”, he said.

Dr Mwin noted she could need surgery or a chemo-radiation depending on her case. He revealed that the surgery could cost up to GH? 20,000.00 while chemo-radiation could cost over GH? 10,000.00 excluding laboratory tests and medications.

Health Insurance

The Government of Ghana established the National Health Insurance Scheme (NHIS) under the National Health Insurance Act 2003 (Act 650), which was later replaced by a new Act 2012 (Act 852) to provide a broad range of health care services to Ghanaians through district mutual and private health insurance schemes.

Mr Asraf Kele, the Upper West Regional Public Relations Officer of the NHIA in an interview with the Ghana News Agency (GNA) disclosed that breast cancer diagnosis and treatment were both covered by the NHIS.

The interview is part of the 'Mobilizing the Media for Fighting COVID-19" project being implemented by the Journalists for Human Rights in collaboration with the Ghana Journalists Association (GJA).

Further checks by the GNA on the NHIA website confirmed in a news article posted on January 9, 2016, which states: “Breast and cervical cancers are now covered by the NHIS, the public must, therefore, not wait till cancer gets its worse stages before seeking care”.

According to the news item on the website, “most people think that cancers are costly to treat, perhaps that’s the reason why they wait that long before seeking proper medical help. But the good news is that the NHIS covers breast and cervical cancers so why do you wait till it’s too late before reporting for medical treatment?”

But Madam Evelyn Osei-Amoah, an Oncology Nurse Specialist at the Tamale Teaching Hospital (TTH) where Madam Amina has been referred to since 2020, speaking to the Ghana News Agency (GNA) stated that “breast cancer treatment is only covered by the NHIS on paper and not in practical terms”.

“The medicines are so expensive and the government is not able to buy for the hospitals so you come to the hospital and the medicines are not there for you to be treated”, she said.

She noted however that the TTH had a Social Support Unit that sometimes provided support for breast cancer patients who cannot immediately afford the cost of treatment or can genuinely not afford it at all.

Madam Osei-Amoah explained that for those who could not immediately afford it, the Unit would step in to take up the cost after which she would be given a reasonable time to pay back in instalment.

The Oncology Nurse Specialist said for those who could not afford at all, the Social Support Unit, based on its financial strength at that particular period may decide to foot the bill for the patient free on otherwise.

Mammography Machine

Meanwhile, Madam Osei-Amoah in an earlier report filed by the GNA in Tamale in October 2021 revealed that there was no mammography machine for women above 40 years in the five regions of the North to have their breast adequately screened of cancer.

She said the non-availability of the machine was a huge gap in the screening and treatment of cancer in the area and also presented untold difficulty to women who had to bear the extra cost to travel to Techiman in the Bono East Region to have the screening done.

“So, there are some we write for them and they won’t even go and do it, and that is a huge challenge”, she told the GNA.

Data on cancer

According to Globocan 2020 data, sourced from the International Agency for Research on Cancer under the World Health Organisation (WHO) website, Ghana has a total of 24,009 (9,931 males and 14,078 females) new cases of cancer with 15,802 deaths and 47,029 prevalent cases (5-year).

According to the data, a number of new cases in 2020 for both sexes and all ages suggest that breast cancer recorded the highest of 4,482 (18.7%) cases, liver cancer 3,452 (14.4%) cases, cervix uteri 2,797 (11.6%), prostate 2,129 (8.9%), Non-Hodgkin lymphoma 1,197 (5%) and other cancers 9,952 (41.5%).

For a number of new cases in females alone and for all ages, breast cancer remained at 4,482 (18.7%) cases, cervix uteri 2,797 (19.9%), ovary 1,001 (7.1%), liver 978 (6.9%), Non-Hodgkin lymphoma 543 (3.9%), and other cancers 4,277 (30.4%).

According to the Union for International Cancer Control (UICC) website, the WHO estimates that 70 per cent of cancer deaths occur in low-and middle-income country countries (LMICs) and, by 2030, LMICs are expected to bear the brunt of the expected 24.1 million new cancer cases per year.

Target 3.4 of the Sustainable Development Goal three (SDG 3) enjoined member countries including Ghana to commit to reduce by one-third premature mortality from Non-Communicable Diseases (NCDs) including cancer through prevention and treatment and promote mental health and wellbeing.

From the data above, breast cancer is not just only the topmost disease among the top five cancers for females, but also the first among the top five cancers for both males and females.

This calls for the need for the country to pay urgent attention to providing the necessary resources for both the diagnosis and the treatment of cancer to prevent loss of lives from a preventable disease.

Until mammography machines are provided across the five regions of the North and for women in this enclave to adequately have their breast screened for cancer, the plight of Madam Amina and many other women will continue to remain bleak and precious lives will continue to be lost.

The coverage of breast cancer under the NHIS should not remain on paper whilst women continue to die of the preventable disease; government must commit to providing the necessary resources for women to be able to access the services in all health facilities to save their lives and give through meaning to the NHIS policy.