Until the day in May 2016 when she found a lump on the side of her breast, 36-year-old Chidimma Oyenkachi didn’t know much about breast cancer. There wasn’t much information about it in the media, she didn’t talk about it with her friends or family, and she had never had the opportunity to learn about it from a health professional. So when she made a hospital appointment in capital city of Abuja, she was surprised to find her worst fears were confirmed. “I was booked for a screening test and I was told that the lump was cancerous,” Chidimma recalls.

Social protection is extremely limited in Nigeria, with approximately 95 per cent of the population surviving without health insurance – Chidimma included. After spending much of her savings on the diagnosis and surgery to remove the lump, she couldn’t afford the huge amount required for her to undergo a mastectomy and radiotherapy. As a result, the doctors placed her on chemotherapy to reduce her stage 2 cancer symptoms.

Two years later, after receiving financial support from the Abuja-based cancer care organisation Project PINK BLUE, Chidimma was finally able to undergo surgery to have her left breast removed. She has now been cancer-free for since last year.

Chidimma is one of the lucky ones. According to the World Health Organization (WHO), Nigeria has one of the highest cancer mortality rates in the world, with approximately four out of five cancer cases resulting in death. Last year, no less than 115,950 Nigerians were diagnosed with cancer, and 70,327 died from the disease, according to figures from the Global Cancer Observatory – up from 102,079 new cancer cases and 72,000 cancer deaths in 2012.

Breast cancer is one of the leading causes of death amongst Nigerian women and the most prevalent form of all cancers in Nigeria, comprising 22.7 per cent of all new cancer cases in 2018 and 37 per cent amongst women.

The reasons for the growth in cancer rates in Nigeria and the extremely poor outcomes are varied: increasing exposure to cancer risk factors (such as unhealthy lifestyles and environmental pollution), late diagnosis, poor access to healthcare, ill-equipped hospitals and strong religiosity all play an important role. But perhaps the key issue is that most people simply cannot afford the high cost of cancer treatment, be it radiotherapy, chemotherapy, immunotherapy or surgery.

The human cost of underfunded healthcare

Earlier this year, two of the biggest names in Nigeria’s vibrant cultural scene – the internationally-renowned art curators Bisi Silva and Okwui Enwezor – both died within a month of one another from cancer. While their deaths have helped move the needle on discussing the topic of cancer in Nigerian society, the disease is still shrouded in secrecy, with societal stigmas pushing many sufferers into isolation and away from seeking help. “Sometimes when you are diagnosed and you go to the hospital for treatment, some of the doctors make it seem like you have a death sentence,” says Chidimma.

Runcie Chidebe, a cancer control advocate and executive director of Project PINK BLUE, says there are a couple of major challenges facing cancer patients in Nigeria: “Some patients catch the cancer early but cannot afford medical treatment. The other issue is that some people have no access to medical care for cancer, due to the lack of treatment facilities available.”

Nigeria has only nine cancer treatment centres to serve a population of 201 million people, with only four radiotherapy machines (one of which is owned by a private hospital in Lagos).

In addition, only three out of the 20 federal teaching hospitals in Nigeria have cancer-diagnosing machines (either radiotherapy or biotherapy), while many of the machines used in Nigerian treatment centres are no longer used in other parts of the world, because they are considered obsolete.

Despite the recommendation of the 2001 Abuja Declaration (where African Union member states agreed to allocate 15 per cent of their national budgets to healthcare), Nigeria still lags woefully behind. This year, the federal government allocated just 4.1 per cent of the national budget towards health; however, this is a marginal improvement on the 3.9 per cent allocated last year.

Grassroots initiatives

Nigeria’s president, Muhammadu Buhari (whose own undisclosed health issues have forced him to take a significant amount of time off work and seek foreign treatment abroad) has promised to focus on improving the country’s facilities for the prevention, early diagnosis and treatment of cancer, exemplified by his commission of a new US$11 million cancer treatment centre at the Lagos University Teaching Hospital earlier this year.

In general, most progress is taking place at a federal level. Nevertheless, there are several grassroots initiatives attempting to tackle the problem across the country. Nnenna Samuila and Jeminat Olumegbon founded the Female Bikers Initiative in August 2017 to help create awareness of various female health issues, particularly breast and cervical cancer. The group is an offshoot as the D’Angels Motorcycle Club, the first all-women motorcycle club in Nigeria, and the goal of the FBI is “to sensitise women and girls to be conscious of routine screening and cancer awareness across Nigeria and Africa,” says Olumegbon. “We are riding to change the culture of ignorance and reduce the mortality rate of women dying from cancer disease in Nigeria.”

As well as providing free breast and cervical cancer screening to hundreds of women in the Nigeria commercial capital of Lagos with the support of the Optimal Cancer Care Foundation and Sebeccly Cancer Care, they ride across countries in west Africa to offer free screenings and to sensitise women about the threat of cancer.

Other domestic nonprofits are also backing these efforts. J-Rahpa Hospital in the south-western city of Ibadan, Sapphire Medicals in the eastern city of Port Harcourt and Joyce John Cancer Foundation in the south-eastern city of Abakaliki, supported the FBI with free cancer screenings for 881 women.

Dr. Boma Orumabo is president of the Sapphire Health Group, which organised screenings with the FBI in Port Harcourt. He says that prior to their collaboration, very few women attended screenings. “They would mainly trickle in after the death of a close friend or relative, but after our partnership with the FBI, we now have an influx of women coming in.”