Why Kenyans spend millions to treat cancer in hospitals abroad
What you need to know:
- Government data shows that this costs Kenya about Sh15 billion annually.
Most Kenyans cannot afford to travel abroad for treatment. Hospitals are poorly equipped and the charges extremely high.
Three months into her retirement, Dr Bilha Muthoni Murage started feeling uncomfortable with a constant stomach ache. For a year, she ignored the pain, but it was getting worse.
She knew that once she retired, she would not be able to use her insurance card. She decided to go for a full body check-up at MP Shah Hospital. To her surprise, her liver was enlarged. The doctor recommended a CT scan, which showed that her gall bladder was inflamed.
She went for a second opinion, which confirmed the diagnosis. Her doctor suggested an urgent biopsy. Within five days, the results were out, she had cancer of the gall bladder. “It had moved to the liver from the gall bladder,” she says.
For a correct diagnosis to be done, her doctor recommended a positron emission tomography-computed tomography (Pet-CT) scan to know the extent of the cancer cells. Only the Aga Khan Hospital had the machine but there was a long waiting list. The earliest she could get a scan was after seven months. The diagnosis was done in January 2018. She was scheduled for a scan in August.
A Pet-CT scanner is an imaging tool that combines two scanning techniques, allowing doctors to see any changes in the activity of cells and where they are taking place.
The machine gives an accurate indication of the progress of the disease in its earliest stages. It will also scan and detect the location and extent of cancer that has recurred after initial treatment and spread.
By then, the scan went for Sh70, 000, but the National Health Insurance Fund was covering the treatment.
“This needs to be done as quickly as possible. I am sending you to India for the procedure ... we have to find out what’s going on with your body,” She was told by her doctor. The scan is not as expensive in India as it is in Kenya but other costs came into such as accommodation and food. The scan was Sh60, 000 just Sh10, 000 cheaper than Kenya.
Apart from just the cost of treatment, Dr Bilha said the promptness and concern from the doctors made it easier for her treatment and to curb the spread of the disease.
“We arrived on December 23 and, after two days, we had the scan results, I was briefed and asked to sign my consent. On December 28, in the morning, I had my first session of chemotherapy,” she says
If this was in Kenya, the scan alone would have taken weeks and, before the start of the treatment, it would have taken months of waiting, often up to a year.
Given that Dr Bilha went to a private hospital, the charges were a bit higher but for the general hospitals, a Pet-CT scan costs about Sh40, 000. For two sessions of chemotherapy, a combination of first-line cancer drugs (Cisplatin and Gemcitabine) Dr Bilha paid Sh80, 000.
This is way cheaper than Kenya but other costs make it expensive. The family would spend Sh3, 000 a night on accommodation for two and Sh10, 000 per month for the six months they stayed in India. They paid Sh244, 000 for one air ticket. When the family was leaving for India, the church conducted a funds drive which raised Sh3.5 million.
“For the six months that we were in India, we used over Sh2 million,” she says.
But most Kenyans cannot afford to travel abroad for treatment. Hospitals are poorly equipped and the charges extremely high.
Only three public hospitals—Kenyatta National Hospital (KNH), Moi Teaching and Referral Hospital in Eldoret and Kenyatta Teaching, Referral and Research Hospital (KUTRRH)—have comprehensive cancer treatment facilities in the country. But the long wait, expensive treatment and late diagnosis make it impossible for people to get treatment on time.
Cancer patients all over the country flood the three overwhelmed facilities to get affordable radiotherapy and chemotherapy sessions. But they can sometimes wait up to a year for an appointment due to a backlog. The KUTRRH has a comprehensive cancer diagnostics and treatment centre which focuses on early diagnosis, treatment and management of cancer while making the treatment more accessible for patients. The facility can scan 60 cancer patients per day. It costs roughly Sh75, 000 for a Pet-CT scan in private hospitals.
Every year, thousands of Kenyan patients travel abroad for specialised medical attention. Some of the favourite destinations are India, South Africa and the United Kingdom. Of the three, India is the cheapest place to get treatment, and the UK is the most expensive.
Basic calculations show that a single patient needs at least Sh1.5 million or more to meet their treatment, medication, accommodation and other expenses depending on the country they settle for and the disease. This amount is way out of reach for a majority of the population.
Most have to fundraise to get treatment in private facilities such as Aga Khan, MP Shah and Nairobi Hospital that offer specialised treatment at exorbitant prices or simply wait to die. In Kenya, cancer kills around 30,000 people every year, while 47,000 people are diagnosed with cancer annually with over 90,000 prevalent cases over the past five years, according to government data. More than 10,000 Kenyans travel abroad each year for treatment of various ailments, especially cancer. Government data shows that this costs Kenya about Sh15 billion annually. Kenya Medical Practitioners and Dentists Council chief executive Daniel Yumbya said going abroad for treatment does not guarantee better outcomes.
“Whereas the treatment expenses overseas in some cases may appear more pocket-friendly than in Kenyan hospitals, many patients travel oblivious of a myriad of added costs,” says Dr Yumbya. Besides hospital fees, patients pay for accommodation, air tickets and food as separate bills. In most cases, family members accompany the patients, adding to the costs.
“Such costs make treatment abroad extremely expensive and many patients, unable to meet these expenses, end up being detained in foreign hospitals for unpaid medical bills. This only adds to the suffering of families already strained by anxiety over the health of their members,” Dr Yumbya adds. He says that, after treatment, a patient needs to plan for any necessary after-care upon returning home.
“One must talk to their doctor to plan for medication and other post-operative needs that may arise from treatment. It would be quite difficult for a practitioner abroad to physically follow up on a patient who sought treatment from them,” This will again cost money,” he says.
This happened to Dr Bilha, who, when she came back from India, was told to stop taking the drugs that she was placed on while in India and placed on locally available drugs. The drugs would cost Sh160, 000
After nine months of her return, the cancer returned. She could not travel back to India because of lack of funds and had to get her treatment in the country.
Another biopsy was done and she was placed on a new drug, Ketruda, The drug goes for Sh500, 000 per cycle after every three weeks and can only be found at Nairobi Hospital. NHIF pays for Sh412, 000 and she tops up Sh70, 000 because her retirement cover dictates so.
“I am glad it can cover that but this is because of the amount I pay in my cover, how about other Kenyans, it is not easy treating cancer. It is a disaster,” she says. She has exhausted her cover for this year. She has done five sessions with 13 cycles left. She is pondering where to get money to cover the remaining cycles.
She is planning for a fundraiser next month until the next financial year when the national insurer will pick it up. She needs at least Sh6.5 million for the remaining cycles. The Nation managed to pay top up Sh30, 000 for her next session.
Erick Wangeci*, who travelled to India last year, left treatment halfway as he could not afford treatment and money for accommodation.
“The treatment is affordable but the cost of living is not cheap. We just need to add more cancer centres since the number of patients has since increased,” he says.
Dr Rashid Khalani, who was recently appointed the chief executive officer of the Aga Khan University Hospital, says it pains him to see Kenyans spending over Sh10 billion to get treatment abroad yet there were solutions locally.
“We have the infrastructure. We have the right people. We have the right technology. So people do not need to go outside to get quality care,” Dr Khalani says.
He said patients are coming from all over the continent from countries such as Uganda, Tanzania, the Democratic Republic of Congo, Ethiopia and even Malawi to Kenya for specialised care and all the country needs is to promote inbound medical tourism. In 2017, the council developed rules for referral of patients abroad. Under the rules, a medical or dental practitioner cam only refer a patient for treatment abroad where there is evidence of inadequate expertise or medical facilities to handle the condition locally, when referral is the most cost-effective option for the patient; and when the patient opts to pay for medical intervention abroad.
This means that Kenyans who want to seek treatment abroad must inform the Health Ministry and the council.
