UGANDA: High cost of Burkitts lymphoma

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GULU, 25 November 2010 (IRIN) - High poverty levels and a lack of awareness are among factors preventing parents in parts of northern Uganda from accessing timely care and treatment for their children suffering from a widespread viral cancer, Burkitt’s lymphoma. The disease is a malignant tumour associated with the Epstein-Barr virus (EBV) that is endemic to central parts of Africa and New Guinea. The EBV virus is linked to lymphomas (immune system cancers) and nasopharyngeal cancers in humans, according to the UN World Health Organization (WHO) [ http://www.who.int/vaccine_research/documents/Viral_Cancers.pdf ] . In northern Uganda’s Lira District, some residents are struggling to provide care for their sick children. “I am waiting for the day the child will pass away because there is nothing I can do, I don’t have money. It is better the Lord puts him to rest than all this pain and suffering,” Cicilia Odongo, a mother of six, told IRIN in Lira’s Agwata Village. “No one wants her child to die but I can’t see any hope here.” Odongo, 38, is nursing her seven-year-old son Paska Angwec, who has been bed-ridden for the past five months barely able to turn his head due to swellings on his head and neck. Burkitt’s lymphoma has a peak incidence at the ages of six or seven, according to WHO. Unable to raise the 50,000 Ugandan shillings (about US$22) transport fare to Gulu Hospital, Odongo, a former internally displaced person, is relying on traditional treatment, and she is not alone. “We are trying [the herbs] because we have no option; if we had the money, do you think I would be wasting time here?” Margaret Akelle, another Lira resident, asked. A traditional herbalist, Arwoti Okao, told IRIN he received cancer patients from the neighbouring districts of Amolatar, Apac, Gulu, Oyam and Soroti. “Parents pay 10,000 Ugandan Shillings [$4.30] for every visit to get the herbs. When the swelling [tumour] is ripe, I cut it off. [But] it’s difficult to cure a person suffering from this disease,” he said. Referred to as “two jock” in northern Uganda, Burkitt's lymphoma is locally associated with bad spirits. Intensive treatment “The treatment, chemotherapy, is intensive, involving staying in hospital. When the patient is weak, the body fails to cope with the treatment,” Valeria Chalbi, a doctor at the St Mary’s Hospital in Lacor [ http://www.lacorhospital.org/ ], told IRIN. The anti-cancer (cytotoxic) drugs to destroy cancer cells are administered every two weeks for about three months, Chalbi said. Treatment may differ depending on affected body parts, with various drugs being used in combination. The endemic disease in Africa is more often manifest in the jaw, while the non-endemic disease presents frequently as an abdominal tumour, according to WHO. At the St. Mary’s Hospital in Lacor, most of the patients seeking treatment are from the Lango sub-region, Michael Mawanda, a doctor, told IRIN. Lango, he said, has a high malaria prevalence as do most of the other areas where the disease is prevalent. According to WHO, the Burkitt’s lymphoma belt extends from West to East Africa between 10 degrees north and 10 degrees south of the equator, continuing to the eastern coast of Africa, characterized by high temperatures and humidity, which is probably why an association with malaria is suspected. On average 80-100 children seek treatment at St Mary’s Hospital annually, with at least 500 children having been treated there since 2005. Some 82 children had sought treatment between January and October. While the hospital provides free treatment to children under-five, older children under 12 and 15 pay an admission fee of USh15,000 ($6.8) and USh25,000 ($11.3) respectively, in addition to drugs, hospital tests, personnel and bed costs, amounting to an estimated 1.27 million Ugandan shillings ($576). The cost is out of reach for the majority in the region, despite being heavily subsidised compared with treatment elsewhere, which would cost about USh2 million Ugandan ($909). Inadequate staffing and equipment remain an issue. “Even in bigger hospitals, it is challenging because many tests have to be done to [conclude] that a patient has cancer,” said Mawanda. ca/aw/mw © IRIN. All rights reserved. More humanitarian news and analysis: http://www.IRINnews.org