Mammography in Kenya’s Biggest Hospital is a Nightmare

Back in 2010, my mother started having bad breast pain at age 55. She had just retired as a nurse from Kenyatta national hospital (KNH), the biggest hospital in Kenya and East Africa. My mother worked with KNH for many years and she had built herself up the corporate ladder slowly by slowly up to when she retired with a decent retirement package. Little did she know that she would have to go back to KNH to seek help to save her life from killer breast cancer. Doomed she was.

The nightmare started when she was referred to mammography department to confirm her diagnosis. If I could go back how all this unfolded, initially my mom thought she had a boil on her breast ans treated it as if it was one. Her breast was swollen, red and tender and had a hole that was oozing foul-smelling pus. As a nurse, she knew exactly how to treat a boil from home without going to the doctor. She thought she got this.

Months and months went by with her boil getting more and more swollen, red and from a small hole to a bigger wound. It is expected to develop swollen lymph nodes closes to the infected wound and so, having swollen lymph nodes on the same side as “the boil” wasn’t alarming to my mom. It all seemed to follow the normal expectations of an infected boil. Antibiotics both topical and systemic didn’t make any improvements until I called my mom from Boston, USA and asked her seek a physician advice.

As soon as she got to the doctor, breast cancer image was screaming and shinning to the doctor’s ears and eyes. It was at this point she was referred to KNH to get a mammogram. My mom thought she knew her way around in KNH but to her surprise, the only mammogram machine was out-of-order and she was told it shouldn’t take long before they could have it repaired.

Six or so months later, the mammogram machine was restored and the waiting list was as long as they get. Call it corruption or whatever you want to call it, my mom through knowing whomever she knew could not be screened any earlier than a month ahead from the day the mammogram machine was restored. That was a big lie. The machine had up and down time almost every other day. The corruption was open.  The ones who could use the back door and give the technicians/radiologist chai/kitu kidogo (corrupt money) were given priority.

At times, playing by the rules is a recipe to death! We had to use the corrupt way and my mom got a mammography the same day. Think about this for a second, besides paying for mammography, we had to corrupt somebody to do it. Otherwise, a year or two would have passed waiting for the mammography which was obviously confirming the truth.  After the doomed mammogram, my mom had breast tumor — DUH! Her affected breast was more than twice the size of the unaffected one. Long story short, we ended up spending more than KSH 15,000 for the mammogram due to travel, corruption and the cost of doing the mammogram.

Full body CT scan was done together with biopsies and the truth unfolded that she had a stage 4 breast cancer with metastasis to the lungs.  Her breathing was compromised anyway as a long time asthma sufferer.

Surgery was done successfully but radiation therapy was way too expensive to afford. We tried chemo therapy, fund-raisers left and right. We afforded a few radiation therapies up to a point when she had to be put in critical care unit. The critical care unit in KNH private wing is a money milking cow. ‘

My Mom succumbed to breast cancer 11 months after the damn mammogram was completed. My mom died in pain, weak, wasted and with smelling breast cancer wounds that had perforated the skin to look like cauliflowers with bloody pus.

Kenyatta national hospital ought to change the corruption culture that one has to pay something behind closed doors to get anything done. From what I later got to know, down times on this precious mammogram in heart of Kenya’s capital, in the biggest hospital in East Africa is due to intentional sabotage. Wait times are not only caused by low number of mammogram machines in Kenya but also due to human sabotage to create artificial demand.

I strongly believe, just like the corrupt police system in Kenya, KNH higher officials are part of this corruption scheme. No one gives a damn. There is no way to explain how a mammogram machine can be “out of service” for 6 plus months without higher management intervention, while few individuals are using the machine privately on tax payers money.

I know my mom died of breast cancer gone too far before intervention but the situation in KNH is killing thousands more. What about those who can barely afford a mammogram? How are they going to afford the damn corruption money? Who has answers to my painful questions? Does anyone give a damn anymore or is it a matter of self-enrichment?

Cost of Mammogram in Kenya. Does it Matter?

So, if breast cancer is such a killer in Africa, how comes women are not lining up to get mammograms in cities like Nairobi? Is it the cost of mammography in Kenya that is too high or is it that there are no equipment to service all the women at risk? Is it that women are not even aware of the risk or it is that no one really cares about breast cancer?

The truth is, all of the above factors contribute to this. In a simple random survey done in Kiambu Kenya, 71% of women of all women interviewed have never heard of the word “Mammogram”. 88% of women over 40 years old of those interviewed have never heard of mammography in Kenya. Only 11% have heard about mammography and only 7% have ever had a mammogram. None of those interviewed had a preventive screening mammogram

Cost of Mammogram in Kenya
Mammograms in Kenya have no standardized price. The cost primarily depends on where it is taken. Some hospitals like Nairobi Hospital charge around KSH8,000 or about $100. Compared to world average, this is relatively cheaper than most countries. But the cost of $100 for preventive mammogram is not affordable to over 80% of susceptible women in Kenya. Even 25% of that price is not affordable to 80% of Kenyan women. The only way to increase the number of preventive mammogram screening is through government funded project or donor funded mammography.

Mammogram Machines in Kenya
Kenya has a population of about 45 million people and about 18-20 million women are over 40 years old, requiring annual mammograms per Center of Disease and Control (CDC) recommendations. While mammogram machines are not the most expensive gadgets Kenyans can afford, it is discouraging to investors to buy equipment but consumers cannot afford to pay for tests. It’s heartbreaking to note that over 90% of all mammograms done in Kenya today are done for diagnostic reasons, not preventive reasons. Kenya has just over 10 mammogram machines and 95% of all these machines are located in Nairobi

Lack of Knowledge
While they say “Ignorance is a bliss”, the kind of ignorance we face in Kenya is not a bliss. This is the ignorance that kills because not knowing about breast cancer does not stop breast cancer from killing young moms and sisters. The level of awareness about breast cancer in Kenya and the rest of Africa is extremely low. We have to create necessary awareness starting with the closest woman we can reach.

Kenyans living abroad should really consider informing their loved ones about preventive mammograms. Sponsoring mammograms for loved ones in Kenya could help save a life of some one you really love.

Believe it or not, there is not one single mammography trained specialist among the few radiologists in Kenya. The few radiologists in Kenya have cross-trained across many disciplines to accommodate many under-served areas of diagnostics. Mammography technicians are as well cross-trained across many disciplines and have no mammography specific training backed by continuous education and skills update as technology and evidence based practice evolve.

The cost of mammography in Kenya is not standardized but even the most expensive hospitals charge below developed countries average price. Mammography machines are expensive and sometimes not the most worthwhile investors can channel their money to. Majority of Kenyans live below poverty line and cannot afford even highly subsidized mammograms annually. Majority of women in Kenya and all over Africa have never heard of mammograms. Lack of awareness is the biggest contributor to poor breast cancer screening in Kenya.

How Kenyan Women Can Stay Ahead of Breast Cancer

  1. Women with a family history of breast cancer can lower their risk by breastfeeding their babies according to the Archives of Internal Medicine. In their study, it was revealed that Women with a family history of breast cancer were 59% less likely to develop pre-menopausal breast cancer if they had ever breastfed. In the past, majority of Kenyan women breastfed their kids but industrialization and urban life is decreasing the breastfeeding. This may have contributed in the current increase in breast cancer incidences in Kenya.
  2. Reducing dietary fat may reduce the risk of breast cancer according to the Women’s Intervention Nutrition Study in America. In the wake of economic growth and urbanization in Kenya, fatty foods intake like KFC chicken and red meats is on the rise. Our traditional low-fat high fibre foods like beans and vegetables offers the best breast cancer protection.
  3. The link between obesity and breast cancer have been very clear for many decades. Obese women are at higher risk of breast cancer than lean women. Eating small food portions of well-balanced diet low in fat and red meats is a good way to protect yourself from breast cancer.
  4. Mammography is the best way to detect breast cancer in its earliest, most treatable stage. If it’s time to schedule your mammogram, make the appointment now. Most Kenyan women over age 50 has never had a mammogram according to a simple questionnaire conducted my Cancer Free Women in two local churches in Nairobi. Over 70% did not even know what a mammogram is. Among the 200 participants, 21% has had a close family member dies of breast cancer. Cancer Free Women has created a platform/website where you can sponsor a family, friend or a random person to get a free Mammogram in Kenya.
  5. Avoid Excess alcohol intake and smoking.