“Since that day, my life has been nothing but suffering and paying out money.”

This is how 40-year-old Hawa  sums up the medical journey that took her from her hometown Timbuktu to Bamako, Mali, and a diagnosis of cancer.

Medical tests, biopsies and surgical procedures have taken over her life since 2009. Her numerous medical appointments have meant travelling between Mali’s capital city and her home region, at a time when the latter was descending into chaos. But it was several years before Hawa was finally diagnosed with cancer.

She is now receiving palliative care and support from Médecins Sans Frontières (MSF) teams in Bamako as part of a new project set up in partnership with Mali’s Ministry of Health.

“I spent so much time hanging around on benches in clinics and hospitals being told the tests were negative and there was nothing wrong that, by the time I was finally told it was a tumour, I was totally drained,” she says.

Cancer as a growing health challenge

Hawa’s case is far from unique. Quite the opposite, in fact. The World Health Organization estimates that in 2018, there were more than one million new cases of cancer in Africa.  In years to come, non-communicable diseases – cancer in particular – may become one of the primary causes of death in Africa, even though the continent struggles with the ravages of infectious diseases, such as malaria, tuberculosis and HIV/AIDS.

Although there’s little data available for Mali, Bamako and the neighbouring district Kati hold registers. According to the International Agency for Research on Cancer, there were more than 13,000 new cases of cancer, most of them breast and cervical, in the country in 2018.  

In Bambara, the most widely-spoken of Mali’s national languages, the word ‘bô’ is used to refer to cancer. ‘Bô’ means ‘curse’, a spell someone has cast, which is why when people are told they have the disease, they often turn to healers and marabouts.

Traditional beliefs are deeply entrenched and despite the authorities’ efforts to improve cancer care, remission is rare in Mali. Beyond sociocultural factors and insufficient knowledge of the disease, for many patients the medical journey is not only extremely arduous, but also unaffordable.

Bottlenecks and prohibitive costs

Some anti-cancer drugs and chemotherapy and radiotherapy treatments are provided free of charge by the State. But everything else–medical imaging, biopsies, consultations, check-ups between chemotherapy treatments, painkillers and drugs –still have to be paid for. 

A simple scan can cost over 100,000 CFA {approx. €152} and because drugs for injection during chemotherapy are often out of stock, patients and families have to buy them themselves in pharmacies.

Some families are simply unable to shoulder this financial burden in the long-term and many patients abandon their treatment. For health workers, giving patients prescriptions they know they don’t have the money for is particularly disheartening.

In addition to the prohibitive costs, there is a shortage of specialist staff and units. For example, Mali Hospital in Bamako has the country’s only radiotherapy department. As it is overwhelmed by demand, patients can wait months for their first radiotherapy session.

When it is no longer about curing but caring

These financial and material barriers are among the main reasons why most patients receiving treatment in the public hemato-oncology department in Bamako’s Point G University Hospital are in the advanced stages of the disease.

There are few or no treatment options available to patients with stage 3 cancer (when the tumour has spread to the lymph nodes or tissue around it) or stage 4 (the tumour has metastasised to other organs). Remission is no longer a possibility and all the medical team can do is manage their patients’ pain and discomfort and provide them with support. That’s why, in November 2018, MSF began offering free palliative care and support services in Point G hospital and patients’ homes.

Seventy-seven-year-old Bambi has breast cancer. Her pain was so severe when our teams began treating her that she’d lost the ability to speak. Along with pain management, MSF treats the side effects of chemotherapy, non-cancer disorders, and wounds caused by tumours.

These wounds are often large, superinfected, malodorous and unsightly, and are partly responsible for the social exclusion and rejection of patients, even by those closest to them. But, with proper nursing care, wounds can be cleaned and reduced, which has a very positive impact on the everyday lives of many of MSF’s patients.

Maady, who has oral cancer, could no longer eat and the sight of his wounds repelled his family. He has now re-engaged with his loved ones, he has people to support him and he can eat again. Communicating with patients and families is an essential part of MSF's work. It requires explaining the disease, building trust and identifying everything that can be done to help make the patient more comfortable – from the mattresses they sleep on to what they eat.

Since November 2018, MSF’s teams in Bamako have given around 1,750 consultations to patients with cancer. 103 patients received home-based care between January and September 2019.

In addition to training healthcare staff and assisting the hemato-oncology department in Point G University Hospital in partnership with the health authorities, we plan to continue expanding our work in oncology. We notably intend to increase screening to ensure that cancers are diagnosed at an early stage and also facilitate access to medical care.