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Already stretched resources for management of terminal disease take back seat with facilities feeling the brunt.

As global attention remains on fighting coronavirus disease, it is double jeopardy for many patients with chronic illnesses as some have been sent home to confront their conditions with inadequate medical care.

Ironically, people with chronic illnesses have been identified as being at risk of contracting the virus yet many of those living with conditions such as cancer, kidney ailments and diabetes feel neglected as the world focuses on coronavirus.

Jane Onyango, a caregiver to four cervical cancer patients, says the situation has not been easy since the country reported the first coronavirus case three weeks ago.

  “When the corona pandemic began, we went to Kenyatta National Hospital (KNH) and were told that there is no way they could treat us because of coronavirus and they would minimise the number of patients with other ailments to be treated,” says Jane.

 A follow-up visit to the hospital yielded the same feedback. She had to plead with the doctor to treat her patients and since they had already done their laboratory tests and planning (processes required before radiotherapy), the doctor agreed to start treatment. 

Chemotherapy cycles

For 48-year-old Grace Wangui, who had just completed eight cycles of chemotherapy and breast mastectomy when the pandemic started the situation is different.

Although she is recovering, she requires Sh7,000 for a scan, something that National Hospital Insurance Fund (NHIF) has told her cannot be offered cover at the moment. 

“Wanahitaji hiyo scan ndio wajue mahali cancer iko (They require the scan to know where the cancer is but I don’t have the money,” she says.

Experts are sounding an alarm over the release of hundreds of cancer, kidney and diabetes patients from hospitals in a bid to decongest health institutions in the battle against coronavirus.

Most hit are patients seeking treatment at the KNH, Jaramogi Oginga Odinga Referral Hospital (JOOUST), Kisumu, Moi Teaching and Referral Hospital (MTRH),  Eldoret and Coast General Hospital, which have suspended radiotherapy services.

Matters are complicated by the fact that the patients cannot travel abroad for treatment due to ban on international travel.

KNH has three radiotherapy machines, the only ones available in a Kenyan public hospital.

The hospital last week released more than 60 cancer patients who it claimed were in a stable condition. Each of the machines is used by between 60 and 80 cancer patients daily. 

“People with non-communicable diseases like diabetes and cancer are likely to be in a higher danger because of their sensitive state given most of them are the aged.

These situation calls for a fine balancing act because it is certain most of the cases that are managed by the clinicians particularly in public health facilities know the fluidity involved,” said David Makumi, the vice- chairman of Non-Communicable Diseases Alliance of Kenya.

Sitna Mwanzi, the chairperson of Kenya Society of Haematology and Oncology, also warned against haphazard discharge of the patients.

“This is a special population and some of them have to go for dialysis, surveillance or surgery process such as chemotherapy and radiotherapy.

Some like diabetes and high blood pressure patients are more likely to take a severe hitting so they must take precautions,” she said.

Others believe that keeping patients in hospital would do more harm to them than good. 

JOOUST hospital boss Peter Okoth says doctors were conducting evaluation on cancer patients in order to discharge those with suppressed immune systems.

He said there would be elaborate follow-ups on those released because cancer is a terminal disease.

“We are following criteria for emergency and urgent cases with those needing surgery given priority.

Those being released are for their own protection. Cancer patients are immuno-suppressed so we don’t want to hold them unnecessarily long in the hospital,” he said.

“Those who can come daily for chemotherapy do not need to stay in hospital.

It is not beneficial for them to be in hospital for them and therefore we don’t hold them. But we do follow ups on these cases because they are terminal.” 

At MTRH in Eldoret, doors are only open to critically ill cancer and kidney patients.

“We are only admitting cancer patients who are in critical condition in our wards while those who are in stable condition are advised to continue with treatment from their homes,” said a nurse who sought anonymity.

Patients commute

Evans Osimba who was referred to the facility from Kisii Level Five hospital last week is among hundreds of patients who have been advised to commute from home since their cases are not critical.

His sister in-law, Jane Kwamboka, has been delivering him daily for blood transfusion before he is put on treatment.

“He would have been admitted in the ward were it not for the outbreak of coronavirus which has forced the hospital to discourage admission for cases that are still stable,” she said.

Most cancer patients at the unit had come from Kisumu, Kakamega, Bungoma, Kitale, West Pokot and Baringo.

There was a long queue of the patients who had come for the first time expecting chemotherapy and radiotherapy treatment at the hospital.

However, the hospital’s chief executive officer Wilson Aruasa, said they were attending to all patients.

“We are now operating at approximately 60 per cent capacity for outpatients and inpatients.

This is because those stable enough have been attended to and released for follow up as per the booking appointments.

At the moment we have attended to all our diabetes patients and as for cancer, we are going on with treatment of both children and adults suffering from the same,” said Aruasa.

But non-communicable diseases alliance official Makumi warned of a possible crisis if the discharge is not managed with care.

“Some conditions will require home care but what is the guarantee that doctors’ advice or prescriptions will be followed through.

Plus we know the private hospitals are costly. If the government puts off chemotherapy and radiotherapy sessions, we will have another crisis,” he cautioned.

Patients who had plans to travel abroad for treatment have also been forced to suspend them.

James Moima, a principal at a secondary school who is undergoing chemotherapy at KNH, said he could not obtain the service after the hospital suspended most radiotherapy treatment.

“I had an appointment but I was turned away twice because officials told me that treatment for cancer patients has been suspended.  

“My family had made arrangements that I could travel to India for treatment but I cannot do so because of the international travel ban,” said the teacher.

Florence Mwende, a cervical cancer patient, is in the same predicament as her plans to travel to India have stalled. The treatment for most beginners had been suspended indefinitely.

KNH boss Evanson Kaimuri maintained they were treating all patients in critical condition.

“We are still attending to cancer patients as usual including radiotherapy, we are also attending all emergencies as usual.

The sick patients are still getting their treatment in KNH the only thing we stopped is visitations by relatives to reduce the traffic in the hospital.

“All the three machines are working and no patient on demand will be sent away. We just do not want congestion.

To avoid congestion, it’s only that the clinics are reorganised during the day,” he said.

At the Coast Provincial General Hospital, the region’s largest referral facility, medics are advising cancer patients and others with non-communicable diseases to stay away from hospitals. – Reporting by Harriet James, James Magayi, Reuben Mwambingu, Robert Ochoro, Barry Silah and Winstone Cheseremi)