Senegal's cancer patients struggle for treatment

Patients have nowhere to turn after the
country's only radiation therapy machine
stopped functioning in 2016.









Senegal's solitary radiotherapy machine broke down
 on December 28 last year, leaving the country's only 
radiation therapist and small team of technicians idly
 waiting as patients were turned away or offered 
alternative treatments.

The machine uses radioactive cobalt-60 to produce 
gamma rays that halt tumors in organs near the skin. 

Installed in 1989, it is from a generation of devices that 
are completely phased out in most developed countries.

The machine has broken down many times before.
 Doctors who are familiar with the technology say such 
a machine should normally not exceed 20 years' use.


The Senegalese government promises that three state-
of-the- art linear accelerators, which are standard 
elsewhere, will be installed by August.

This is somewhat surprising given that Senegal’s
 hospital system is a reference for the West African sub-region.

Patients cross borders to receive diagnoses, treatments
 and surgeries. The hospital in Dakar boasts a research 
unit and some of the only modern DNA sequencing
 machines on the continent.

The strength of the country's health system, which
 doctors are proud to say is more than 100 years old, is
 due in large part to a long-standing high level of medical education in Senegal.

Medical students from Algeria and Morocco come to
 Dakar for research and studies. Yet the system is fragile
 and overwhelmed.

Almost 14 million people live in Senegal, but only a 
handful of doctors focus on cancer.

Doctors in the developed world recommend one radiation
machine or linear accelerator for every 200,000 people.

Senegal has one, and this year it is broken. So the lines
 in the cancer ward are long.

We were fascinated by this story and wanted to film it.
 But accessing the primary city hospital with cameras
 has always been nearly impossible. This time, things
 looked different, and the small team of cancer doctors appeared to welcome us.


Consistent failure

We took the opportunity with caution. It seemed this
 crisis had struck the cancer team personally, and at
 least several were eager to talk. Behind closed doors and
 off-camera, some spoke of their anger that such an old 
and sometimes dangerous machine would still be the standard for the country.

"We should have linear accelerators," they said, shocked 
that the state had not invested a few million dollars in the 
new machines. The staff had been trying to raise 
awareness of the machine’s consistent failure since 
2015, when it broke down and electrocuted a patient on 
the table.

It also burned others. They were amazed that only now 
the media seemed to be taking notice.

They took us in to see the device, to look at the bespoke
plastic masks that were made to hold patients still, and to
watch as the great old machine head - with radioactive
 cobalt 60 at its centre - swivelled in a wide arc over a cold plastic bed.

Interviewing patients, which we had assumed would be 
the straightforward part of the shoot, was even more
 difficult. The word cancer leaves a deep stigma across
 these wards, even though it is written in clear red paint
 on the entrances.

Babacar, our fixer, kept saying: "It's like Aids, you don't tell
people you have it".

One divorced patient said that if she were known to have
cancer, she would never be able to marry again. Another
wanted to ask her husband for permission before speaking. 
A third refused to show her face.

Several agreed on the terms that cancer never be 
mentioned, which was of course, not possible.

After two days of asking patients for interviews, we were
leaving empty-handed when a nurse called me to join her
 at the foot of the stairs. "A patient upstairs can see you, you can film him”. We were thrilled and nearly raced up the 
steps. She grabbed my arm. "You cannot use the word cancer," she said.

"It’s taboo," he told me. But we're in the cancer ward, I said.
"Don’t use the word," she insisted, telling us that the patient's
grandson was there with him. "Does he know it's cancer," I
asked? Yes, he did.

We entered the small cell in the recovery ward to find an
 84- year old man wearing a neat scarf, a small religious hat and a wide smile. He had been a soldier for Senegal, one of the revered veterans who stood up as the shackles of colonialism were cracking but not yet breaking in the 1950s. He was sick, but feeling fine.

He had a basket full of medicine and a catheter bandage 
on his hand. We interviewed him, learning that he had no 
pain and that he was happy to pay whatever was needed for the treatments he received for his mysterious ailment.

"Treatments should be expensive," he said, because 
medical expertise should not come cheap. No mention 
of cancer.

The interview ended and the nurse came in. She pulled
 back his gown to reveal a wide chest bandage. "This is 
for the tumor we removed," she said, as if tumor and
 cancer were two entirely unrelated terms.


Constant chemotherapy

Beyond the hospital, we were led by a member of
 Senegal’s League for Cancer (LISCA) to a younger 
woman of 40, living in the suburbs, who was suffering immensely from breast cancer.

She let us interview her in her home, with her family
 near, something that was clearly very upsetting to her.

She was undergoing constant chemotherapy. Her hand was
swollen and her voice was soft. I asked about her diagnosis.

She deferred entirely to her doctors, saying that she was not
given choices in her treatments, and the costs, as we had
also heard at the hospital, were unending.

Family supported her for visits: a few hundred dollars here
and there, with the total running into the thousands.

Our shoot extended over two days, but by the end, we had
enough material and strong voices.

We called once more, the day after our long hospital visit, to
ask specifically how many patients had received burns - or
other injuries - while fixed to the old machine’s table.

"No more calls please, no more questions" was the only
answer after the call had been passed from one hand to
another. Word had gone round. The window of availability
 and openness had closed.