 Good morning to you. Thank you very much for keeping it Y254. This is why in the morning my name is Ram Agukko and you're just in time for the next conversation of the day and today it's all about cancer awareness, cancer screening, cancer prevention. Today on Health Tuesday let's talk about cancer and currently it was at number two the last I checked but I'm told it is that it was a number three I'm told is number two in terms of the leading causes of death in the country we shall understand more about that in a bit but help us understand more about this cancer screening and cancer awareness. I'm joined by Dr. Asaf Kinyanjui who is a palliative care provider and also the chief executive officer that's the CEO of the Nairobi Hospice, Karib Sana. Thank you. Hope you're well Dr. Hari. I'm very well. And remember you can be part of this conversation from wherever you're watching us from the hashtag is why in the morning at Ram Agukko and that Y254 channel so you can find us head over to Facebook, Twitter and give in your feedback. Remember we are live on our website at www.kebc.co.ke4-y254. Participate with us. We shall be able to sample your feedback as you continue with this morning conversation. Dr. Hari, before we went on air you're saying we are moving from number three to number two in terms of cancer being the leading cause of death you know why so we've been having this conversation on cancer and based on what has been taking center stage especially in the media of late is about cancer awareness and you know I'm now wondering what is making cancer to be so rampant that it is increasing the number of deaths in the country. Thank you for that question. We have different theories why we have a high number but for sure some of the things which are contributing is that there is a significant change in our lifestyle putting us more at risk of cancer. Number two is also that the government has really invested in screening and awareness and even and I want to thank them in India because I've also been very active in terms of creating awareness so it means more people are now being going to health facilities and be diagnosed with cancer like in before where people used to die and sometimes they die from cancer and no one knew that they had that disease so it's it's it's about the increased awareness and also because of the changes in lifestyle putting more cities in at risk of getting cancer. So through that we now see the increased numbers because people are now aware about it people know what's going on. If you talk about cancer screening what exactly are we looking into here? So screening is a modality of trying to look at people in their general population whether they have the disease or not so for example if you some of the common cancers we have the cancers of the breast which affect both men and women we have the cancer of the cervix that affects women and these cancers are screenable so what happens is that people will walk into a health facility and they'll get checked whether they have these cancers or not and therefore from that day then they are able to if they have no disease then they are able to be guided on how to continue being disease free. If they have the disease then they are guided in terms of how they will get the cure and how they will be able to work that journey. You know as you talk about cancer screening I know for many young people out there who are watching they we like googling a lot you know and we like checking ourselves to see if we have cancer and if you go to google there is a lot you will find you know would you recommend that you know checking yourself you know because there are some who are afraid of you know going to the hospital being told that hey we are screening you you know they see it as a big deal they check themselves you mentioned breast cancer you know if you if you read online they will tell you I don't know how you you know to check yourself what's your thought on that it's good for them to be aware of their body because I mean most of the instance patients will tell you maybe I was taking a shower and felt a lamp or maybe I realized I had some discharge or I have lost some weight so it's good for one to be quite cautious about their health and how their body is but I would add people to not rely on just on their own findings but to seek health and from practitioners because for example the breast cancer we initially we used to advocate for self-breast examination but we realized that a good number of people still don't have the right technique and therefore they still end up missing and having a false source of sense of hope that they are okay until when they get to health facility and then they are examined by healthcare provider they realize they already have the disease and sometimes the disease has already advanced so it's it's it's good to want to be aware but it's very important for people to follow the regular screening guidelines that have been put in place instead of just going to google and then google things and then you begin to panic yes and then you go to the doctor with misinformation yes when the doctor tells you something you're like but that's what I learned yeah very true because that that's what you go through in hospitals yes the perceptions the misconceptions about cancer before we touch on on on other things I want you to I want to take just a step back and look at some of the preventive measures that the Kenyan youth can be able to implement on the ground to prevent cancer what are some that just to mention but a few yeah thank you and actually when I look at the youth I'm actually very worried and not just me most of the people in healthcare sector because they are some of the risk factors we call modifiable risk factors these are the things like use of tobacco if you look at the consumption of tobacco nowadays among the youth it's very high and now they have moved from the usual cigarettes now we are doing a shisha we are doing vaping some are even now moved to chewing all those are tobaccos it has become a thing yes especially on social media and people see it as a trend yes and from that I can tell in the next 10 15 years the country might not be able to cope with the burden of cancer from from those are some of the lifestyles number two if you look at alcohol consumption which is also another risk factor which is modifiable again the youth are consuming a lot of alcohol both the the conversional and the illicit then if you look at health diets the youth no longer take vegetables and no longer take fruits we like quick simple foods the fast foods and those foods have a lot of fat in it another chemicals that could also put it if those want to cancer you have mentioned a few earlier when you started you mentioned that nowadays the lifestyles changed yes people are people want quick things yes microwaves yes you know yes and actually even if you look at even in terms of transport people used to work maybe from upper hill to cbd but nowadays if you tell the youth to do that so even in terms of physical inactivity we are not as active as we are before all these things now end up predisposing one to cancer so there's a lot of lifestyle changes that need to be addressed and especially to the youth but also the other things which the youth also need to be aware is that there are family genetics or things which will not be mind will be able to change things like if you are in your family where there is high risk of individuals having cancer then you need to be more aware and to go for screening regularly because then the risk of you getting the disease is slightly higher than you know yes exactly if you look at some of these home remedies that people take they say that they're trying to prevent cancer so they would go for some concoctions or what i thought in regards to that these home remedies that people come up with yes in the notion that i am preventing myself from getting cancer in the future yeah most of these concussions are not scientifically proven number two they have a lot of chemicals so once you might be thinking you are running away from cancer then you had a putting more harm into your body for example some people taking some of these concussions add up with kidney failure because your kidney is trying to excrete those toxins and you also add up with liver failure so i would urge people to be very cautious as they take those concussions at home because it might be more harmful and very limited benefit to them while i was going through some of the things that pertain to cancer i was seeing that there are different preventive measures and divided primary secondary and tertiary maybe you can move to define to us just in a layman's language what exactly we're talking about okay so we are looking at primary prevention is where you are saying you don't have the disease and you want to remain in that state so you issues of lifestyle issues of changing your lifestyle to make sure that you live a more healthy lifestyle addressing the things we talked about yeah looking at issues of early screening so that at least you don't get the disease or this is so so primarily before yes you get a disease yes okay so if you move to sort of the secondary you already probably have been diagnosed with a mild illness that may provoke you to get in cancer for example people who have a higher risk of getting peptic ulcers or people who keep on complaining of hyper acidity they are at a higher risk of developing cancers of the stomach so if they address that early then they reduce the risk sometimes there are people who have a swelling and that swelling is non-cancerers so if it's detected early and the doctor intervenes and probably moves that cancer through surgery through that that swelling through cancer through surgery then you don't get the cancer so that's a false sort of the secondary intervention if you move to the third intervention the individuals who already have cancer they have been cured but they need to be followed up because we know because of the interventions they have received they put them at a slightly higher risk of recurrence or getting a new type of cancer and therefore they need to have a sort of follow-up regularly by an oncologist who will be able to keep on assessing them and Australian and making sure that they don't get rid of the cancer so I talk about one cancer leaving a paving way for another type of cancer or one cancer getting you know mild and reducing and then coming up again later on in life yes the others so it could be two aspects for example you might find a lady who had breast cancer it was still in early stages so it was removed and I went through the whole chemotherapy did you therapy six four five years down there right the next breast is affected and it's purely because she still retained the risk of getting the cancer so that's why we say even if you are treated for cancer you need to continue with follow-up because of those you still retain some risk of developing cancers in the future yeah so that's that's usually the usually tertiary sort of preventive mechanism yeah now what would be your advice to the Kenyan youth today when it comes to preventing cancers because people love these myths and misconceptions about cancer prevention yes okay well that's a very good question so why people the youth need to appreciate that cancer is not what people think used to think is about witchcraft or is it because of traditional cases and such things it's mostly something to do with either the environment you are in and as like the lifestyle or it's because of the genetics you can't run away from your genetics if like the blacks have a higher risk of developing some site of cancers than the white women have higher risk of developing some cancers than men so those are things you might not be able to change from your environment but the youth what they need to really focus on is things they are able to control the lifestyle and keep on insisting they need to really to look at their lifestyle and change their lifestyle because that's where we'll be able to win these battle against cancer you know they it's interesting because if you look at the rates of stress among the youth it has increased so much and one common thing that I always hear I everywhere I go are peptic ulcers peptic ulcers yet if we do not deal with it at the primary stage yes it can actually become stomach ulcers yes I want to to briefly touch on some of these methodologies of cancer screening because that is now where we get into the cure yes and or trying or treatment how is it that you transition now from screening into treatment what is the procedure how should that can you understand these modalities that pertain to all the steps that are there are within okay yeah that's a very good question for example if you look at a disease like breast cancer so individuals who we encourage for women who are probably about 30 they need to go to a hospital and get a healthcare provider examine their breast when they get the age of 40 then they get the apart from the healthcare provider examine their breast they need to go through mammography so mammography is a sort of a sort of an x-ray which now looks at the inner part of the breast to see whether there are any changes if you do that process then the the doctor picks up there are some changes within the breast then what will happen is that they'll now go to a process of biopsy so all this time does this happen once or is it a series of treatment it's a series of process it's actually a process because once now the biopsy is removed and the the doctor is able to confirm the patient has cancer then now the treatment starts so so and there's the same case even for something common which is like the cervical cancer it's caused by mostly associated with a virus called human papyroma virus so what we encourage and the ladies who are 25 years and above is that they need to go for screening to identify whether they have that infection whether human papyroma virus infection once they hit the age of 30 we apart from screening we need also to follow up if your screening is stands positive then we have to make sure that we follow up very closely to ensure that you don't get developed into getting the cancer if you get the cancer then now we start you on treatment you talked about the cervical cancer yes i want to bring it yet another type of cancer especially in these times of covid the lung cancer yes you know how does it you know get handled in this particular scenario of the screening of the treatment okay lung cancer is quite challenging to in terms of screening and like the common cancers one is because it's a very hidden organ but what current people are doing is that for individuals who are at risk and they have to be assessed because they have maybe they are smokers or they have a high family incidence of lung cancer so what happens is that a sort of investigation first they might do or next day just to check whether the lungs are okay yeah if if there is something suspicious then probably they might do more investigative or intensive investigations and that investigations might involve even taking a sample of areas affected just to be sure whether is a lung cancer or something else remember in our region lung cancer is not the commonest but it's what is we are starting to see patients having this and one of the challenges that in our area is also we have a lot of TB which sometimes can be mistaken for lung cancer so again for patients who have been diagnosed with TB I always advise them that they need to be very cautious if they're not getting well with TB treatment they need to seek a second opinion because I've seen it's as as patients who have been receiving TB treatment only to be really discovered later in the lung cancer and most of the time by the time now the discovery is being made you're already in advanced stages and you've taken so you've gone you've taken so many pills and drugs yes it's just so too much in your body that your body can't take it very well when it comes to the COVID-19 virus is there a connection between this COVID virus and the lung cancer and can one affect the other considering that we are trying to advocate for what to get vaccinated yes very good question if you look at the impact of COVID virus on the lungs it has a lot of causes a lot of damages so if one has any other underlying lung disease then your chances of you getting severe form of COVID are high and also getting recovery and treatment will also be very challenging so I've seen instances where some individuals had probably TB before and then they get COVID those people they try to get the severe form of COVID and most of the instances even have weird uploads in some of those patients in is the same case even with the lung cancer so I'll advise people who have had histories of illnesses only with their lungs they need to be very cautious they need to make sure they are vaccinated and they need to be there with all the COVID data plot of course to ensure that they don't get the COVID disease here and it's interesting because we leave it a time where people allow some are so fearful if someone coughs next to you yes you are very true it is a normal cough maybe there is just something there or some allergic reaction when you cough people are fearful I want us to touch on the perspectives of finance and this is a very heavy one because many are complaining that it is expensive cancer treatment is expensive going for chemotherapy very expensive and it takes a toll on somebody you know more or less it goes to this is there light at the end of the tunnel when it comes to this financial baggage that people are going through if I reflect back probably six seven years ago yeah and it's I think the situation is getting better before the NHIF like the national hospital insurance fund used to cater very little for cancer treatment but with the continuous advocacy from different stakeholders and also the input from the government the NHIF is coming up again in terms of supporting cancer patients but it's not to the required extent for example there are some patients who have a and I pick one disease like prostate cancer and you find they have been put on some medications and you find one dose for a month probably they need to spend about 130 000 that's not affordable to most of the common families in Kenya so we we are still pushing the government to make sure that as they implement the universal health coverage that they also factor in the cancer treatment and also palliative care so that these patients can be able to get the required support without experiencing the hard economic challenges associated with treatment because as you said cancer treatment is quite expensive yeah yeah I'm looking at the there's a bill in the parliament that is going to be discussed today yes that is going to touch on NHIF that will require all others to you know pay for it yes but I'm looking at the effects especially for those with chronic diseases including cancer is it going to have an effect on cancer patients especially when it comes to their money and how deep does this actually go especially considering that we have patients who are mostly middle class and lower class okay yeah that's a very good question and actually is a good concern to most of the healthcare providers one is we are happy that if we are able to bring more people on board then we have more resources to add to that can be able to cover for patients who need support from NHIF the biggest challenge I foresee is that they also want to put some sort of a copying in terms of what would be the benefits to some of these patients yes yes and that might also be able to affect families significantly because I've seen they want to reduce like the for the patients who are going to have this is I think they want to reduce from 9,000 to 6,000 yes so you start wondering then who covers the difference because the hospitals will still continue charging the same amount unless the government then intervenes and reduces the figures so if they need to approach it with a very with caution and also having in mind the people with chronic illnesses and my urge is to the government I wish they could also pump in more resources so that at least even as we recruit more people on board to NHIF then you also have funding from the government to cater for for the patients with chronic illnesses and you know what would be your your your voice to that Kenyan who is concerned about this bill that is going to be discussed in parliament the voting is going to be today I don't know if it's that no it hasn't started yet what would be your your voice to that Kenyan what would you tell that Kenyan who is concerned that it could affect them negatively if it is passed I think we start to lose to to gain more if we have more people joining the scheme yeah we we start to and I think most of us and by now when we are in 10 or 15 WhatsApp groups for people fundraising for medical treatment if all these individuals head in NHIF most IK will not be spending all this money supporting so I would be urge actually most of the people to actually agree and support the move let everyone have NHIF coverage and then once we have more resources then we can push for better packages for people and especially for chronic illnesses so that at least we have people being almost catered fully for during the course of their treatment it means that things that we need to do to cushion ourselves during times like this how best can we be able to minimize these risks that are there on the ground is there a way that that Kenyan youth watching today can be able to set himself up or herself up in order to cushion themselves from these effects of cancer yeah so one you have one has to set individual goals and has also to have a sort of individual responsibilities yeah I know the youth have a lot of pressure I see nowadays they say there is bogey there is guange there is all these things are happening exactly and we have to be sort of aligned with that sort of movement but remember what I have seen is that once you're hit by the disease it affects you as an individual and not you as a bogey so so one another reason why people have to make individual decisions and follow them so and have their own personal principles so that if your bogey decides they want to go and smoke you know the impact of smoking on your health and you're able to say no I'm not going to join that group I better be looked like I'm not playing with them for the sake of your health again one of the other challenges I've seen with the youth is also that there's a lot of risky sexual activities which also presupposes youth to a lot of a lot of cancers and not just cancers associated with the sexual organs but now also we are starting to see an increase in cancer of the throat cancer of the in the mouth and even in our cancers and if you look at critically you realize and also have some elements in terms of the sexual practices so even the youth also need to be aware that some of these things which end up looking like very fun and entertaining could have very catastrophic health effects exactly they need to take individual responsibilities we need to take care of ourselves yes and we shouldn't take life for granted some say we only live once there's a lot of much I let that notion and I said yes but you also die once very true very true I want you to tell us because you you are a palliative care provider how do you do this as you handle cancer patients just in a nutshell so cancer patients have multiple challenges so they have physical issues like pain they have most of them if they are receiving chemotherapy or other interventions they will come with weaknesses they will come with the nausea vomiting so as a palliative care provider who has to do is look at their physical symptoms and especially issues like pain and manage it we also look at these patients from the social perspective their settings and especially patients coming from the informal settlement how do we bring in the community to support them so that they can be able to work with this journey remember most of these patients when they get the disease family members friends all of them leave these patients so this patient works the journey alone so we bring the communities and friends together so that they can be able to support these patients and their family we also do what we call psychosocial support help the patient cope with the disease and the family in terms of counseling we also help in terms of spiritual support because you are very spiritual society so patients are asking what have I done to my maker to deserve this illness and bringing on board the spiritual leaders so we'll be able to guide them helps a lot because there is a lot of stigma that is attached to cancer and finally we also work closely with legal practitioners because patients also need to make a legal decisions regarding one their health and if the disease is also in advantages they also need to make decisions regarding the inheritance their properties their children and that's for a health practitioner in the palliative care field has to look out from this patient from a holistic perspective so you address all these issues to ensure that the patient is well supported and also the family members yeah and what what you do it I if you don't be taken for granted actually it it it it it it needs heart it needs patience and it it needs understanding what are some of these um the experiences you've had as you handle cancer patients that you know took you by storm you know there are those instances where you you meet somebody and you interact with them and then they they tell you things or they go through something that makes you you know go back and learn to appreciate what you have because at the end of the day it's also a learning process even for a palliative care provider it is probably I'll maybe summarize it by giving a case example yeah we recently received a call from a community health volunteer to go and see a patient in one of the slums uh so we met this lady who is about in a late 30s I think she must be around 38 she's a single mother of three she has the last one is four years then she has advanced breast cancer when she went to mastectomy mastectomy is removal of the breast the husband said I married a lady with two breasts now you have one I don't see as now continuing with this sort of relationship and family and the husband walked away so got divorced they separated wow so you you find this lady who now depends on well wishers and the neighbors to feed her family you find the first one who is in form one is a primary caregiver so she has to come from school prepare the meals for the family uh and also dress the mother because the mother is bedridden so you sit back and you you start wondering what what will be the life of these children because for sure the mother is having an advanced disease and is going to die what will happen to the these children in terms of their school in terms of their welfare and also you start also wondering what is going through the mind of this mother seeing that she's helpless and she's receiving support from the kids and well wishers those things are the things you start appreciating when you wake up in the morning and you have a cup of tea in your house and somebody else is screaming in pain because of the disease and then they don't have anyone else to support them and yeah which one day uh at a time we should have a conversation on palliative care providers because you you in as much as you're giving care to someone you also need someone to care for you very true very true very true the instances when my team visits a patient they come back probably at around one or two and looking at their faces i just tell them take a break because the the trauma the emotions had a long day yes had a long day in the office wow yes ah it's it's good and that's what we need you know we need to to really emphasize on this cancer screening and prevention is very very important what is Nairobi hospital is all about just in brief so we are a charity organization that was established about 30 years ago to support patients and families who are diagnosed with heart to cure illnesses we we ask we don't only focus on cancer but we also focus with patients with HIV organ failure in the illness that we know is going to have a significant impact on patients life and their family so we look at the patients from holistic perspective yeah we do home visits for patients who are very ill so we visit them at home and for the patients who are stable enough they are able to come to our facility we also organize a daycare on those days so where patients come in and exchange ideas and encourage each other and sometimes we also in provide professionals to come and give them professional advice so we are able to support most of our patients and as an institution about almost 80 percent of the patients are not able even to pay for our services so we lie on well wishes to be able to raise funds to continue supporting these patients yeah and you're doing a fantastic job so far thank you I want us to wrap this conversation just to bring it to a close in the nutshell our take home for the day when it comes to cancer screening and prevention how do you speak to that Ken and Yutho is watching you out there what will be your final word my final word is that you have to take individual responsibility about your health it's no longer about a group or a movement but it's about you taking responsibility addressing the issues we have mentioned about the risk factors and ensuring that you go for regular screening and you also support individuals and families that are affected with this disease no Dr. Kenyanjui thank you for coming thank you for the opportunity I appreciate it so much you're doing a good job keep doing what you're doing uh that is Dr. Kenyanjui the palliative care provider also the CEO of Nairobi Hospice uh check the amount reach how can people reach out to you by the way yeah so we especially for the youth we are on Facebook if there's such Nairobi Hospice they'll be able to get us we we also have an office in Upper Hill just next to Kenyatta National Hospital and before 40s so we are they can also pop in and also we have a website they'll be able to get more details about our institution Nairobi Hospice check the amount remember go for cancer screening very prevent yourself from getting cancer and this conversation uh uh that we are having today doesn't stop here we still have much that we have not covered but I want to to take Nairobi Hospice and Dr. Kenyanjui for finding time to join me this morning keep the conversation going on our social media handles the hashtag is why in the morning why 254 channel on twitter at why 254 channel facebook at ram aguko the hashtag as always is one in the morning we are taking a short break but after this we'll be back with much more keep it why in the morning