So crammed is Tanzania's only cancer treatment centre that Rukia Kondogoza, wrapped in bright kanga cloth, has to share her bed with another patient.
A farmer from the rural south of the country, the 40-year-old has cervical cancer -- the biggest cause of female cancer deaths on the continent and a disease that kills one African woman every 10 minutes.
Of the 500 000 women worldwide who are diagnosed with cervical cancer every year, 80% are in the developing world and 71 000 of them are in Africa, according to the African Organisation for Research and Training in Cancer.
"This cancer disease is worse than malaria because of all the heavy bleeding," said Kondogoza, who is one of 7 500 new cases recorded in Tanzania each year. When the doctor brought the news I just accepted it. I knew I could not ignore it because it is there in my body."
Many others do ignore it, however.
More patients than beds
The ministry for health and social welfare says only 10% of cases ever reach the country's only cancer centre, the Ocean Road Cancer Institute, for treatment.
Even so, the institute housed in a 19th century German colonial building with four wards and up to 200 in-patients at a time, is badly overstretched. Patients and relatives crowd the grounds, lying on the dirt outside.
"Right now we have 46 in-patients but only 28 beds," said nurse Felister Massawe of Kondogoza's ward. "The patients are many but the beds are few, so some of them have to stay two to one bed."
Caused by a virus that is passed through sexual contact -- the human papillomavirus (HPV) -- some 200 million African women are at risk from the disease. Condoms do not help because it is transferred via skin contact, not bodily fluid.
By the time symptoms emerge, such as bleeding after intercourse, it is often too late. Tanzania's Ministry of Health and Social Welfare says most come to the centre only once the disease has reached its later stages, making it harder to treat.
One mother dies, leaves five orphans
Of those who develop the disease, 78% of all cases in Africa result in death -- much higher than in the West where screening programmes have encouraged early detection of the illness, which can take 20 years to develop.
"For each of the mothers that dies, she leaves behind three to five children when she dies, adding to the orphan situation," said Professor Isaac Adewole, chairman of the sub-Saharan Africa Cervical Cancer Working Group.
"By the time they die they will have spent most of their money so there will be no way to take care of these orphans," he said at the biennial African Organisation for Research and Training in Cancer conference held in Tanzania this week.
Treatment is also expensive and Kondogoza is among the many who cannot afford a $140 regime of six doses of chemotherapy advised by doctors. She is relying on radiotherapy alone instead, which is provided free by the state.
Adewole said the prevalence of "quack doctors", locals relying on witchcraft, also meant many women were not diagnosed.
"We doctors used to blame women but it turns out they would be visiting health professionals two or three times with no help, so doctors have to share in the blame for these deaths."
Cervical cancer killing young girls
Screening has helped to detect cervical cancer at an earlier stage in developed countries, but no African country except South Africa has a national screening programme.
Rival pharmaceutical companies Merck and GlaxoSmithKline have both developed their own vaccines -- Gardasil and Cervarix -- but no African country has developed a programme to give the vaccine to young girls.
"Cervical cancer kills relatively young women so more life years are lost than with other cancers, but this is a preventable cancer," said Professor Lutz Gissman, Head of Division at the German Cancer Research Centre and one of the team who discovered the virus.
"If you can persuade girls to get a vaccine shot, the problem will be drastically reduced in the next 10, 20 years."
Lower price being negotiated
The Cervarix vaccine is licensed in more than 100 countries, including 11 in Africa. GSK is undertaking a study of 666 women in Senegal and Tanzania -- where the vaccine is already licensed -- to monitor the effect on the immune system and its safety.
Adewole is in favour of administering girls aged nine or 10 in their last year of primary school with the vaccine, which should be administered before the onset of sexual activity.
"Not all children go to secondary school so we need to reach them earlier," he said.
Many are put off by the high price of the drug, which sells for about $300 in the United States, but GSK says it will negotiate a cheaper price based on its policy of tiered pricing.
For Kondogoza, sitting on her bed as patients give each other pedicures with bare razor blades amid hacking coughing, it is too late for a vaccine. For her four daughters it may not be.
"Anything is okay if it will prevent the disease for these young children," she said. – (Reuters Health, November 2009)
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