KENYA :The hidden caste system killing kids with cancer

Their tiny bodies can barely survive the harsh treatment. Eventually, eight out of 10 succumb within five years.

But the two that survive must pay a price for the rest of their lives.

That is the reality of children with cancer in Kenya.

In 2019, Dr Gilbert Olbara, a young paediatrician practising in Eldoret, set out to find out why most children with cancer were not making it past five years after falling diagnosis.

Eight out of ten children diagnosed with cancer survive the five years in developing countries, but in Kenya, only two do.

What Dr Olbara and his colleagues found was a dark, hidden caste system that largely determines who dies and who survives.

It had to do with money – if one has money to pay for treatment or insurance, or not.

“Treatment results differed significantly between patients with different health insurance status at diagnosis,” he says.

Perhaps due to debilitating hospital bills, 37 per cent of uninsured patients abandoned treatment, compared to 28 per cent of the insured.

He says 37 per cent of insured patients had event-free survival, while only 24 per cent of uninsured patients had.

Olbara and his colleagues published the surprising results in the SpringerLink journal, and the results have continued to draw attention.

“Children without health insurance had significantly lower chance of event-free survival,” he says.

Families of those who survive have many things to worry about. The children face learning problems, poor growth and developmental delays resulting from the harsh chemotherapy when they are young.


Another medic, Dr Festus Njuguna, of Moi Teaching and Referral Hospital, also revealed a caste system where children without insurance die more.

Njuguna, Dr Sandra Langat, and paediatric oncologists Gertjan Kaspers and Saskia Mostert from the Amsterdam University Medical Center documented the life of Tom, a Kenyan boy born in 2014 to HIV-positive parents, who was diagnosed with HIV at six months.

The boy’s mother abandoned him at his grandmother’s home when he was only two years, without revealing her HIV status and that of the boy.

“My husband and I had warned her against getting together with the boy’s father since we knew about his HIV status, but she did not listen. I suspect she was afraid to face us when she got infected,” the grandmother later said.

The grandmother found out about Tom’s HIV status when a nurse from the local clinic was looking for him because he had been lost to follow-up for a year – since his mother abandoned him.

Patients are considered lost to follow up after failure to return to hospital for more than four weeks for scheduled appointments.

“I felt ashamed when I found out that my daughter and grandson were infected,’’ the grandmother said.

He was put on ARVs again. The drugs are free but Tom would need about Sh120 for blood test, once every three months.

His mother died of HIV-related complications in 2016, and the biological father, who was separated from Tom’s mother, committed suicide.

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