Kenyatta National Hospital, Nairobi, Kenya

Kenyatta National Hospital – Tower Block.

Kenya is located in East Africa. It borders Lake Victoria and Uganda to the west, Tanzania to the south, the Indian Ocean and Somalia to the east, and Ethiopia and Sudan to the north. It is divided roughly into two equal parts by the equator. About 42 ethnic groups comprise the population, with English and Kiswahili being the official languages.

Kenya has a population of about 35 million. It is divided into eight administrative provinces. The capital city of Nairobi has a population of about three million. Due to the limited resources available to the Ministry of Health for the provision of health care services, there is plenty of room for improvement in bringing high-quality health care to the people of Kenya. Like other African nations, Kenya is facing an AIDS pandemic, which severely strains healthcare resources.

Kenyatta National Hospital (KNH) in Nairobi is the oldest hospital in Kenya, having been founded in 1901 as the Native Civil Hospital and renamed the King George VI Hospital in 1952. Until 1987, KNH operated as a department of the Ministry of Health, dependent on MOH for much of it day-to-day management. For the past two decades, the hospital has achieved greater efficiency as a state corporation, managed by a board with responsibility for administration management and program development. Today, KNH is the country's chief referral, teaching and research institution. The 1,800-bed, government-supported facility provides medical education in association with the University of Nairobi. Nursing and paramedical training are provided by the Medical Training Center.

Kenyatta National Hospital offers the following specialized services relevant to cancer: radiotherapy, medical oncology and hematology, surgical oncology, pathology and palliative care.

In Kenya, cancer ranks third as a cause of death after infections (including HIV) and cardiovascular diseases. Efforts are underway to put in place a registration and surveillance system which will provide data on the incidence of cancer in the country. This will eventually help with projections for the future.

In 1994 the Ministry Of Health responded to a call by the World Health Organization to set up a national cancer control program. Although a lot of effort was put into this initiative, a change of leadership at the Ministry Of Health in 1997 resulted in the work being abandoned.

The Ministry Of Health is now in the process of reviving the national cancer control initiative. Unfortunately, due to various reasons, including lack of funds available for the provision of health care, cancer is not on the MOH list of priorities. Topping the public health agenda are HIV/AIDS, reproductive health, maternal & child health, malaria control, environmental health, sexually transmitted infections (STI), TB control, and an expanded program for immunization, among others.

Male Female 1. Head & Neck Breast 2. Esophagus Cervix Uteri 3. Prostate Head & Neck 4. Stomach Esophagus 5. Kaposis Sarcoma Stomach 6. Liver Ovary 7. Non-Hodgkin Lymphoma Skin 8. Skin Kaposis Sarcoma 9. Colon Non-Hodgkin Lymphoma 10. Eye (Retinoblastoma) Eye (Retinoblastoma)

The most Common Cancers in Kenya. Data from Nairobi Cancer Registry at the Kenya Medical Research Institute (KEMRI).

Province Hospitals # of Hospitals Providing Cancer Care Rift Valley 88 1 Nyanza 87 2 Western 59   Eastern 58   Nairobi 54 3 Central 51   Coast 46 1 North Eastern 6   Total 449 7

The distribution of hospitals by provinces as of 1999/2000. There are two types of health care delivery systems in Kenya—public and private services. Private health care services are provided by faith-based organizations, non-governmental organizations (NGOs), wholly commercial and non-commercial institutions.

While the fight against cancer is secondary to other important public health priorities, we are making some small strides. Training in cancer management and care is conducted at the University of Nairobi at the post-graduate level in medicine, surgery, hematology and pathology. Training in radiotherapy, medical oncology and surgical oncology are carried out abroad.

Dr. Ian Magrath, Dr. G. Kiarie and Ms. Anne Korir in New Nyanza Provincial General Hospital.

University of Nairobi, School of Medicine.

Some of the notable risk factors for various cancers in Kenya include: Habitation of malaria areas of the lake Victoria region and coastal lowlands (Burkitt Lymphoma) • EBV infection (nasopharyngeal carcinoma and Burkitt lymphoma) • Poor hygiene and low socio-economic status (cancer of the cervix) • HIV/AIDS (Kaposi sarcoma and lymphoma)

Kenyan physicians are joining hands with non-Governmental organizations (NGOs) to help raise awareness of cancer, and are working toward prevention, early detection, diagnosis and treatment. Some of the relevant NGOs are the Kenya Cancer Association, Kenya Breast health, Kenyas Society for Haematology and Oncology. We are also building a community of health professionals dedicated to advance the fight against childhood cancers. When in 2005 the International Union Against Cancer (UICC) launched its world cancer campaign, with a particular focus on childhood cancer, six institutions in Kenya agreed to participate. Kenya's "My Child Matters" project team includes medical oncologists/hematologists, pathologists, surgeons, radiotherapists, a public health practitioner and a cancer registrar — are drawn from the following institutions: Kenyatta National Hospital, University Of Nairobi, Kenya Medical Research Institute (KEMRI), Aga Khan University Hospital, The Nairobi Hospital and Hurlingham Oncology Clinic. The "My Child Matters" project in Kenya is focused specifically on raising awareness of the prevalence of Burkitt's lymphoma to increase early detection, ensure prompt treatment and attempt to identify associated environmental and familial factors. Through both our study/project with UICC and an existing INCTR treatment study, presently ongoing at the Kenyatta National Hospital, we will be working jointly for the benefit of Burkitt's lymphoma patients in the Nyanza and Western Provinces of Kenya. The team members working on these projects share a common purpose: the creation of cancer awareness through publications and the development of educational materials; research in various aspects of cancer; and sharing of cancer information and local networking. Our challenges include the lack of resources to establish an institution that would coordinate and direct efforts made by various groups towards reducing the burden of cancer in Kenya.

N.A. Othieno Abinya, School of Medicine,
University of Nairobi, Medical Research Institute and Hurlingham Oncology Clinic,
Nairobi, Kenya

J. Githanga, School of Medicine,
University of Nairobi and Kenyatta National Hospital,
Nairobi, Kenya