We lost our aunt early this year after a progression of cancer within 6 months. The explanation was that we took long to detect the cancer and therefore it was diagnosed at advanced stage. However, 6 months before the diagnosis our aunt had been given a clean bill that she was free of cancer after attending routine health screening including that of cancer – there is therefore a big gap in screening and early detection. The result is that cancer is being detected late when our chances of survival are much fewer.

Last month, my sister in Law (the wife of my young brother) was diagnosed with breast cancer at 31 years of age and the good news was that it was clinically graded as stage 1. After wise consideration by our Doctors they have prescribed for her the best treatment that they know of: surgery to remove the potentially affected areas followed by chemotherapy and radiotherapy. Before this, I have known the three terms and used them freely as a pharmacist. However, this time I had to take them home, plan for their execution and see that my sister emerges with a clean bill of health.

We had to move fast. My sister had health insurance which requires her to pay only 20% of treatment costs, air tickets and accommodation for the patient and caretaker. This was still a lot of money (about one year of salary for the wife and husband. Fortunately, the family had some savings and they committed it for the operation which has been done successfully in Nairobi. It is now time for chemotherapy. Doctors have done tests and confirmed that the effective chemotherapy will be Herceptin (Pranstuzumand) plus a Taxane based regimen. My brother rushed around Kampala and discovered that a complete regimen of Herceptin will cost them a cool 126m Uganda shillings equivalent to 50,400USD. Greatly disturbed he called me and asked me to look into this issue as a pharmacist.

Information available at http://en.wikipedia.org/wiki/Trastuzumab paints a threatening fact about the cost of the drug – that it is not available for the low income earners in the developing world: “Trastuzumab costs about US$70,000 for a full course of treatment, Trastuzumab brought in $327 million in revenue for Genentech in the fourth quarter of 2007. Australia has negotiated a lower price of A$50,000 per course of treatment. At the time of its introduction there was controversy in New Zealand and the UK about public health funding of this drug due to its high cost and perceived limited overall survival benefit (though not breast cancer-free survival benefit in the adjuvant setting). A case brought by a cancer victim in the UK succeeded on appeal after the local health authority refused to fund her treatment. After a sustained campaign from cancer sufferers, the Ontario Ministry of Health in July 2005 decided that it would pay for treatments with trastuzumab and two other new and controversial anti-cancer drugs. Since October 2006 trastuzumab has been made available for Australian women and men with early stage breast cancer via the Pharmaceutical Benefits Scheme. This is estimated to cost the country over A$470 million for 4–5 years supply of the drug. Roche has inked a deal with Emcure in India to make an affordable version of this cancer drug available to the Indian market. Roche has changed the trade name of the drug and has re-introduced an affordable version of the same in the Indian market. The new drug named Herclon would cost approximately RS 75,000 INR in the Indian market. Biocon Ltd, announced on 26 November 2013 that it has received Marketing Authorization from the Drugs Controller General of India (DCGI) for its biosimilar Trastuzumab being developed jointly with Mylan, for the treatment of Her 2+ metastatic breast cancer. The regulatory approval for biosimilar Trastuzumab in India is the world’s first biosimilar version of Herceptin® to be brought to the market. The biosimilar Trastuzumab will be marketed in India under the brand name of CANMAb™ by Biocon and is expected to be available to Indian patients in Q4 FY14.” This information confirms that the cost for this medicine is clearly a barrier even in well established economies. No need to mention for a resource strained Uganda.

Our extended family (sons and daughters of my father) is a family of middle income professionals and I estimate that the cost of the prescribed chemotherapy is equivalent to one year of salary and wages for the entire extended family. But family members are not able, let alone willing to forego a whole year’s income to procure this treatment. I found myself in a prolonged prayer petitioning our God for divine intervention. At the climax of my prayer the idea to share this challenge came to my mind and here I am. I have discovered that if you are living in resource strained countries like Uganda, one incidence of Cancer may wipe out the hope and financial base of entire families. Cancer is therefore ugly and it is quietly ravaging our society. As a pharmacist, I feel greatly challenged – especially by the lack of access to appropriate chemotherapy due to financial barriers! My mind is stuck on what could be my contribution. How shall we provide cancer treatment to a population some of whose members are living on less than a dollar? I have read somewhere that the level of development of any community could be judged based on how they treat the weak and vulnerable – What is the position of the international community? More questions than answers!

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