Travails of Delivering Effective Radiotherapy in Nigeria.

TO THE EDITOR:

This letter is written in response to the recent article in JCO Global Oncology by Leng et al[1] entitled “Infrastructural Challenges Lead to Delay of Curative Radiotherapy in Nigeria.”

It is well known that Nigeria is the most populous nation in sub-Saharan Africa and has oil reserves for the next 200 years. Furthermore, Nigeria’s predominant income as a nation, besides foreign remittances, is petrodollars.[2,3] With regard to petroleum exports, this accounts for 91% of Nigeria’s export earnings.[4] As to the importance of remittances from diaspora Nigerians to Nigeria, certainly the disparate impact of exportation of Nigeria’s intellectual capacity (MD brain drain) will continue unabated.[5] As such, its health care manpower dilemma will remain unchanged for the foreseeable future.

The authors acknowledge the extent of problems related to Nigeria’s electrical grid. As a solution to electrical infrastructure problems and the delivery of effective radiotherapy, Nigeria’s teaching hospitals must increasingly be used as centers of effective radiotherapy delivery. These teaching centers, of which there are now 20,[6] would be excellent starting points for improving cancer care capabilities and availability regarding radiotherapy. Leng et al[1] and I[7] have mentioned the solution of Kumar and Bhasker[8] with modernized cobalt-60 treatment machines. However, another seemingly workable option is to develop/construct off-grid local microgenerating capacity for each teaching hospital.[9] This may lead to reliable electricity delivery for the effective operation of treatment machines.

Of cancers mentioned by the authors (breast, prostate, uterine cervical, and head and neck), most have effective vaccines (eg, for human papilloma virus in cervical and head and neck cancers) and screening tools (eg, for prostate-specific antigen). Optimum use of the vaccine for human papilloma virus, for example, could mitigate the need for expensive, complicated equipment requirements in the meantime.

There is a tendency to become paralyzed by over-analysis. Therefore, at some point, Nigeria’s medical professionals and political leaders must regain control of the narrative of poor health care delivery in cancer care by rationally using its oil wealth,[10] for example, to improve health outcomes of its citizens.