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📍  DAR ES SALAAM

Moses Echodu, 34, is a cancer survivor who was diagnosed with Burkits lymphoma — a type of cancer that affects the lymphatic system — in 1998. Two years later, he was declared cancer-free.

It all started when, at the age of eight, Echodu felt a niggle in his leg on his way home after playing football. He became unwell.

Thinking it was a fever, his grandmother initially gave him fever tablets for two weeks. But when this did not help, she took her grandson to Nsambya Hospital in Uganda's capital Kampala, where he was found a rotting vertebra.

The little boy was operated on.

Three months after the operation, Echodu's jaw began to swell, forcing him to return to Nsambya Hospital, where he was referred to the cancer ward.

“When we did some tests, they found that I had Hodgkin's lymphoma (Hodgkin's disease) and my cancer was at stage four," he says.

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Echodu was enrolled on a free medication for Burkits lymphoma by Dr. Dennis Burkitt, who was at the time the head of the cancer ward at Mulago Hospital.

It was a timely, life-saving intervention because Echodu's family could not afford to pay for cancer treatment.

According to Echodu, cancers like Burkits lymphoma, leukaemia (cancer of blood-forming tissues), retinoblastoma (cancer of the eye) and other childhood cancers clear fast if the diagnosis is early and subsequent treatment is adhered to.

"During my treatment and healing process, I started feeling like my death was inevitable," says Echodu, who underwent chemotherapy and radiotherapy.

But two years after being found with cancer, he was declared cancer-free in April 2000.

'I live in fear'

Today, Echodu currently serves as programme director of the Uganda Child Cancer Foundation at the Uganda Cancer Institute in Kampala, where he creates cancer awareness among young people and advocates for policies to improve access to cancer services for this group.

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But at a personal level, Echodu admits that much as he has spent 24 years now cancer-free, he has failed to shake off the fear of the cancer recurring.

Cancer may come back years after treatment. According to health experts, it may return because treatment missed cancerous cells or because treatment did not affect some cells. 

What is comforting to know is that healthcare providers can treat recurrent cancer and that people often live for years with recurrent cancer.

“What troubles me is there are times a child is declared cancer-free then after like three weeks, they are brought back to the institute, that it [cancer] is back and after a brief period, we are told this child is gone [dead]," says a tearful Echodu.

"I don’t know how many times I check myself in a year. I live in fear and this trauma is too much.

"Can you imagine when you see anything unusual, the first thing you think about is 'Is it back?' and then you do a test."

Moses Echodu has been cancer-free for 24 years now

The cancer that Echodu managed to beat over two decades ago — Hodgkin's lymphoma — is a relatively aggressive cancer and can quickly spread through the body. 

Despite this, it is also one of the most easily treated types of cancer, according to the World Health Orgaisation (WHO). 

Recommended treatment plans depend on one's general health and age because many of the treatments can put a tremendous strain on the body.

During her presentation about strengthening the integration of cancer prevention and palliative care services into broader health services during the just-concluded International Conference on PEN-Plus in Africa (ICPPA 2024) in Tanzania's port city of Dar es Salaam, Dr Sharon Katai Kapambwe described the cancer situation in Africa as distressing.

She is the technical officer in charge of cancer control at the WHO Africa Regional Office.

Dr Sharon Katai Kapambwe speaking in Dar es Salaam

Kapambwe warned that without prompt action, the annual number of cancer deaths in Africa might soar to a staggering one million per year by 2030.

Currently, cervical cancer is the leading cause of cancer deaths among women in sub-Saharan Africa. 

Among the 20 countries in the world that carry the highest burden of cervical cancer, 18 are in the WHO African region.

Most countries in the region have no officially recommended cervical cancer screening test, and no country uses the high-performance Human Papillomavirus (HPV) test as the primary screening tool.

The WHO African region ranks third among all WHO regions in HPV vaccine coverage, with 33% of girls having received at least one dose.

According to the UN health agency, 28 out of the 47 member countries in the region have introduced HPV vaccines to their national immunization programmes. Only five have reached the target 90% coverage and above.

Kapambwe urged African countries to leverage on advocacy, like inclusion of four childhood cancers on their national health insurance, strengthening HPV vaccination, as well as screening of all cancers and treatment.

"We talk about the 90-70-90. That means: 90% of the girls will be fully vaccinated with HPV by the age of 15, 70% of women are treated and screened with a high-performance test by 30 and 45 years of age, 90% of women with pre-cancer and neglected cancer is managed adequately.

"So we are taking the life-post approach to see these women. The challenges have an end if we look at what we have achieved. Only 33% coverage is where we are as Africa, and only five countries were able to reach the 90% goal as of 2022."

In 20 years, cancer death rates in Africa are projected to overtake the global average of 30%. 

This is more so because cancer survival rates on the continent currently average 12%, much lower than the average of over 80% in high-income countries.