A woman and her child stand outside the Butaro Hospital in Rwanda.
KIGALI, RWANDA – Rhoda Uwayesu, 5, is a smiling girl who tries to live like any other girl her age, even if she is suffering from eye cancer.
Rhoda was born in Kigali, Rwanda's capital, with a little white line inside her right eye. Her parents thought it would disappear as she grew up. But instead, it got worse.
When Rhoda was 1, her eye began to hurt. Her mother, Mukashema Triphine, says she tried to ease her pain with aloe vera, but it continued to worsen.
“My daughter was crying all night saying that her eye was hurting,” her father, Mushimiyimana Alex, says. “I carried her to Kacyiru Hospital, where they gave us a medicine.”
Doctors treated Rhoda’s eye for about two years without diagnosing it as cancer. Then at age 3, she went blind.
“We tried our best to find what was wrong with the eye,” says Mukeshimana Assumpta, a nurse at Kacyiru Hospital.
She says that the hospital prescribed various types of medicine, including tetracycline for bacterial infections.
“But the case was difficult, as it was the first case we faced,” she says.
Rhoda’s was the hospital’s first eye cancer case. The hospital staff eventually transferred her case to the larger King Faisal Hospital in Kigali.
Dr. Raphaelm Kalengayi of King Faisal Hospital says that Rhoda was born with retinoblastoma, a rapidly developing cancer that develops in the cells of the retina. So surgeons there removed Rhoda’s eye.
But this didn’t remove the cancer. Doctors transferred Rhoda to Kabgayi Hospital in Gitarama province, where she met a specialist in ophthalmology.
“I hope that in coming days, my daughter will feel well,” her mother says. “She received an operation, but she have to be treated for six months to make sure that the cancer disappears.”
Rhoda’s parents can’t afford to send her to school, but they do have health insurance thanks to a government plan that has been working to achieve universal access in recent years.
Rhoda goes to the hospital every week to get fresh dressings and her eye cleaned at Kacyiru Hospital. She also goes for chemotherapy at Kabgayi Hospital, which has made her lose her hair and her appetite.
Rhoda cries as her mother urges her thin daughter to eat some food. She is usually too weak to play with other children, but her mother says things are better now than they used to be.
“Even if she is suffering, she plays with other children,” she says. “Before, many people around were afraid to see her eye. But today, it’s different. They are used to her illness.”
Her parents say they hope the treatment will cure her.
“Now, I feel a bit better,” Rhoda says. “I can sleep well without pain.”
Rwandans say that cancer is no longer a disease of the rich, with the disease increasingly affecting people in low-income areas and children. This change has exposed a lack of preparation in the country to prevent, diagnose and care for cancer cases. Acknowledging this gap, the government and international health organizations are partnering to build infrastructure to combat cancer in Rwanda.
Cancers have been the most daunting and least addressed of noncommunicable diseases in Rwanda, according to the Ministry of Health website. From 2007 to 2011, 3,420 patients – including 320 children – were diagnosed with cancer, according to the national cancer registry.
Stomach cancer was among the top-10 causes for hospital admission and death in 2010 and 2011 at the University Teaching Hospital of Kigali, according to a Ministry of Health report.
For a long time, the majority of Rwandan population thought cancer was a disease of the rich.
“Before, cancer used to attack rich and old people only,” says businessman Mukuralinda Pascal, one of Rhoda’s neighbors. “But today, cancer is everywhere in Rwanda, and children are affected by this disease every day.”
The complexity of cancer control increased enormously following the shift of the disease burden from wealthy to less affluent countries, said Dr. Margaret Chan, director-general of the World Health Organization, in a 2010 speech. According to the latest WHO statistics, cancer causes around 7.9 million deaths worldwide each year. Of these deaths, around 70 percent now occur in the developing world. A disease once associated with affluence now places its heaviest burden on poor and disadvantaged populations.
A 2012 press release provided by Partners In Health, a Boston-based organization working in Rwanda, notes a lack of preparation to handle this increase.
“We’re fighting a lack of optimism,” says Dr. Paul Farmer, co-founder of Partners In Health, in the release. “There’s so much cancer in the developing world, and we don’t have a plan to treat it.”
But Rwanda has big plans to expand advanced cancer care to hospitals around the country, using a newly developed set of treatment options, according to Partners in Health.
Habimana Jamvier, a government health adviser in Kigali’s Kimihurura district, pledges the government’s commitment to this partnership.
“As policy recommendation, it is necessary to establish effective, affordable and workable cancer control plans, which would require the integration of clinical and public health systems in Rwanda in order to fight the onslaught of cancer,” Jamvier says. “Rwandan government must be the driving force in implementing cancer control programs.”
The Ministry of Health and development partners launched in July 2012 the first national cancer referral facility in rural Rwanda. The Butaro Cancer Center of Excellence, located in Rwanda’s Northern province, aims to provide cancer services to some of the country’s poorest communities.
“From what I’ve seen so far, I’ve been amazed at how proactive the government is,” Dr. Neo Tapela, who works with Partners In Health and the Rwandan Ministry of Health, said at a press conference surrounding the center’s opening. “I think it’s particularly because of the history of Rwanda that makes it so passionate about moving forward.”
In the past, medical technicians here have received little or no training on cancer treatment. But high-level international partnerships are changing that.
Last year, the Dana-Farber Cancer Institute sent nurses from Boston to Rwanda to teach cancer care techniques to the eight nurses chosen for the new cancer ward in Butaro. The institute has also committed to donating cancer medication, according to the Partners In Health press release.
The Ministry of Health established a five-year strategic plan in the 2010-2011 fiscal year to prevent, control and manage cervical cancer.
The government has also been prioritizing universal health coverage in recent years. More than 90 percent of Rwandans had health insurance as of 2010, according to the Ministry of Health, an increase from 44 percent in 2006.
