In my first part, I tried to elaborate the challenges Cancer patients are passing through. This second part will focus on the status of cancer in Eritrea, possible causes and political awareness needed to call the International community to act on the principle of basic human rights.
Cancer in Eritrea
Cancer is a global challenge. No country is immune to cancer. without a doubt, it is the most challenging health related issue for the 21thC and coming centuries for human kind. Today, cancer is the 2nd leading cause of world wide death. According to WHO reports, about 8.8 million people died in 2015. Though cancer is difficult to be cured, preventive measures can reduce cancer incidences by 30 to 50% by avoiding certain habits or not exposing to harmful radiation and/or chemicals. Developed countries are spending billions on research and development of methods to prevent and cure cancer. Because of cancer, the world is losing US$ 1.16 Trillion on cancer estimated costs.
Like all over the world, Eritrea is not free from cancer. But there is some uniqueness about this secretive and totalitarian state. Little is known about it to the world. Because of Eritrea’s secrecy and extreme censorship, it is almost impossible to get information in almost everything. Because of this, there is public awareness about health related problems. To the extreme and rare opportunity, some scientific publications are seldom are found here and there. After long time research, I came to find some important information by the help of search engines. These rare publications have lots of information
Though no concrete and official data are readily available to the public, these scientific publications are now coming with detailed information that reveals the extent of cancer in Eritrea. They are strong enough to enhance our consciousness and scope of understanding about the danger and extent of cancer in Eritrea.
According to a study conducted by Adom, H., et al., 2016, cancer is becoming a growing concern in Eritrea. A research conducted based on data collected from Management Information System of the Eritrean National Health Laboratory (ENHL), Ministry of Health, shows, 19,636 cancer cases were registered between 2000 to 2010 out of which 9,482 were positive. Women are found to be more prone to cancer than men. As it is given in the table below, 60.82% were found to be among the Eritreans diagnosed with positive cancer. Figure 1: Cancer Incidence in Eritrea from 2000 to 2010, Source: Adom H., et. al, 2016
What type of Cancer is killing Eritreans most?
For Eritreans, breast and ovary cancer among women are so prevalent and frustrating type. Almost any ordinary Eritrean has heard about it for the last 20 years. Thousands of women are victims and many of them have died after years of suffering.
What was not normal to hear two categories: (1) about men who suffer from cancer and (2) young girls to be victims of cancer. Cancer is becoming merciless disease for both sexes no matter to which age group they belong. Not only those who are already living with cancer, many Eritreans, as young as 15 years and as old as 70 years plus are under a risk of chronic cancer exposure.
The six most commonly occurring cancer types among men and women are bone, connective and connective tissue, skin, rectum, Oesophagues and colon cancer. However, breast cancer is dominant among women and prostate among men. The second most important cancer type in female and male were cervix uteri and prostate cancer. Bone Cancer is prevalent in both female and male. Ovary cancer is also more incident cancer type among females.
According to 2014 WHO Country Profile Report, 1,400 death report was registered for female and 800 for the male. Out of this 1,400 female, 25.6% death were caused by breast cancer, while cervix uteri and Ovary constitute 13.1% and 7.1% respectively.
Figure 2: Country Cancer Profile 2012 (Source click here)
As shown in Figure below, breast cancer is widespread among women of age greater than 60 years. At this time, many mothers of age between 40 to 45 are also exposed to breast cancer. The trend looks different for Cervix Uteri. Women of age between 40 to 50 years old seem to be more exposed to Cervix Uteri while women of age greater than 50 are less exposed. Leukaemia (commonly known as blood cancer), though not significant compared to other types. It is of a great concern as it is attacking men of age between 20 to 35 seriously. While breast cancer and Cervix Uteri are dominant among female, prostate, and leukaemia are in the male.
Figure 3: Age-Specific Incidence rate per 100,000 in 2000-2010, both sexes (Source: Adom, H., et. al., 2016).
Dominant Cancer Types and Their Possible Causes in Eritrea
If you can not read it, please click here Common Types of Cancer in Eritrea
Table 1: Cancer types and their cause
1. Contraception Pills
In general, use of contraception methods among women is believed to be one of the major sources of Cancer. Birth control methods like oral contraceptives birth control shot, birth control implant, skin patch, vaginal ring etc. are major causes f cancer among women.
Proper knowledge on how to use them is therefore vital to choose what type of contraception methods best serves in accordance the body immune system capabilities. If they are taken without proper medical advice and check, their consequence can be dangerous.
In Eritrea, let alone to have different choices, awareness about contraception methods is very low. For example, a 2002 ERITREA DEMOGRAPHIC AND HEALTH SURVEY shows that the mean number of methods known by all women was only 4.3% and the average national use was 8%.
It is now hard to deduce that Eritrean women use contraceptive methods blindly. It is not abnormal to see women simply exchange contraception pills (if they know anything about its existence) among themselves.
During my stay in Eritrea, I have witnessed unprofessional hospital/clinic nurses(workers) bring contraceptive pills from their work place and give to their friends without any medical check and inscription at the request of the user.
The most cancer types commonly associated with contraceptive pills are breast and ovary cancer. Today, breast cancer is one of the most common cancers affecting Eritrean women. According to 2014 report by WHO, there were about 370 deaths making it 39th in the world rank.
Figure 5: Breast cancer
2. Dietary Habits or Diets
Eritrean diet system is highly dependent on cereal products and vegetables. Milk and milk products are also daily food diets though these days supply is very limited. It is hard to stay meat is consumed by the majority. In general, Eritrean diet habits are a balanced type with a complementary behavior. However, things are changing for the last 20 years.
At this time, Eritrean food habit system is changing because most of those traditional food and food products are not available. Milk and milk products are now almost non-exist or very expensive to buy. Fruits and fish are not in the habit of Eritrean diets with the exception of small geographical locations. Fruits are not widely available across the country and if they exist, they are very expensive. Though the country is blessed with 1200 km of sea coast and abundant fish resources, only about 2% of Eritreans consume fish.
Among dairy products, butter is believed to have cholesterol type which plays a positive role to protect breast cancer. Consuming organic butter increases body immune system. Especially saturated butter have strong anti-tumor and anti-cancer properties. It contains conjugated linoleic acid which has a strong character of an anti-cancer agent and immunity booster.
Before it became a luxury food and started to be consumed only for special occasions(such as wedding and holidays), it was a normal diet component in almost every house. As domestic animals diminished and cheap oil became available at the market, butter is replaced by processed oil. This has drastically changed food habits of most families.
Mothers who gave birth used to eat only butter prepared food for at least 12 days. Though it was consumed in the belief of its energy values, science has proved that it has a role to protect cancer by boosting their immune system. Newly married couples were also provided with butter prepared food for the entire period of their honeymoon. At this time, it is hard to be served with butter. And this could have added the risk of breast and ovary cancer in women.
Another diet which can have a negative effect is consumption of red meat. Though Eritreans have no habit of consuming raw red meat, some families might be affected by it to a certain extent.
In general, Eritreans are in the state of malnutrition. It is hard to get a balanced diet. In consequence, the immune system is getting weaker leading to cancer victimization.
Cancer types caused from unbalanced diets include – rectal, Oesophagues, connective and connective tissue, colon cancer and breast cancer.
A friend of mine sent me an important message about the effect of stress on cancer. To quote him-
“It is so disturbing to see many Eritreans are being diagnosed with cancer. You know I am reading a book by Dr. Leonardo Caldwell, balled one answer to cancer. He repeatedly talks the reason for getting cancer is stress, stress, and stress. He even openly advises for people not to do chemo or radiation, because he calls it a faster death. He recommends some ways to get out of your stress and other stuff. It sounds logical to me after reading most of the pages. If you can read the book, or listen to his youtube videos. I wish we can translate what he said and share it with others.”
I found his comments more relevant to the current condition of Eritreans. There are many reasons to live Eritreans in stress. There are so many reasons. Stress is becoming part of Eritrean life. There is economic stress, social stress, political stress and environmental stress. And research has proven that stress the main cause of cancer these days.
Studies in several countries have revealed that women in deprived areas have significantly higher rates of cervical cancer. Some of the types of cancer caused by stress include – breast cancer and Uteri Vertex cancer.
4. Consumption of Poorly Stored Cereal Grains
Improper storage of cereal grains such as sorghum, maize, millet wheat, groundnuts, lentils etc., are the major source of cancer causing fungus. These cancer causing fungi produce toxins called “Aflatoxins”. Major fungi that produce aflatoxins are Aspergillus flavus and Aspergillus parasiticus which strive in warm and humid areas. Grains stored improperly and for long period of time are the favorable condition for the multiplication of these fungi. Once consumed, the consumer can be exposed to cancer.
Eritrean diet solely depends on cereal grains. Since production is not sufficient, most of its demand is imported from countries like Sudan, Ethiopia(illegal importation) and India. To my knowledge, there no Food Quality Standards that puts strict regulation on Imported Foods with the exception of few. Importation is in bulk quantity. Before distribution, those imported cereals are stored in poorly constructed storage houses owned by Eritrean Board of Grains (EBG) throughout the country and privately owned small storage house. Sometimes, these grains are stored for years without reaching to the consumer.
I had a chance to enter some warehouses owned by Ministry of Agriculture. It was hard to stay inside for more than 30 minutes or more. The odor is so strong and stinking. There was no doubt that such kind of environment was convenient for fungus developments.
Other cereals are stored by business owners for marketing. Since price depends on season and yield, usually these business owners store grains for a longer period of time leaving them to be exposed to fungi attack. On high seasons, farmers could have some excess crops produced. These crops have no proper storage systems built leaving them exposed to fungi attack.
Crops which are sensitive to cancer causing fungi include maize, groundnuts, sorghum, wheat, lentils sesame, etc. As shown in Figure
Figure 6: Maize crops attacked by fungus
Figure 7: Groundnuts attacked by fungus
Cancer caused by these toxins produced by these fungi is a leading cause of death across the world. For example, Liver cancer(as shown in the figure below) is one of the prominent type caused by Aflatoxin.
Figure 8: Liver cancer
5. Exposure to Ultra-Violate Rays
It is not logical to say that Eritreans can be in danger from exposure to ultra-violate rays as they live most of their days exposed to direct sun rays. In general, because of adaptation to local environment, Eritreans have a skin pigment that can protect them from UV radiation. But it varies depending on the geographical location one used to live. Highland Eritrea is relatively cooler and the sun is not burning. In the other hand, lowland Eritrea is very hot and the sun is burning. UV rays are therefore more aggressive in the Highland than the lowland. A Highlander is therefore not able to resist lowland of Eritrea.
Though most Eritreans have settlements in their respective geographical location, due to military conscription and relocation, people are always moving from one area to the other. This movement exposes them to a different environment.
Eritrea has a forced military service system. To get training, all Eritreans are obliged to go the central military training center found in the lowland. Those who are coming from the Highland are new to such harsh climatic environment. Temperature is very high(usually greater than 35 degree Celsius and almost no trees. As a result, those who join the military training from the Highland are primary victims of UV rays.
Though exposure to sunlight can have a positive effect, if one is exposed for expanded duration, it can affect the immune system of the skin thereby causing skin cancer and connective and connective tissue cancer.
6. Exposure to Asbestos – ጀሶ
Almost any Eritrean uses Asbestos for many purposes. Besides being relatively cheap, it has many uses. No one can believe that this material has a substance that can cause cancer. I remember to keep asbestos in my house all the time. Many electricians and construction workers use it like any normal construction material. It is available in all construction equipment selling centers. They have neither special packaging material nor are stored properly. People who own construction selling centers are exposed on daily basis. What these people, including me and almost all Eritreans, are now aware is asbestos can cause cancer.
Asbestos is a known substance that causes different kinds of cancer. Some of the types of cancer caused by this carcinogen are mesothelioma( rare cancer that affects thin membranes found in the chest and abdomen), lung, larynx and ovary cancer. When the person who is exposed to Asbestos smokes, the probability of cancer is aggravated. Its effect can also be expanded to family members of workers/people exposed to asbestos.
To my knowledge, there is no rules or regulation that limits asbestos use. Countries like the USA have occupation Safety and Health Administration agency responsible for safety regulations that limit asbestos use. So far, Eritreans will continue to be exposed to asbestos until enough public awareness develops and the probability of being a victim will be there.
7. Exposure to Benzene
Many Eritreans are exposed to Benzene. People who work in garages, car drivers and some construction workers use it on daily basis without any safety. Workers in industries, garages, shoe manufacturing, gas stations and people who live around, construction areas, etc are exposed to benzene.
For the last 15 years, fuel has become a scarce resource. It almost not gets it from formal gas stations. As a result, many people are engaged in selling fuels illegally. Many family houses, garages, and secret stores became distribution centers. These fuels are either stored in barrels or jerricans. The materials used to hold fuel are not proper. Often, the place is contaminated by fuels spilled. These areas become polluted by these gases. Many people swallow fuels while pumping manually from one container to another.
What is not known to Eritreans is that fuels in general and benzene, in particular, the major cause of cancer called leukemia, a type of cancer commonly known as “blood cancer”. People exposed to high levels of benzene have a high probability of developing leukemia. Children are also easily affected by benzene to become a victim of childhood leukemia.
To my knowledge, there is no any government measures that work to reduce people’s exposure to this harmful substance. And people are not aware of its potential danger.
8. Smoke （ትኪ）
Researchers have proved that smoke is the main cause of cancer. But they are all based in a cigarette as a reference. Many Eritreans consume tobacco either in cigarette form or as it is. The primary victims are men as smoking is not common among women in Eritrea. What is most important is smoke that comes from wood burning in the family kitchen.
Eritrean families depend on firewood to cook food. As women are mainly engaged in food preparation, they become primary targets. Therefore, cigarette smoking might not have such much significant in Eritrea as that of smoke that comes from fire wood burned at home. In some areas, it is not easy to get firewood. Instead of cow dung cakes (ክቦ）is used in place of firewood. Smoke that comes from cow dung cakes has harmful gas called Polycyclic Aromatic carbons. This toxic gas has a potential cause to cause cancer.
Therefore, it is not the only cigarette that can cause cancer but indoor smoke can be a potential cause of cancer among Eritrean women.
Figure 9: Lung cancer
Cancer types associated with smoke are Lung, Breast Cancer, colon cancer, Oesophagues, prostate, rectal and Uteri Vertis.
9. Alcohol Consumption
Alcohol consumption in Eritrea is a special case. It is hard to say that Eritreans consume alcohol for many reasons. Commercial alcohol production is very low and expensive. What Eritreans consume most is therefore traditional beer made at home. Th percentage of alcohol of these home made beer is very low(approximately 5 to 6%). Unless it consumed at high volume, its side effect can not be considered very risk compared to those with high alcohol content. But there is another commercial alcohol product which is consumed widely
Eritrea produces very limited varieties of liquor. In fact, they are only four varieties. What is unique about these products is their alcohol content. They are around 40%. Before 2000, consumption of alcohol was low compared to beer. However, starting from 2000, the only existing beer making factory has reduced its beer production and people returned to Alcohol as alcohol which was relatively available in the market. This alcoholic consumption habit has affected many Eritreans.
Figure 10: Liquor types produced in Eritrea
Therefore, the change in habit of alcohol consumption could have an impact on the health of many Eritreans. Cancer caused by consuming alcohol include – breast cancer, Oesophagues, rectal cancer, colon cancer, stomach cancer etc.
10. Early age Sexual Intercourse and Sexually Transmitted Diseases
Though this subject is broad to deal with, in general, sexual habits of Eritreans is changing. Early sex is not unnormal today. Parallel to that, HIV/AIDS and other STDs are high these days.
For example, the study conducted by Adom, H. et al (2016) has found that cancer cases and HIV/AIDS infection were extremely high in 2005. The study has not explained why but one can learn that there is a direct correlation between HIV/AIDS and cancer. If there is any thing that can be said about 2005, it is the year of the health crisis in Eritrea.
Figure 11: 2005 Cancer and AIDS/HIV Crisis in Eritrea
What Happened in 2005?
Many Eritreans may remember 2005 as a year of rounding of thousands of Eritreans families, massive migration, forced payment of 50,000 Nakfa for anyone who flee the country illegally, restricted or no movement, noticeable change within the political system of PFDJ etc. In this year, coupon was introduced to distribute food ration in all major cities.
On the other hand, 2005 was a year of the health crisis. The highest number of HIV infected record and cancer cases boomed in this year. In 2004, It can be remembered as “Year of Eritrean Health Crisis
Cancer is increasingly affecting Eritreans. Since 2000, the number of positive cancer cases is growing. It is affecting all ages, male and female. No one is free today from cancer.
The causes are almost easy to predict. Eritreans should have full awareness on the possible causes of cancer. The right thing is to prevent cancer. Once affected, the probably of treating it is very low. To prevent cancer, Eritreans should change their life style.
Though the government is doing nothing, it has to introduce a campaign to enhance public awareness through all possible means.
WHO and other international agencies should help Eritrea to develop its capacity of introducing preventative measures. At the same time, there is a need to build infrastructure that treats cancer inside Eritrea. Going abroad for treatment is extremely expensive for Eritreans. In addition, the life of the whole family is affected.
Those who are taking treatment in Sudan, keep your strong spirit. Cancer is more of psychological. The more you stay strong, the more you have a chance of curing. Yordanos Tesfay is a good example.
Message to those who are helping cancer victims in Sudan
I have a message to those who are working hard to help cancer victims in Sudan: BRAVO. You are hope of life. May you have guidance from the Almighty. You humanistic solidarity is more than anything.
To my fellow fighters for justice:
Let us unite. Health is basic human right. Let us make our voices heard.