Dr. Omolola Salako is an expert in radiation oncology, specialising in the treatment of breast, head and neck cancer, brachytherapy, economics of cancer and other solid adult tumours. She is a hybrid Radiation Oncologist who manages patients in a multidisciplinary approach with current treatment guidelines and is an active cancer researcher. In addition to her clinical responsibilities, she is a patient advocate with extensive skills in counseling, cancer advocacy and survivorship. She is also the Founder and Executive Director of Sebeccly, an innovative cancer charity with a vision to empower and treat cancer patients. She is passionate about bridging the gap cancer patients face in accessing accurate information, care and resources. In addition, she is the founder and CEO of Oncopadi.com, a friendly cancer app. The Oncopadi is Africa’s first digital oncology clinic that will offer information, navigation and online medical consultations to cancer patients. Omolola is the youngest of 70 Consultant, Clinical, and Radiation Oncologists in Nigeria and she practices in the Department of Radiation Oncology, Lagos University Teaching Hospital (LUTH). Omolola obtained her MBBS degree from the prestigious College of Medicine, University of Lagos, completed her oncology residency in Lagos University Teaching Hospital and obtained her Fellowship from the Faculty of Radiology, West Africa College of Surgeons. An active cancer researcher; she has authored and co-authored several publications in high impact journals locally and abroad. Omolola is an alumna of Lagos Business School and Enterprise Development Centre (EDC), a multiple award-winning scientist and social entrepreneur who has attracted grants from the National Institute of Health/National Cancer Institute, Union International Cancer Control, Memorial Sloan Kettering Comprehensive Cancer Centre, ACT Foundation and the American Cancer Society. In this interview, she speaks of her journey into oncology, why cancer mortality rate remains high, fighting myths and misconceptions of the disease, and launching Oncopadi.
Tell us about your journey into the world of Radiation Oncology?
About 14 years ago, my sister was diagnosed with advanced kidney cancer. I was a medical student in school at the time and as a family, we rallied round to provide care for her in the country and abroad. Caring for her during that period was what made me realise what cancer patients and their loved ones go through. Prior to this, during my pre-clinical years, my exposure to cancer patients was minimal. So, my sister’s case was my first personal, hands-on experience. Unfortunately, by the time she was diagnosed, the disease was advanced. The nature of kidney cancer is such that it gives no early warning signs. After the diagnosis, she lived for two months afterwards. Of the two months, I was with her for six weeks, and this experience exposed me to the true meaning of life, love, giving and living while alive. Throughout medical school after her death, I became passionate about cancer patients and volunteered/interned in several organizations, including the hospital where she was cared for and passed away. After medical school, I decided to venture into oncology even though this wasn’t popular at the time because of the high rate of deaths in this specialty. I was privileged to be mentored by Professor J.T.K Duncan and late Dr. Kofo Orija. My sister’s death shaped my career, my purpose, and led me down this path. I am currently one of just 70 Radiation Onclogists in Nigeria. In her memory, I founded Sebeccly Cancer Care in 2006. Sebeccly Cancer Care is committed to promoting cancer awareness, providing quality cancer screening, treatment, survivorship services and facilities for the community.
We strive to ensure that cancer patients have life-long access to care through education, research, advocacy, treatment support and delivery of high-quality care.
Some of Sebeccly’s milestones include producing a Consultant Radiation Oncologist in 2013, illuminating four public parks and National Arts Theatre Pink in 2014, attempting a Guinness World Record to form the largest pink human awareness ribbon made up of 7500+ people #12KLLP in 2015, celebrating our 10th anniversary and launching the #AMazonProject in 2016 and launching the #TimeToScreen programme that screened 500 women last year. This year, we will screen 4000 women and launch #Oncopadi before the end of the year.
Why is the mortality rate still so high despite improved awareness?
It is a multi-pronged problem. Firstly, more than 80% of cancer patients present late. They do so due to a number of reasons. In some cases, it is due to ignorance, lack of awareness treatment facilities, prohibitive cost of care, abandoning orthodox care for non-orthodox care, and so on. If more cancer patients present with early stage disease, have health insurance/access to a patent assistance program, if radiotherapy machines are functional, and cancer screening made more accessible, and also made a national priority, the mortality rates will reduce. These strategies have been used in developed countries. Also, private sector investment in cancer care needs to increase for us to change the narrative. We should not rely solely on the public sector. I believe the public and cancer patients should have access to accurate cancer information because knowledge is power. For instance, over 60 per cent of cancer patients have received care with non-oncologists and this causes delay and complications. As much as we are having small wins in detecting some cancers early, we are faced with a dearth of radiotherapy facilities and many cancer patients cannot afford care. In Nigeria there are 120,000 new cancer cases every year to less than 70 radiation oncologists. And some states do not have radiation oncologists present. Obviously, a significant number of cancer patients across the country do not get diagnosed, or do not receive specialist care. The cost of breast cancer care can range from N800, 000 to N20 million. Many cancer patients cannot afford this care in the public and private hospitals and this is the reason why some cancer patients walk away from the hospital.
What does #TimeToScreen entail and what made you come up with it?
Our programs at Sebeccly are centered around creating cancer awareness, providing cancer screening and patient assistance programs as well as promoting cancer research and survivorship issues, as well as promoting cancer research and survivorship. Over time, we have created many campaigns, such as the #TimeToScreen. TTS was developed by Sebeccly Cancer Care to reduce the incidence of breast and cervical cancer, which account for 50,000 cases per year in Nigeria. In any clinic around Nigeria, 60 percent are women with breast and cervical cancer. Therefore, we responded to this situation by instituting TTS, which has now screened 1,000 + women. And by December 2018, we would have achieved a milestone of screening 4,000 + women. We have detected and treated six cases of Stage 0 Cervical Cancer. And through TTS, we have prevented six women from developing cervical cancer. The program has also detected 60 women with breast abnormalities, of which two have been diagnosed with early stage breast cancer. And we are currently following up with all women with such abnormalities. Act Foundation and Access Bank fund TTS. It is this kind of investment that helps community organizations to amplify our impact. Through the TTS, we are reducing the numbers of cervical cancer patients and detecting breast cancer early. This strategy will ensure that fewer cancer patients present to the hospital late.
Despite the high rate of death, why is awareness still very poor?
I believe it’s because there is no coordinated, national plan on how to drive cancer awareness from the urban to the grassroots. There are pockets of activities being conducted in different parts of the country, but till it becomes coordinated, reaching at least 60 million Nigerians at once and of these, 40 million go and get screened, we will not go very far. Presently, the fight against this disease lacks collaboration and coordination, strong media advocacy and so on. The death rate is high because of late detection, most come in when they begin to experience renal failure and excessive bleeding. I am aware there is late presentation and late diagnosis (where a patient presents early to the wrong doctor and is misdiagnosed). When a woman detects a lump for instance, a doctor must examine the breast and take a history then conduct imaging before conducting a biopsy to determine if the lump is benign or not. Sadly, when the lumps are removed, they are thrown away or buried and when they come back, we have to ask for a new lump. Women need to begin to take their health more seriously and in these days of technology, we need to employ it to work for our health. Do your research on doctors, on the hospital, doctor’s capabilities and available treatments before settling on a doctor. Part of the reason patients present late is because they don’t have access to the right information. We are building a cancer app at Sebeccly called Oncopadi (the friend of a cancer patient), a friendly cancer app that connects patients to oncologists within 10 minutes. It has a network of cancer survivors online who want to share their stories, dispel myths regarding cancer. We need patients to be informed so they can present early. We are trained to cure if we have chemotherapy and radiation available, not just manage patients that are already terminal. We can only do this when patients present early and can afford the cost of treatment.
Speaking of myths, there are several dangerous myths that are common among cancer patients. What is Sebeccly doing to combat this?
People do what they know and go to places they trust, hence, good information is key. There is a trust problem with hospitals sadly and many people shy away from them even though that is where the best care is available. It’s easy for many people to go the traditional or spiritual way because this is the way of life for many. This is why we say collaboration matters: we have religious institutions that support our vision. We have some patients that go to their religious leaders who tell them to avoid us, as they will die whilst we have others that urge their members to go for treatment while supporting them with prayers. The belief system of these leaders matter and if we get it right with them, we will be winning some more battles. I’m not saying miracles don’t work but add treatment, proper diet and good emotional support while praying. Most people run away because they are afraid, treatment is costly and the bad things people tell them such as nobody survives. Those that survive don’t want to share their story because they don’t want to be stigmatised. Doctors can talk but nothing beats hearing the message from a survivor. Seeing our survivors give us hope of progress and the desire to go despite all the problems. We need more radiotherapy machines and affordable chemotherapy for all; these would go a long way in improving survivorship. Presently, we have just eight radiotherapy machines in the whole of Nigeria and of that figure, just three are working. In a country where 120, 000 new cancer patients are being diagnosed (let alone the old patients), this is a problem. The waiting queue is about three to four months; we can’t cure such cancers because this degenerates into late treatment. However, this is about to change as some hospitals are planning to get radiotherapy machines. Hopefully, the infusion of the private sector in the public hospitals, the machines will constantly work. But the main problem after the privatization becomes that of affordability because the prices are going to quadruple.
What can be done then about affordability if the people that need it cannot access it?
Sadly, there is a lot of poverty and this is a major concern in accessing and diagnosing treatments. I would urge as much as possible that poverty be removed because even in the communities where we go to screen people free of charge, they will tell you screening is not their problem and cancer is not their portion. They tell us to keep our screening and offer them the refreshments we brought. These people are hungry and screening is the last thing they are thinking of. It takes us almost a year to counsel these set of people on something they should’ve been aware of 10 years ago. Ideally, by the age of 21, you should be undergoing pap smears and regular screenings. Anyone can have cervical cancer; once you have engaged in sexual activities, you are at risk. With screening, we can prevent and catch it early. Of all the women we screen at Sebeccly, at least three percent have a cervical abnormality and are at high risk of developing cervical cancer and we track them and make sure they don’t slip through our hands. When we go into a community, we screen and treat free and this is only possible because ACT Foundation and Access bank fund us. Our goal this year is to screen 3000 women and of this number, we expect to see 90 with cervical abnormalities, track them and follow them up. If the government doesn’t take responsibility, we would not be able to record the kind of success we want. The Federal Ministry of Health recently launched a National Cancer Control Plan (NCCP), which is great, but they say they need about N92 billion to effect.
While they are looking for this money, let us start with what we have, collaborate and consolidate what is on ground. There are over 200 Primary Healthcare Centres in the state, how many are screening for cancer? How many women know where to access screening? Most women we screen at Sebeccly are being screened for the first time in their lives. Access is a major issue; all PHCs should have functional screening centres. Also, there has to be a strong follow up team and qualified hospitals patients can go. It is frustrating working in this space because we are doing more of prevention and palliative measures than actual treatment but when we detect something, what next? The women cannot afford it and I ask myself sometimes if I should be screening when the treatment isn’t available. However, I remain optimistic that the situation would turn around.
Tell us about your 3000 Women screening programme holding at the Redeemed Christian Church of God (RCCG)?
To screen a woman for breast and cervical cancer costs less than N2000 at stage zero, while treatment costs just about N60, 000. It takes between 10-20 years to progress to full blown cancer from stage zero and treatment then runs into millions of Naira and there is even no guarantee for cure. Going through cancer that can be prevented is just unnecessarily painful. So, we thought of a place where we can access at least 3000 women from all over the country and the RCCG convention was a readily available choice. We know we might be likely overwhelmed but this is a pilot programme and we would know how to progress from here on. We can only do this because we have financial backing and capacity building opportunities, if we were to do this on our own, we would only be able to screen 500 women at most. So, from the 7th to the 10th of this month, we would screen thousands of women from all over Nigeria, educate, conducts mammograms, ultrasounds and so on. If we detect any lump, we are going to do a biopsy to determine if there is cancer or not and women would be able to get the results immediately and refer them to our partner government hospitals. We would screen, diagnose and support treatment fully.
What other major programmes have you lined up apart from the 3000 Women campaign?
We are launching Oncopadi in October and we intend to get at least 2000 patients using the app. We want it to be a simple tool that would help cancer patients ask questions from the right sources, know where the radiotherapy machines are working, important things that would help their journey and record their journey on what they are going through, check symptoms, side effects on a journal on the app. We want a woman with a breast lump to be able to connect with a skilled doctor that specializes in that area. This app would basically breach the gap of access to cancer specialists. Another programme we are working on is the 1K for cancer, which is a crowd funding and we have been able to realise N1.3 million since March when we launched it for the treatment of six of our patients. We were able to do this through voluntary donations from various people, online and offline. This money helps us sustain our survivorship clinics on Tuesdays and support the treatment of cancer patients we detect during our #TimeToScreen campaigns. We are constantly looking for volunteers, donations and partnership so we implore Nigerians to partner with us in any way they can.
What is your message to women?
Take your health seriously; prioritise you, your mental, emotional, spiritual and physical health over everything. You are only wealthy or relevant when you’re healthy. Take care of yourself as much as possible. Hypertension is another killer of women; a lot of women are walking about that don’t know they are hypertensive. Live stress-free, more deliberate lives where you deliberately choose what matters to you and makes you happy and gives you joy. If you haven’t been screened, this year mustn’t end without booking an appointment to check yourself completely. Walk into any government hospital or diagnostic centre and do a test, stop putting it off. Check your blood sugar, blood pressure, maintain a healthy weight, and put yourself first always.