Kaposi's sarcoma (KS), an HIV-related cancer, may not make headlines in southern Africa, but dealing with this disfiguring and potentially deadly illness presents a daunting task for health workers.
How to administer chemotherapy at a small rural clinic is just one of the many difficulties faced by health workers treating patients with KS at 10 health facilities run by international medical charity, Medicines Sans Frontiers (MSF) in the Chiradzulu district of southern Malawi.
Other challenges are the lack of infrastructure and safety equipment for injection-driven chemotherapy, poor case management and problematic drug supplies, MSF health worker Yamika Kapitao told the annual meeting of the Rural Doctors Association of Southern Africa (RuDASA) in Swaziland in August.
Malawi has a national HIV prevalence rate of about 12 percent, but according to surveys by the Ministry of Health and Population, southern districts like Chiradzulu and nearby Thyolo have recorded HIV prevalence rates of 21 percent. MSF research presented at the meeting found that about 7 percent of 11,100 ARV patients surveyed in Thyolo district had KS.
"The incidence rate in Africa is still lower than developed countries, but because of the sheer number of our patients, and because they present so late [for treatment], it remains an ever-present danger," said Dr Francois Venter, head of the Southern African HIV Clinicians Society, who noted that the cancer was difficult to manage even in better resourced healthcare settings like academic hospitals.
KS causes abnormal patches of partially cancerous red or purple tissue to grow beneath a patient's skin, including the lining of the mouth, nose, throat and other organs. These lesions can be painful and if they spread to the digestive tract or lungs can cause bleeding and difficulty breathing, according to the US-based National Cancer Institute.
ARV treatment does not protect against KS - all of the roughly 400 patients MSF treated for KS in Chiradzulu in 2010 were on ARVs - but the drugs can prevent advanced KS from developing. The American Cancer Association has noted that in the absence of ARV treatment, KS can advance rapidly and lead to death in just six months.
The road to better care
In May 2010 MSF drafted guidelines for the care and treatment of KS patients at its clinics in Malawi, and began devoting specific days to treating the disease. KS care was previously only available at district-level government hospitals.
Kapitao said the KS clinic days had led to better data collection and patient monitoring, and had allowed nurses to better prepare for chemotherapy, and minimized their exposure to radiation.
The organization is now planning to train palliative care teams to handle difficult cases, and to develop a protocol to guide health workers regarding the special needs of KS patients, including how to dress lesions.
MSF medical coordinator for South Africa, Dr Eric Goemaere said that more also needed to be done in the area of diagnosis.
"We still need to do a lot of training on what KS looks like," said Goemaere, who recommended educating patients in waiting rooms about the symptoms of KS so they could bring these to the attention of their doctors, many of whom missed the signs because they rarely asked repeat patients to undress.
Goemaere said access to chemotherapy, and drugs with fewer negative side effects for HIV patients with already compromised immune systems, was generally poor in Africa, partly because of the high cost.
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions