When my cousin was diagnosed with Cancer, I thought I had seen it all. There are some images that sear themselves into your memory, refusing to fade no matter how hard you try to forget. For me, one of those images is of a man from Bauchi, diagnosed with a sinonasal adenocarcinoma (a type of cancer in the back of the nose and face), who now spends his days chasing a cure that seems to be draining him, rather than curing him He was referred to Kano Cancer Centre, a facility that has become a magnet of last resort not just for Nigerians from the far reaches of the North, but for desperate souls from Niger, Chad, and Cameroon.

He told me of his daily ritual: rising after Subh prayer at 6 a.m., leaving his home while the world is still grey, just to secure a spot for radiotherapy that day. The centre, overwhelmed by the sheer volume of humanity it was never designed to serve, operates on a first-come, first-saved basis. The physical changes in him are stark, his skin has grown darker, his frame has shrunk and watching him is to witness hope and despair in a brutal, daily wrestling match.

The oncologists who treat him are not miracle workers; they are soldiers fighting a war with empty clips. According to a recent assessment by the Nigerian Cancer Society, Nigeria has barely ten functional radiotherapy machines for a population exceeding 200 million. The International Agency for Research on Cancer (IARC) says we need over 120.

Of the eight government-funded RT centres, only two consistently treat patients with functional linear accelerators, with most relying on outdated 2D techniques and lacking imaging support such as CT or MRI simulators. Patients are forced to wait weeks or months for treatment, often with disease progression during the delay. This equipment deficit is compounded by erratic power supply, inadequate maintenance, and the absence of clinical residency programs for medical physicists.

Then there is the issue of manpower. What is a machine without a human hand to guide it? Nigeria currently faces a severe shortage of clinical oncologists, with less than 80 specialists left in the country serving an estimated 120,000 cancer patients.

Not all doctors are oncologists. I have absolutely no clue about radiotherapy myself. To put this in perspective, the global standard recommends one oncologist per 250 cancer patients.

Sixteen states in Nigeria currently have no radiation or clinical oncologists at all. In Gombe, one oncologist sometimes starts clinic in the morning and closes around 10 p.m. because he is also covering Maiduguri. Meanwhile, Lagos alone has almost 50 per cent of all oncologists in the country a dangerous geographical imbalance that leaves the entire northern region underserved.

The association of Radiation and Clinical Oncologists of Nigeria has repeatedly urged government at all levels to invest more in oncology infrastructure and workforce development, but their pleas have largely fallen on deaf ears Then there is the issue of money. The cost of treatment is perhaps the most crippling barrier of all. The man from Bauchi cannot afford admission, which costs between 50,000 and 150,000 per day.

To afford the radiotherapy treatment which costs between 1.5 million and 2 million, he had to drain from his family’s life savings as well as rely on crowd funding from relatives. Other costs include Transport, feeding, medication and other necessities. Across Nigeria, individual chemotherapy doses can range from 150,000 to 500,000, while comprehensive breast cancer treatment is estimated at 20 million, far beyond the reach of average households.

Health experts estimate that over 70 per cent of cancer care in Nigeria is funded out-of-pocket, forcing families into debt and hardship. The NHIA’s cost-sharing arrangement with Roche, where patients contribute just 20 per cent of the cost of select chemotherapy medications, is a welcome intervention but remains limited in scope and reach. Similarly, the NHIA’s 50 per cent subsidy on radiotherapy expenses capped at 400,000 is a commendable gesture, but against a 2 million bill, it is like offering a cup of water to a man drowning in a river.

To fully grasp the suffering of these patients, you will have to witness it. Asides the financial cost, which is obvious, there is the hidden emotional cost that presents as indignity of cancer treatment. When you see a man who used to do well, a retired permanent secretary, coming to the NHIA office to beg for his monthly Zoladex (a drug used for prostate cancer that costs between N200,000 to N300,000 because it is out of stock, it breaks your heart.

As a doctor and manager, you put in the order, but the contractor is slow and due process is even slower, all while the patient continues to deteriorate. If the patient decides to vex and buy it outside, what about the next dose? I have seen patients on Zoladex for four years! 300k every month for 4 years for a middle-class retiree? And this is just one drug fa, there