Socio-demographic characteristics of the study participants
In this study, a total of thirteen cancer patients and two healthcare workers who work at the oncology center were enrolled. Out of these participants, eight were females. The mean age of the participants was 38 years. In addition, 12 participants were married and five of them were farmers (Table 1).
Table 1
Socio-demographic characteristics of lived experiences of patients living with cancer undergoing chemotherapy in Felege-Hiwot Comprehensive Specialized Hospital, Bahir Dar, north-west Ethiopia, a phenomenological study, 2021.
Participants | Characteristics | Number | Percent |
Sex | Male | 07 | 46.67 |
Female | 08 | 53.34 |
Age | 18–24 | 02 | 13.34 |
25–34 | 1 | 6.67 |
35–44 | 07 | 46.67 |
45–54 | 03 | 20 |
>=55 | 02 | 13.34 |
Educational status | Cannot read and write | 03 | 20 |
Elementary school | 06 | 40 |
High school | 04 | 26.67 |
Higher education | 03 | 20 |
Marital status | Single | 02 | 13.34 |
Married | 12 | 80 |
Divorced | 01 | 6.67 |
Occupation | Farmer | 05 | 33.34 |
Government employ | 03 | 20 |
Merchant | 03 | 20 |
No work | 02 | 13.34 |
Nurse Professional | 01 | 6.67 |
General Practitioner | 01 | 6.67 |
Family monthly income * | No income | 2 | 13.34 |
Saved on account | 01 | 6.67 |
<=860 | 04 | 26.67 |
861–1500 | 01 | 6.67 |
1501–3500 | 02 | 13.34 |
3501–5000 | 02 | 13.34 |
>=5001 | 03 | 20 |
Family history | Yes | 02 | 13.34 |
| No | 13 | 86.67 |
NB: - * Ethiopian Civil Service monthly salary scale for civil servants |
Description of the cancer patients
All participants received chemotherapy every 21 days of the month. Greater half of the participants received more than five chemotherapies (Table 2).
Table 2
Description of participants living with cancer undertaking chemotherapy in Felege-Hiwot Comprehensive Specialized Hospital, Bahir Dar, north-west Ethiopia, a phenomenological study, 2021.
Participant code | Age at diagnosis | Sex | No_ of chemotherapy received |
P1 | 52 | F | 5 |
P2 | 42 | F | 3 |
P3 | 46 | F | 6 |
P4 | 44 | F | 12 |
P5 | 40 | M | 12 |
P6 | 50 | M | 6 |
P7 | 40 | M | 5 |
P8 | 38 | F | 4 |
P9 | 44 | F | 5 |
P10 | 23 | F | 2 |
P11 | 63 | M | 1 |
P12 | 24 | F | 3 |
P13 | 58 | M | 6 |
Thematic findings
The findings that emerged from the analysis of in-depth interviews are presented and arranged as themes and subthemes. For this study, data analysis has revealed five main themes and thirteen subthemes. The major themes were financial problems, affected social roles, psychological impact, seriousness of the disease, and challenges to getting chemotherapy. These main themes also have thirteen subthemes (Table 3).
Table 3
Thematic findings on lived experiences of patients living with cancer undertaking chemotherapy in Felege-Hiwot Comprehensive Specialized Hospital, Bahir Dar, north-west Ethiopia, a phenomenological study, 2021
S. No_ | Main theme | Sub-theme |
1 | The seriousness of the disease | Incurability of the disease |
Condition of the disease |
1 | Financial problem | Cost of treatment |
Cost of Transport |
2 | Affected social role | Interrupt Social life |
Spiritual activities |
Interrupt family life |
Exhaustion |
Role dysfunction |
3 | The seriousness of the disease | Incurability of the disease |
Condition of the disease |
4 | Psychological impact | Mental distress |
Changed emotional status |
5 | Challenges to get chemotherapy | Inaccessibility of the service unit |
Unavailability of treatment and lab. Investigation |
Theme 1. The seriousness of the disease
The theme focuses on two basic sub-themes: the incurability of the disease and the condition of the disease. These two sub-themes explore the experiences of cancer patients living with chemotherapy; the difficult condition of the disease; and its economic influence.
Sub-theme 1. Incurability of the disease
Nine participants explored the condition of the disease as an incurable disease and considered the disease as it was deadly. They explore the disease manifestation and its painful condition, which were the major reasons to describe it as serious.
Study participants also explored the reason for a disease that makes it serious such as the combination of the nature of the treatment and its side effects. Almost all (11) participants discussed the side effects of the treatment as nausea, vomiting, alopecia, and being unable to eat or drink, especially until 15 days after chemotherapy started. It also restricts them from participating in their daily activity, and social life and has some psychological impact on the participants. Due to such conditions of the disease and treatment, different participants consider it as they were punished by God. Participants investigate disease conditions that are dangerous to people and render humans hopeless. The participants stated, " I consider cancer to be an incurable illness. I just state, "When will I die?" because that is how I feel—today, I will die tomorrow. The agony is intense, excruciating, and difficult " (52-year-old female patient, P1).
The above idea is supported by experts who work at the oncology center and discussed that cancer is a killer, it is not healed. As a result of this, the family and surrounding community were upset and waited until the day that the patient would day. " It was challenging because, although I understood that cancer was fatal and that there was no cure, I still knew very little about the disease " (HCW, Gp, P15)
Some of the participants also echoed the seriousness of the disease related to history heard in the community as cancer disease is an incurable, deadly disease. As a result, when they talk about cancer, they become shocked, upset, and cry emotionally, they want to die immediately. Their family also crying, and psychologically depressed, the following participant expressed, “It was really difficult, and I was crying like a baby when I got the results. My relatives were all crying and miserable at the time. Was quite concerned. My spouse, my mother in particular, and each of the brothers. How did this occur?” (40 years old cancer male patient, P 5)
Experts who work in oncology centers supported this idea by - “It is expected that such an incident would be taken extremely seriously, particularly in the beginning of therapy or if you are a new patient in our room. They are agitated and frustrated” (HCW, Nurse, P14)
In addition, they verbalized that the severity of cancer has a greater effect than other chronic diseases and contributes to decreasing their immunity and exposure to different diseases. Such conditions of the disease influence them to describe it by comparing it with the other diseases they know. The participants explore the following, “I was previously ill with tuberculosis (TB), which is a fairly mild and non-heavy illness, but this tumor is heavy. I don't think TB is painfullike cancer. The medication for cancer is unavailable and the tumor is quite large”. (40 years male patient, p7)
Sub-theme 2. Condition of the disease
Chemotherapy was administered to study participants to alleviate severe pain. Most participants (10) explore, as they don’t know the first manifestation of the disease in the early phase. Due to such reasons, they experience severe pain before they get the exact treatment for the disease. The pain of the disease varies from participant to participant.
Most participants described the side effects of the chemotherapy. That were, serious vomiting, nausea, general body weakness, and psychological pain related to alopecia, insomnia, itching, a headache, and muscle spasms, tiredness, were persisted for 15 days after completing the chemotherapy. For this reason, they were restricted from their job, social life, and religious activities. Because of this among the study participants two of the participants wanted to stop their treatment schedule to relieve them from this suffering. The study participants describe their experience as the following: "Oh, I didn't test the food; I was sick for a week and the smell is like coffee, coffee, and food." I will vomit even if I taste anything that is not fatal. When it does this to me, they [my family] give me diluted sugar and say that it is the best thing for my soul. I'll take it seriously, but it will be revealed, I promise. Indeed. I spent a week sleeping on the ground. I can taste the meal and go shopping after I feel better. Every day is a feeding. What are the children sleeping and eating? Because I could manage them, I brought both a plate and two plates. That's the method I used." (42-year-old female patient, P 2)
“I was blind and deaf for eight days after receiving radiation and chemotherapy. On the eighth day, I don't eat since it makes me feel queasy; after that, I stand up straight. It helps me feel better, but when I walk around, I get scared. They tell me this is because of the medication” (52-year-old female patient, p1).
Almost all participants try to describe a condition of the disease becomes worsens while they live with chemotherapy and its side effects. It proceeds until they are restricted from feeding rather little liquid matter to prevent the side effects of the chemotherapy.
“I get severe pain from the medication, it bothers me, I can't eat after taking it, my knees feel like they've been drenched in hot water, I don't eat when I feel the sun, and something burns my body. I can no longer take medication without becoming burned or sick to my stomach” (38-year-old female patient, P8).
Theme 2. Financial problem
This main theme is divided into two subthemes: treatment costs and transportation.
Sub-theme 1. Cost of the treatment
The participants involved in this study explored the expensiveness of the treatment. Some chemotherapeutic drugs are not available in government hospitals. Most of the time, the treatment drugs came from private clinics, and some were also not widely available in the town. These produce psychological disturbance in the family and interrupt the treatment schedule.
The shortage of the economy aggravated the seriousness of the disease and its influence on their family. Its influence on their family was the common reason to describe the disease as serious. Almost all the participants describe cost as the main cause of interrupting chemotherapy service based on their schedule. The following participant stated the same thing as,
"When I arrived, it was stated that the drugs were not there. My husband then went to Gondar and purchased the drug. Now that the third round has ended, I am in pain. I came to ask if I could get the medicine I requested in Addis Ababa, but I was not given it there. It was stated that a receipt was required, so I did not take the medication. Also, it was indicated that the disease was becoming more serious and that the pain was increasing (cries)." (44-year-old female patient, P9)
This is supported by the experts in the center stated “Unfortunately, medications can occasionally disappear. Unlike other medications, it is not accessible overseas, and even if it were, patients would not be able to purchase it. The cost of medicines is relatively high. No one purchases and uses them. The majority of cancer sufferers therefore have health insurance. Consequently, if this [hospital] has the medication, it will be purchased and used. Nevertheless, it will provide a challenge for us if it is withdrawn. As a result, once the district stops paying the hospital, health insurance will terminate. Additionally, they could have to wait a few months for the district to pay or for the renewal before they can restart” (HCW, Nurse, P14).
This is supported by experts in the service unit “There is an issue with inputs. If a drug is unavailable, they expose themselves to overly costly purchases, spending up to 6,000 to 8,000 birr per cycle, and then spending time importing Addis Ababa. In addition, there is an imbalance between the patient and the service center. There are almost 1,000 patients and the facility is limited to 18 beds and a small number of rooms, so schedule an appointment with those individuals. The nation faces an issue with the two-month waiting period. In the interim, there may be issues, and those who are savable may not be saved. Their level may fluctuate, their distribution may alter, and these issues persist” (HCW, GP, P15).
As a result of the expensive of the treatment, they sold any expenditure including their houses. These have influenced the living conditions of the whole family. The study participant describes her experience as the following,
‘’It would cost a lot of money; I was sold my house. It costs a lot of money, so they sold my whole house because of the disease, and they paid for it themselves and there, more than 100,000 birrs.’’ (46 years old female patient, P3).
Most of the participants were emotionally related to financial problems because it is expensive even for the bed in a health institution to take the treatment. Almost all (11) participants are spending their saved money and their assets to get the treatment. The drug they obtained in private was very expensive. Some of them obtain the treatment with the help of the other after they finish their own money. The following study participants explore their experience as follows, “There's an issue [money issue] (she lets out a cry). I told them I needed money when I got there. In her words, "You needed money and you're going to be a private hospital to conduct an investigation." It was tears, and I had no money. Daily labor is what I do. Once I have borrowed money, I will arrive”. (38 years female patient, P8)
Sub-theme 2. Cost of transportation and other expenditures
The participants explore that the fee of the transport from the treatment center to home and to return to the treatment center was so expensive which was double the fee at the time, if they did not pay, they would interrupt their treatment (chemotherapy). Also, the cost of beds in pension or” medeb/መደብ/’ ’was high which influenced the quality of life of the family. The following study participants explained as follows:” I don’t have any money. I will come to the treatment by borrowing 50 and 20 Birr from the neighborhood.” " (42 years, female patient, P2).
This is supported by experts in the service unit as
“There is a problem with inputs. When a drug is not available, they are exposed to expensive buying. They spend up to 6,000 to 8,000 birr per cycle and then spend time to import Addis Ababa. Beyond that, the patient and the service center are not balanced. Almost greater than 1,000 patients and is confined to a limited number of rooms and 18 beds. So, make an appointment with those people. There is a problem in the country and there is a waiting period of two months. In the meantime, there may be problems, and those who can be saved may go unsaved. Their level may change, their distribution may change, and these problems exist.” (HCW, GP, P15)
“Some come from the North Wollo area, which is a problem to go to the Dessie area, from the North Wollo Lasta Lalibela area (311km) (now four). There are 3 patients from the neighboring area of Benishangul Gumez (Zigem kebele) (298km) (now 3 patients), now we have two patients in the Oromia region (450km), one of whom has passed away. Apart from the Oromia region, new ones have now arrived. Although there is no cancer to say cure, we can still call it cure, even though she has gone home. Most of East Gojjam is from here. Long-distance treatment is a challenge.” (HCW, Nurse, P14)
Theme 3. Affect usual role
This theme has five sub-themes: restricting social life, affect spiritual activity, interrupt family life, exhaustion, and role dysfunctions.
Sub-theme 1. Social life restriction
The disease has an impact on the participant's social life, which affects the participant's involvement in community activity. Due to this, some of the participants, especially at the early stages of chemotherapy; don’t want to be seen by anyone while they get chemotherapy services because they think it will affect their family and social relationships.
Some participant explores as they discriminate while they participate in some activity of the community. Because of the disease and miss awareness of the community which understand the disease as transmittable. Due to this some of the participant especially at the early time of chemotherapy, don’t want to be seen by someone, while they get chemotherapy service because they think it affects their family and social relationships. The following study participant explore their experience as the following,
The following study participant explores their experience as the following: "How could she have cancer? They said it was like the early days of HIV. Now I'll tell you how far I've come. Initially, I used to isolate myself from people and knew I wouldn't be in a relationship. Now I'll tell you how far I've come. They believe it's something I purchased and that it's contagious. (58 years old male patient, P 13).
“I was so stunned that I even covered up when I saw someone I knew. Because of how thin I was, people assumed I had AIDS (she smiles really). I quickly covered my face when I learned that AIDS was keeping her from getting cancer since the more cancer she loses, the less cancer she will have. I was shielded. They call me a lot of names, but I ignore them and walk by” (46-year-old female patient, P 3).
Sub-theme 2. Exhaustion
The experience of exhaustion was related to a lack of potential and energy, which results in a decreased capacity to perform daily activities even after they leave their job. The participant's social life suffers as a result of their restricted activity because they are unable to move as freely as they would like. The participant always had a feeling of hopelessness related to their decreased capacity to perform their daily activity. The following participant describes the effect of the disease on their daily activities as follows: - "Why do you think it's difficult to do daily activities?" What can I say about chemotherapy? (laughing) This is hard, hard to describe. The medicine is hard, hard. Meanwhile, some doctors take care of us and reassure us. When we go home, the pain stays for five days. There is nausea, vomiting, the smell of food, and disgust, it is a test for up to five days. There is a fever for five days. Daily activities are extremely difficult for me. I don't have the energy. I can't work as I want. It is heavy. I can't move with my capacity. So how can I manage this?" (44-year-old female patient, P4).
Almost all of the participants express living with cancer as a severe disease. The most common reason for the severe condition of the disease was not able to perform their daily activity as they needed. They wait their time inside their home since they fear the community. The condition of the disease prevents them from performing their daily activities. Some participant experiences weakness before they get chemotherapy. Which makes them stop the job they did before by decreasing their potential. The following study participants in this research explore their experience as the following, “I simply quit my job. [Sadden him]. I quit my work. After I contracted the illness, my employment was terminated. Thus, it significantly affects my work. I can't move by myself as it hurts me and I can't do my work. Thus, it affects my work [angry]” (58 years old, male, participant. P13).
Sub-theme 3. Role dysfunction
Participants have different roles in their families and communities. Some of them were the head of the family; previously, they had a great responsibility to take care of their family members or participate in the community. However, the disease limits their ability to continue in their normal role. When they are unable to support their family and community, it is considered role dysfunction. This was supported by the participant's idea as follows; "Despite my best efforts to support my family, I am unable to work due to my illness. I was receiving treatment from Keble, but at this point, no one can assist us. The expense of my therapy is being covered by my health insurance." (44 years, female patient, P 4).
Due to the effect of disease and the nature of treatment some of the participants make it unfulfilled for their program. For instance, most participants had a dream of joining education at different levels, and some of them had planned to build their own houses. After the occurrence of the disease, almost all of the participants decreased or stopped the program they planned because they couldn't complete the program they planned. This is supported by the following participants of this study; “I am losing a lot of things, including school, my body is shrinking, my skin is changing, I am losing my hair, and I am unable to do anything about my cancer. The chemotherapy takes a long time, so I have to sit through those gaps while at home. The medication is heavy, and if I don't finish the treatment, it will be difficult and I won't be able to live again” (24-year-old female patient, P10).
Sub-theme 4: Interrupt family life
The participants had done their family activities, but after the situation of disease occurred in their lives, they reduced their participation in the family, which had an impact on their marriage. After the disease comes into their life the relationship between the married decreases from time to time. In addition, the community considers that they can’t participate in social life. Such a condition makes it hard to live with the disease and affects their social life. This is supported by the following participants in this study: "He asks the children, "Why don't I leave them alone? I grew up without a father and mother, so why should I leave them? If I don't tell you much, I'll just tell you where I'm going. This is just a conflict. Eh, let's just say I had a hard time, and I didn't want to have sex again because I was tired. I am upset. I want to say goodbye to my children.". (38 years old female patient, P 8)
The impact of the disease and its treatment influences the family life of the participant. Different participants explore the impact of the disease on family life. They conveyed as they stopped the community and home activity to support their child. Such a situation of the participant affects their relationships with family and exposes them to spending extra money while they hire workers for the home activities and boys work in the home as females which influences the psychology of the family and impacts family relationships. the participant of this study explores his experience as the following; “First of all, it's not on fire, I don't work now, my twins are ten years old, and I have kids. When a worker leaves, a lad cooks in this manner; nobody comes to work for you. It has significant sway. I don't wash the kids' clothes if I don't work and eat. My wife and my neighbor are at work right now. This has a significant effect”. (44 years old female patient, P 9)
Sub-theme 5. Affect spiritual activity
Almost all of the participants has good strength in their religion, and they believe such treatment they obtain from the chemotherapy service is blessed by God. They tried to use their praying as a source of coping mechanisms while they lived with the stress related to complications of the disease. Those participants who have good participation in spiritual activity are accepting the disease and the treatment. This discourages them from participating in religious activities. Spiritual activity plays a great role in living without stress. This participant of this study explores her experience of spiritual activity as follows, “I attend church at night, I go at night so that no one can discover me while I am unwell. Stopped drinking coffee with neighbors and I send children to the village and send children to the market rather than me by the reason of fair of stigma” (46 years old female patient, P 3)
Participants investigate how community perceptions influence spiritual activity because they fear stigma in the community and believe this will be exacerbated when they find themselves in crowded areas such as a church, market, or bank; they may not even have participated in EDIR because they believe the disease will worsen. The study participant explores the perception of the community as the following: "The community says that going to church and EDIR is bad. I won't cry now if the individual passes away. since it isn't good. I don't know what they mean when they say that you can't see a corpse. However, stay away from the dead body's location, avoid crowded areas, and I'm not going to Edir. I am going to the private mourning (way). Although the sun is not excellent and I am apart from this, I have not departed. After a year, I'm still at home. I go to the same brotherhood even though I occasionally leave the family." (44-year-old female patient, P 9)
Theme 4. Psychological impact
It has two sub-themes, which are mental distress and changed emotional status. Almost all of the participants who are on chemotherapy for cancer describe having psychological problems.
Sub-theme 1. Mental distress
Almost all of the participants who are on cancer with chemotherapy described as having psychological problems. Those participants face body image disturbance-related anxiety, and they believe that, when they die, they want to die as they have cancer, and they were shocked for their family/ children. Most of the participants also thought that cancer was adeadly disease, and did not have a cure. They also thought the community isolating them related to this disease appeared on them. They explore that the main physical change of the body described by the participants was removing the hair, shirking, and darkening of the skin. The other things appeared on the participants were unable to get enough rest and they have difficulty sleeping, such conditions of the participants increased their level of anxiety and depression and then pushed them to suicidal acts. Some of them explore the impact of the disease on them as follows; “At the time, I was incapable of standing straight and lacked morality. I was irritated after that. "Dr," he said, handing me the [results]. To know my sickness and to die is all I desire. told me about the illness, but I don't think so; I believe I will pass away. I was aware of my illness, I wanted to pass away, and just now I didn't want to live”. (44 years old female patient, P 4).
This result was supported by experts as stated “They initially feel scared and angry because they believe there is no treatment for cancer.”. (HCW, Nurse, P14)
Some of the participants described the emotion was so high that personal equipment was lost at the movement related to stress. They were shocked when they heard the result. Such movement had its impact on the psychology of the individual and their family and also some participants explored that they have ignored to buy anything for their home and they can’t know what they do as a result of the stress. Mental distress as they live with Serious disease and they consider it as a punishment. Such a condition of the participant provokes their anxiety. The following participant explore the experience as follows; “Oh, I was very surprised to learn that. I was so astonished when I realized I had forgotten my bank account when I got on the bus. I was astonished and furious when I got on the bus with Markos to go to Addis Ababa. Oh, I am so depressed at home. When someone buys, what should I buy, and what should I do? Desperation, that is. I have no idea what I will do today, tomorrow, or the day after that. I never went to church, which made me turn around and think that it would cause nausea. I come home early and have a slow social life. The medicine is in my body and I am very debilitated. I just turn, and I fall all the time. It's hard, you can't be right all the time, in food and drink, and at festivals. When they came out with a white dress, I left them alone because I knew that if I wore it now and fell with them, I would get upset quick “(52 years female patient, P1)
Some of the participants live in great anxiety because they consider the condition of their child for the future as a result of thinking that this disease is a deadly disease and they wait for the time of day that they will die. They also cry because of such a serious disease. The study participants explore the experience as the following; “I will desire to pass away. When I said that nothing will be greater than this, this is where I came from. Anxiety was going to kill me. I had three children at the time I was told I was HIV-positive, so I wasn't stressed. However, after hearing this, I came here feeling nervous, crying uncontrollably, and wishing I could die. I only started crying when I saw the kids. I feel like I have a self when the kids explain to me why they are sobbing. Please don't touch it (cries)” (38 years of female patient, P8)
Most participants explore the advantage of accepting the disease on their mental health. Few of them don’t accept what they obtained in the chemotherapy center, even if most of them accept the disease and the treatment. Such a condition of the participant raises the level of stress. The psychological impact of the disease affects not only the participant but also their family member. The problem of participants affects each individual of the family members because when someone is ill in the family member, all of the stress is with the health status of the participant.
“My family was heartbroken. They had been crying. My initial child was born. She works at a university now. When I saw my 7-year-old 11th grader again, they started crying. "It's just a matter of order by God," however, was the only thing my husband said. I wasn't astonished when the kids sobbed, so I didn't mind. Because my mother passed away from cancer when she was just two years old, my sister was very distressed. I told my kids that I would live until I was very old and that nothing bad would happen. After accepting the opportunity, I carried on with my therapy” (42 years female patient, P2)
Those participants face body image disturbance-related anxiety, and they believe that, when they are dead, they want to die when they hear that they have cancer, they are shocked for their family and children. Most of the participants also believed that this was a fatal disease with no cure. They also believed that the communities that were isolating them were linked to the disease's appearance on them. The study participants explored the experience as follows: "When I heard about the disease, I wanted to die. “I think nothing will be greater than this. I was going to die of anxiety. When I was told that I was HIV-positive, I was not stressed; I have three children. But when I hear this, I feel anxious; there are so many tears in my eyes, that I would rather die. When the kids explain why you're crying, I feel helpless. "Please leave me alone (crying)." (P8, 38-year-old female patient)
Sub-theme 2: Alter emotional state
Changing emotional status to live has an impact on the psychological aspect of the participant. Most of them express that they are uncertain while they live with chemotherapy treatment. Many participants describe it as they live in a state of uncertainty. Even though they have a good feeling about chemotherapy, they describe living in worry about what will happen in the future. They live in fear of death due to not having permanent medication. The following participant explores their feeling as the following; " It's really difficult; I'm not sure how to describe it. The final illness is this one. I'm not sure. I can sense the pain. It hurts and you can feel it, which is a defining feature of the disorder. When someone hates me, my behavior changes, I get irritated, and I feel terrible. I'm losing hope because of this. (44-year-old female patient, P4).
Theme 5. Obstacles to get chemotherapy
It has two sub-themes: the inaccessibility of the service unit and the unavailability of the treatment.
Sub-theme 1: Inaccessibility of the service unit
All of the study participants pronounced that the inaccessibility of the service was the main issue that was mentioned as a problem. Even though they can pay for the service, most of the participants didn’t access an alternative. Most of the participants traveled a long distance from different villages to the chemotherapy center to access the service, which was offered every twenty-one days of the month. Such situations make it difficult for them to make it on time to the chemotherapy center according to their schedule.
Most of the interviewers conveyed the shortage of the treatment center of the oncology which is only FHCSH. Most participants traveled long distances to access chemotherapy services. Such situations made it very difficult for the participants to attend in oncology center on time according to their chemotherapy appointments. They complained about the limitation of the oncology service center which was found only in the capital cities which made it hard to get effective management. For this reason, eight patients of the participants explored that as traveled long-distance to have chemotherapy which also exposed them to spending extra money and they repeatedly talked about the inaccessibility of some services and drugs within the FHCSH which is important for cancer patients.
The study participant describes their experience as the following: "I come from Lalibela and its surrounding kebele, which is far from this; eh, it's a challenge; it’s so far; it costs money to pay for transport." I haven't always returned home within a day. I also pay for a bed in the heart of the village."(58-year-old male patient, P13)
This is supported by the experts at the center of oncology: -
“If you can't reach a distance, for example, by appointment today. They come from Lasta woreda [South Wollo] which is 311 km from Bahir Dar city, some customers come from the Oromia region. They said they did not arrive on the day of the appointment due to transportation problems, even if we admit these people where they came from, they will be delayed.” (HCW, Nurse, P14)
"There is a severe scarcity at the center. There is a severe shortage of the center right now. Although no one speaks anymore, cancer is now emanating from every home. unable to manage. While some argue that they ought to be sent for radiation, there is no radiation associated with this. These days, a protectionist attitude is pervasive everywhere you turn. The rate of cancer is rising. Even still, there are too many people to accommodate”. (HCW, GP, P15).
Sub-theme 2: Unavailability of the treatment
The discontinuation of chemotherapy drugs and laboratory investigations, which were costly in private drug stores and private laboratory centers,
“Sometimes the treatment that is necessary for us was not discovered in this health institution, we buy in private pharmacy which is so pricey. If you have money, you did not have service at this time. Additionally, pharmacies and private clinics did not accept health insurance. It is tough.” (24-year-old female patient, P12)
“The majority of the laboratory research was conducted in private clinics, which we visited daily and which charge 300, 400, and 500 times more than government institutions. How do you feel? For my family and me, it is incredibly weighty. Every day, I pray that this hospital would provide treatment drugs and laboratory investigations” (58-year-old male patient, P13).
The experts at the oncology treatment center describe the problem of drug shortages as follows: "Since medications are very expensive and not everyone can afford to buy and use them, it is unfortunate that sometimes they get lost. If the medication is available from this [hospital], people will buy and use it. However, if it is discontinued, that will present a challenge for us. If there is a shortage of medication on the [hospital] campus, that presents a challenge for the patient who is unable to provide it." (HCW, Nurse, P14).