Blogging from the African Organization for Research & Training in Cancer conference
11/11/2009
Molly McHugh Blogs from the African Cancer Conference in Tanzania
How do you diagnose cancer if you can't store a tissue sample because the power goes out periodically? How do you research the particular characteristics of a disease in different phenotypes if you are unable to mobilize the necessary funding? How do you create a sustainable cadre of health professionals if there is not a strong mentoring system in place, and internet connectivity costs 50 times more than in the U.S.? All of these questions came up in today's research symposium, and each of them circled back to the need for strengthening health systems in developing countries, which, it was noted, coincides with the need to strengthen research systems.
Dr. Richard R. Love, scientific director of the International Breast Cancer Research Foundation, noted that the majority of research cases on breast cancer have been middle-class North American and European Caucasians. However, studies that have been done outside this group have often shown that there can be great differences in the development of the tumor and the reaction of the patient to different treatments based on their phenotype. In addition, because of cultural differences and the range of health systems in different countries, the stage at which the disease is diagnosed, and the subsequent treatments, may vary widely. Hence the need for more in-country research, as well as in-country public health approaches to these varying situations, such as training primary health care workers in using cell phone reporting.
Dr. Clement Adebamowo of the University of Ibadan, Nigeria, further outlined the current challenges to cancer research in sub-Saharan Africa by focusing on the need to articulate clear research priorities, a current lack of infrastructure to conduct and manage research enterprises, a poor regulatory and compliance environment, and the trend of collaborative studies being largely driven by the needs and perspectives of the international collaborator. Among his suggested paths to improvement, he suggested the range of opportunities for capacity building in financing - resource mobilization, budget development and evaluation, as well as aspects of government mechanisms for monitoring and assuring equity for all stakeholders. In addition, there is much to be gained from creating and enhancing strong linkages between academic centers, both within and outside sub-Saharan Africa.
Dr. Louise Britton, director of cancer epidemiology and genetics at the U.S. National Cancer Institute, highlighted how researchers could avoid the pitfalls of epidemiologic research. Examples of such pitfalls include cultural issues such as attitudes towards disease, medicine and sexuality, and logistical difficulties like washed-out roads and a lack of reliable power sources. She noted that it was essential to involve local health-care workers, whose knowledge of local behaviors, customs and landscape is invaluable to any project. Again, the need for increased numbers of health-care workers, and training opportunities for them, was made apparent.
Although the topic of this symposium was cancer research in Africa, because of the cross-cutting nature of several of the issues discussed made during the day, the following point was made several times by the presenters: In this world, why can we deliver up to 9 million Harry Potter books in one day, but in some African countries the childhood immunization rates remain below 30 percent. Why can't we deliver essential prevention and treatment mechanisms to those who need it? To change this scenario we will have to look beyond specific disease-only approaches and take a comprehensive view of health systems.
- Dar es Salaam, Tanzania, Nov. 13, 2009
Today the conference was abuzz with a visit from Tanzanian President Jakaya Mrisho Kikwete. Briefly mentioning his own father's death from cardiac cancer, President Kikwete's message to the delegates was one of unwavering support for research and training in cancer. In particular, he singled out the Medical Women's Association of Tanzania (MEWATA) for their work in reaching many underserved populations with screenings, prevention and treatment in several health areas. Coincidentally, I had the opportunity to meet a very active member of MEWATA, learn her story, and that of her organization.
Dr. Lilian Mnabwiru is a native of Dar es Salaam. A few years ago she was able to secure a special scholarship from the U.S.-based Carnegie Corporation to attend the University of Dar es Salaam and then further her medical training at Muhimbili Hospital here in Dar. Out of her graduating class of 206 physicians, there were only 45 women - more than in previous years, but the disparity demonstrates the broad gender gap that continues to exist in advanced science education, particularly in the developing world. Dr. Mnabwiru currently works at a busy government hospital, where patient numbers are high - the maternity ward sees up to 50 births a day - but where staffing is an issue. As she puts it, there is an excellent lab facility, but not enough people to fully staff it.
The Medical Women's Association of Tanzania has approximately 1,000 members, representing female doctors across the country. MEWATA has held health clinics in seven regions of Tanzania, and they have screened more than 64,000 women for breast cancer. Next up? Increasing the number of clinic facilities available throughout Tanzania. This will start with a new facility for an outer area of Dar es Salaam, and they have help - the First Lady of Tanzania has been garnering monetary support and the clinic is in the planning stages.
- Dar es Salaam, Tanzania, Nov. 12, 2009
"An immense public health problem of unquantifiable proportion." This is how the burden of cervical cancer on the African continent was described today by Professor Isaac Adewole of the College of Medicine, University of Ibadan, Nigeria, and Bixby Leadership Fellow in Reproductive Health at the Guttmacher Institute. Adewole's remarks were part of a Glaxo-Smith Kline sponsored symposium today entitled "The reality of cervical cancer prevention: an African perspective." Worldwide, every two minutes a woman dies of cervical cancer. It is a cancer that is found throughout all parts of the world, but the mortality rate is particularly high on the African continent at 80 percent. Why? According to Adewole, several contributing factors include low rates of screening, a lack of political, financial, logistical and intellectual commitment, the twin problem of HIV infection, and missed diagnosis.
Yet there is great potential for significant improvement in prevention, particularly with the increasing availability of HPV vaccination. Of particular interest is a collaborative partnership between GSK and PATH, both Global Health Council members, on pilot projects in India and Uganda. In Uganda, the projects are specifically looking at how to deliver the vaccine to a rural population. In two similar districts, two different strategies have been employed. One district project focuses on delivering the vaccine specifically to 10-year-old girls during CDP+, which are semi-annual child health day fairs. The second district project focuses on delivering the vaccine based on primary school class, wherein an entire class of girls ranging from 10-12 yrs. old is administered the vaccine. In both cases, the vaccine had a high rate of acceptability among girls, parents, teachers and the community, proving that their may be more than one solution to get this prevention measure to a rural population. I spoke with Dr. Emmanuel Mugisha, the PATH project manager, and asked him what has made the partnership between PATH and GSK a success. He emphasized that two-way communication was key. His team could share their questions and challenges with their GSK colleagues, and GSK was continually communicating information they received back from other projects as well.
Perhaps the strongest message of the day came from an audience member's comment: "It is time to not just talk the talk, but we must walk the walk. We absolutely must figure out how to get funding for this issue, and how to make cancer part of the MDGs."
- Dar es Salaam, Tanzania, Nov. 11, 2009
Molly McHugh is membership manager at the Global Health Council.
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