NCDs: It’s Time for a Change
By: Nellie Bristol
It took the patient, a farmer in his forties, an entire day to travel to the clinic in Karatu, Tanzania. He’d been in discomfort for a number of months. He had sought treatment from a traditional healer to little effect: the swelling all over his body, in his neck, groin and armpits, even his liver and spleen, was worsening and he felt sicker than ever. But even at the clinic, geared toward primary care, diagnostic and treatment alternatives were sparse. If he had come in earlier, and he’d had sufficient financing and family support to facilitate his care away from home, doctors could have sent him to a cancer hospital in Dar-es-Salaam, a 10-hour drive. As it was, his disease was too far along. “He obviously had a treatable lymphoma, but we had nothing. We couldn’t do a biopsy, I couldn’t get him medicines and all we did was give him a non-steroidal and send him home to die,” said Sue Miesfeldt, an oncologist from Maine who was visiting the clinic in January 2010 on a self-funded tour of cancer care in the country. The five-year survival rate for what Miesfeldt suspected the patient had, non-Hodgkin’s lymphoma, is 65 percent in the United States with fairly straightforward and widely accessible treatment. The episode left a lasting impression on the Portland physician, who was used to being able to do much more for her patients, if even providing them with more effective palliative care. “I was angered…because just a little bit of distribution of just a piece of what we have in the United States would have gone such a distance over there. That was the most difficult lesson for me,” she said.
