History and ongoing work of AORTIC
Dr James Holland - Mount Sinai Hospital, New York, USA
Can you tell us a little about your organisation, AORTIC?
Many years ago in the late ‘60s I met an African and we became very good friends. His name was Victor Anomah Ngu and he was a research fellow in Boston and through scientific collaborations I got to meet him and we hit it off, we were friendly. So in about 1982 at the International Cancer Congress, which was held in Seattle, Anomah Ngu was there with a Nigerian fellow that I had trained and with a professor of surgery. He, Ngu, had been the Dean at the Ibadan School of Medicine by that time, having previously been the Chairman of Surgery, so he brought his Chairman of Surgery with him, and he subsequently became the Health Minister of Cameroon and he was Cameroonian by birth. With him was a young Nigerian fellow that I had trained at Mount Sinai. So the four of us had lunch with my wife and I was the Chairman of a collaborative group in the United States at the time. I said to Ngu it would be sensible to have a collaborative group in Africa because there’s a great deal of benefit. You dilute the bias of a single observation, you increase the number of patients who can be accumulated, you get multiple intellectual inputs and potentially you can also get resources as a group. So we decided that was a good idea and we set up the African Organisation for Research and Training in Cancer and it has the acronym AORTIC which is the lifeline of blood vessels. We had our first meeting in 1983 in Togo and Williams, who was the youngest of the group served as Secretary General and went around and recruited Africans who were interested in Cancer because there wasn’t any oncology as such in Africa at that time. There were perhaps thirty or forty people at that meeting in Lomé, Togo, and Ngu couldn’t have been more important because there was a single woman who translated French and English and Ngu made the point, and he was bilingual, that the English and French languages were imposed on Africans and we are all Africans, we are not English or French speaking Africans, we are Africans so let not the distinction between Francophone Africa and Anglophone Africa create a problem for us. It was enormously important and there was great enthusiasm.
I learned at the time that some people would have patients come to their hospitals with cancer and the treatment would be a bottle of aspirin and send them home to die. It just seemed so unfair that this was the outcome of colonisation of Africa. So we set out to increase and improve through training and research and education. As such it became very dynamic in the ‘90s, the ‘80s and the ‘90s, and then it became dormant for a while when many of the leaders left Africa for other places. Then it was revitalised primarily in the United States by ex-patriots and became again vital with meetings every two years now, first in Accra, then in Dakar and in Cape Town and in Dar Es Salaam and most recently in Durban and a planned meeting in Marrakesh. Now of the 55 nations in Africa about 40 are represented and have had a major increase in their interest in cancer, in the political impact of this organisation on governmental structures in Africa, in research programmes that have been undertaken and in initiation of collaborative activities with European and American and Canadian universities that bring talent. The fundamental proposition was missionaries don’t really work, they come and they leave and nothing is left behind, this has to be Africans for Africa. So there are some dynamic African leaders who are intellectually superior and dynamic and helping and there is widespread great improvement, I think, in Africa.
An example of one thing: a collaborative work programme in Tanzania that I have done with the Director of the Cancer Institute in Tanzania. The major problem in Africa is late presentation; the patients come with cancers that are so far advanced that he said, ‘If you had to treat the same cancers I have to treat you’d get the same results I get,’ which is true. And that relates to education and economics and transportation, many other things. So we set up a programme in which two villages were randomised and the chiefs of the village knew ahead of time that one would be control and one would be intervention. The intervention village, the Cancer Institute Young Faculty, the junior members of the faculty trained the lay people in the community how to examine a patient because even a high school boy can say, ‘You look sick.’ And they made deliberate incursions into the home and took a history and made an examination and anybody that departed from what they were taught was normal was sent for a medical opinion. In the control village they took care of themselves as they ordinarily would and when they felt sick enough they went to the dispensary. We measured the outcome over three years of the cancers discovered. As you might expect, twice as many cancers were discovered in the intervention village but, more importantly, because the original group had advanced cancers, as we eliminated those in the second and third year the cancers were now down-staged so that they were early cancers and could be treated with an intent to cure instead of an intent to palliate.
That brings about the possibility of saving lives in Africa and this is the kind of thing that AORTIC can do. I hope over the course of time and long after I’m out of the picture that Africans will carry this forward. There has been a dynamic role of Africans doing this, particularly the Presidents who are picked because they are indeed electable from the membership but also the Secretary Treasurer now, Dr Lynette Denny, who has devoted her life to this and is a wonderful human being who is crucially important to the success of AORTIC.