Networking and collaborating across borders in sub-Saharan Africa

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Published: 26 Jun 2014
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Dr Shubhra Ghosh - Project Director of Global Programs, MD Anderson Cancer Centre, Houston, USA

Dr Ghosh talks to ecancertv at WIN 2014 about collaborative research across the world, with specific reference to the work that the MD Anderson Cancer Center is doing with sub-Saharan Africa and the cultural differences that need to be negotiated to deliver the best care.

This is one of the most exciting meetings of the year because it’s really focussed on personalised cancer therapy and that’s where pretty much all of medicine is going, certainly cancer. The best opportunities for our patients lie in the personalised approach. So cancer being so diverse, as it is, there is enough diversity within cancer types plus there is a lot of diversity in the same cancer types occurring in different parts of the world. So at Anderson we work with our colleagues around the world and we do this through establishing institutional relationships with other major cancer programmes. This is a big network, about thirty or so institutions that are premier cancer programmes, they are part of this network. We work together doing collaborative research, academic exchanges and in the last two, two and a half, years we are now looking to engage with our colleagues in Africa because that’s a new setting, lots of opportunity for us to learn and hopefully work with colleagues there.

With the governments within Africa, the sub-Saharan African countries especially, there is a great need for improving the cancer programmes locally which is becoming very apparent. The governments there have realised that they need to pay more attention to developing their own cancer programmes and they’re putting in a major effort at their end and we just want to be part of the whole process, to be able to add whatever we can, both for ourselves to learn from them as well as help them do what they want to do. Of course, this is one thing that’s such a major task no-one can do it alone so we are partnering with the other major organisations who have already been engaging with Africa for much longer than us: the International Union for Cancer Control, the National Cancer Institute, Pink Ribbon, Red Ribbon, with great support from other organisations like the National Breast Cancer Foundation and many others. So this is a very exciting time and we are very excited to be part of this whole changing scenario in terms of, as you may know, the developing world is seeing a rise in cancer cases so the burden of cancer is shifting to the developing world. So this kind of a meeting here, the WIN symposium, is a very exciting opportunity to learn and see how we can bring these personalised cancer therapy approaches to every part of the world actually.

What are some of the projects you are carrying out in Africa?

The profile for cancer in Africa is a little bit different from what we have in the US. It seems like in most of the sub-Saharan African countries cervical cancer is their number one cancer, both in the number of cases that they see as well as the mortality associated with it. In terms of treatments there are major gaps in different approaches. Besides cervical cancer there are other cancers also that are very prevalent there and awareness is growing as we go along. Breast cancer is another major cancer they see among women, prostate cancer among men, head and neck cancers, colon cancers, so some of these cancers are very prevalent. Of course, with HIV survivors you see another spectrum – the lymphomas and actually many younger women develop cervical cancer who are HIV positive. So the profile of cancer is a little bit different and we, at Anderson, hope to learn in this whole process because what we see in Houston may not be the same as what you see in Zambia. So in that sense it is a huge opportunity for us and that’s why it makes us even more excited to engage with our colleagues there.

Are you looking at conventional medicines as well as personalised medicine?

Yes, absolutely. Conventional medicine, bringing all the different ways and different approaches as relevant to the local needs because it cannot be one size fits all and it cannot be just one approach. Obviously you have to make a combination of different approaches, early diagnostic tools have to be employed and cancer prevention has to be a major part of the bigger effort. So approaching it from different aspects is going to help us get there quicker.

What are some of the challenges in setting something like this up?

Actually the challenges are several; one, of course, being the fact that it’s very different from what we see in our hospital and in our setting in Houston. Also the approaches we have, the standards of care we practice are different. Besides that, the cultural differences are also a major aspect of the whole approach to management of cancer. Within Africa the tribes have a lot of influence on the community; a lot of patients like to go to the faith healers and that has been their traditional medicine so coming to hospital to seek treatment and going to the doctor in a hospital setting is not necessarily the first approach for many patients, they would rather go to their tribe leader or the faith healer. So making them part of the whole approach definitely is very important to make sure that you are capturing the largest number of patients who need the care and also to be actually effective in getting the patients to see value in getting care in the hospitals. So there are many challenges but we are really looking for ways to work around the challenges because it’s easier to feel that you cannot do it but if you take one step at a time there are ways to get to a good starting point and then to bigger successes.

In the long run we hope to make it a comprehensive programme but the initial thing would be to identify, working with the Ministries of Health in the individual countries, to identify their own priority areas. If it is palliative care that is most important to them then help them with developing their own palliative care programmes. If it is early diagnostic tools or surgery, depending on whatever is on the list of those individual countries based on their own assessment we can work with them and we hope to be able to train a lot more community health workers because there is an acute shortage of oncologists and physicians on the continent so capacity building would be the major focus in this effort.