We have a poster on something called Project ECHO and Project ECHO is a very simple model of telementoring. It was developed by Dr Sanjeev Arora at the University of New Mexico maybe about ten years ago. He is a gastroenterologist who treats patients with hepatitis C and he realised that in the very rural state of New Mexico there were maybe 30,000 people infected and the only place they could get treated was either Albuquerque or Santa Fe, so just two locations. So he developed a video conferencing group, if you will, of about fifteen clinics and six prisons and basically guided the primary care physicians through the treatment of patients with this disease. It was a complicated set of treatments, it required the patients to see the doctor maybe 12-18 times over a one year period and it was very successful. So the local physicians became empowered and developed the skills necessary to treat this disease, the patients didn’t have to travel hundreds of miles to see the doctor once every 2-3 weeks and it was a way to move knowledge instead of people, if you will. It created specialists among the primary care providers able to treat this illness.

So we’ve adapted this model to a variety of different scenarios for cancer prevention, for management of cancer, in low resource settings. We’re developing one in palliative care as well. So the Project ECHO that we have here in the poster at AORTIC talks about all of our projects but the ones that we’re focussed on particularly, as this is a conference about cancer in Africa, is the collaboration that we have with doctors at the Cancer Diseases Hospital in Zambia, in Lusaka, and also Maputo Central Hospital in Mozambique. We have a multidisciplinary team at MD Anderson who meets on a regular basis with doctors in each of these locations and we discuss difficult cases and the different treatment options. Obviously MD Anderson is a very high resource hospital and these are low resource areas so it’s an opportunity for us all to learn from each other because we cannot offer the same treatment in Mozambique that we can in the United States.

So it’s been a very good working relationship and it offers a nice foundation for continued communication, opportunities for collaboration in a variety of different areas have presented itself and so it has been a very, very good model.

What challenges have you faced?

There’s always the challenge of internet. Really all it requires is enthusiasm on both ends of the camera and good internet. So that is always a bit of an issue but otherwise there aren’t really that many challenges. It just requires interest and a little bit of commitment to develop those relationships, to discuss the cases. Of course it requires time on everybody’s part and that’s sometimes difficult to find but it doesn’t take much time, it’s at no cost for the partners in Africa.

Interestingly, the project that we run with Mozambique is conducted in Portuguese and so we have partners in Brazil who are mostly the moderators of those discussions because I don’t speak Portuguese and neither do any of our doctors at MD Anderson. But we are facilitators and participants but the actual medical discussions and the presentations are done in Portuguese.

Are there any regulatory oversights?

No, it’s kind of make your own, build your own. Project ECHO is actually trademarked and really the philosophy behind it is that you do it in good faith, it’s connecting consultants with providers in under-resourced or low resource settings; it is at no cost to them. That’s basically it so it’s just video conferencing and it’s done in good faith with those tenets behind the process.

What are the next steps for this project?

We have been using Project ECHO for about a year and a half at MD Anderson. Our first project was for cervical cancer prevention in the under-resourced area along the Texas-Mexico border. It’s an area where more women get cervical cancer, resources are very low, there are fewer doctors and nurses in that area, particularly treating patients in the public system. So we have had a very good twice a month connection with the providers, mostly nurse-practitioners, nurse-midwives, physicians’ assistants and a few doctors in that area. It’s part of a larger strategy that we have to bring more women in, to make sure they get the proper screening and the proper evaluation and to find them when they don’t come in for their appointments. So we’re losing a lot less to follow-up. By doing this we hope that ultimately we will reduce the burden of cervical cancer in this area.

So from that we developed also the cancer management for breast and cervical cancer in Africa. We also have a consortium of Latin American partners and we do cervical cancer prevention and management. Again I would say we’re the moderators and facilitators, some of us do speak Spanish, but it’s a consortium of ten countries, representatives from ten countries, and we do that as a Project ECHO also. Our next developing project, I would say, is in palliative care and it’s palliative care in Africa and palliative care in India. So we have a team of palliative care specialists at MD Anderson who are in the process of developing the relationships among the palliative care teams in Africa and India to create that Project ECHO.