By Lawrence Shulman, MD
Dana-Farber, with our partners Brigham and Women’s Hospital and Boston Children’s Hospital, offers patients highly advanced treatments in modern facilities. Our patients also benefit from an excellent staff, clinical research, and extensive resources, and many of them survive cancer to live long and healthy lives.
Is it fair, then, that cancer remains a death sentence elsewhere in the world? In Rwanda, for example, a country of 10 million people, cancer care has been completely unavailable to almost all patients. They die of cancers that could have been cured in Boston.
Dana-Farber/Brigham and Women’s Cancer Center is bringing expertise and resources to countries such as Rwanda, Malawi, and Haiti, in collaboration with Partners in Health (PIH), and with support from the Jeff Gordon Children’s Foundation, the Lance Armstrong Foundation, and Michele and Howard Kessler. Teamwork is critical here; PIH is skilled at delivering health care in very resource-poor places, but lacks specific cancer expertise. We understand cancer, but not how to care for patients in such challenging areas, where much of the infrastructure required for cancer care (such as pathology labs) is missing. By joining forces, we can offer cancer patients of all ages a chance at life.
We’re beginning in the tiny nation of Rwanda, the most densely populated country in Africa and one of the poorest in the world. Our goal is not only to help bring cancer care to individual children and adults, but also to work with the Rwandan ministries in developing the policies and infrastructure needed for this work to take place.
One of the first patients we helped was Francine, who at age 11 had a sarcoma the size of a grapefruit growing out of her cheek. Her PIH doctors conferred with our pediatric oncologists remotely. Her pathology was sent back here for analysis. We supplied her chemotherapy drugs, and surgery was done at a regional center. Today, she is an energetic teenager who greets me on my trips to her country.
Effective cancer care is like a long chain, and any weak link can impede your ability to help patients. You need tools for detection, labs to process samples, pathologists to diagnose, pharmacies to mix drugs, and doctors, nurses, and community health workers to provide the care.
This kind of chain is just beginning at Butaro Hospital in Rwanda, which was opened by PIH last year. Through a collaborative care model there, Dana-Farber supplies cancer medications and same-day expert consultations with our oncologists in Boston. Brigham and Women’s Hospital provides pathology of tumor tissues and surgical expertise. Our doctors and nurses in Boston advise Rwandan doctors and nurses via emails and weekly phone meetings. When I return with a Dana-Farber team in March, we’ll help set up a pathology lab at Butaro Hospital and teach the Rwandan team the basics of cancer care.
Some ask why we do this work, but I ask, why would we not? Having a chance to help such gracious, determined, and smart people, and seeing a healthy teenage girl who otherwise would have died, is a privilege beyond words.
Read Dr. Shulman’s article in The Lancet.
Lawrence Shulman, MD, is Dana-Farber’s chief medical officer and senior vice president for medical affairs. He is senior oncology advisor to Partners in Health and associate professor of medicine at Harvard Medical School.