Establishing women’s cancer care services in a fragile, conflict and violence affected ecosystem in Africa

Abstract

Background:The majority of the world's poorest women (income < $1.90/day) reside in fragile, conflict and violence (FCV)-affected countries, like the Democratic Republic of the Congo. Health services in these settings have traditionally focused on immediate relief efforts, communicable diseases and malnutrition. Recent data suggests there is need to widen the focus to include cancer, as its incidence and mortality rates are rising.Methods: Employing competency-based learning strategies, Congolese health professionals were trained to perform same-day cervical cancer screening and treatment of precancerous lesions of the cervix; same-day clinical breast examination and breast ultrasound diagnostics; surgical treatment of invasive cancers of the breast and cervix; and infusion of cytotoxic chemotherapy. Outpatient breast and cervical cancer care clinics, a chemotherapy suite and surgical theatres were outfitted with equipment and supplies.Results: Combining local and regional hands-on training seminars with wise infrastructure investments, a team of US and Zambian oncology experts successfully implemented a clinical service platform for women's cancers in a private sector health facility in the Democratic Republic of the Congo. Conclusion:We forged a novel partnership between oncology health professionals from Africa and its Diaspora, international philanthropic organisations, a cancer medicine access initiative and an established African cancer centre to build women's cancer services in a FVC-affected African setting. Research

Women’s cancers in Sudan with a focus on cervical cancer: turmoil, geopolitics and opportunities

“…Policies are also needed in collaboration with the international community in addressing the cancer care needs of internally displaced and refugee women in Sudan. Novel approaches implemented in other parts of African conflict zones can potentially serve as models for interventions in these vulnerable populations [ 38 , 39 ].…”

Establishing women’s cancer care services in a fragile, conflict and violence affected ecosystem in Africa

“…A total of 241 women have undergone surgery, consisting of 183 breast lumpectomies, 58 modified radical mastectomies and 48 axillary lymph node dissections (LND) (Figure 2). The specifics of this programme and outcomes are described in the accompanying breast manuscript [17].…”

“…This report gives an overview of our approach to programme implementation in which workforce training was integrated with service delivery and clinical infrastructure development [9,13]. Other manuscripts in this series provide a detailed and rigorous evaluation of the clinical outcomes of our activities [15][16][17].…”

To parachute or not

“…The activities resulted in the successful transfer of diagnostic and surgical skills to local Congolese collaborators. In partnership with the healthcare facility where the activities were implemented (Biamba Marie Mutombo Hospital) a new women's cancer care infrastructure was simultaneously developed that offers life-saving radical surgery for early cervical cancer and breast cancer; oncoplastic and palliative breast surgery; and chemotherapy for cervical and breast cancer [9][10][11][12]. Along with compensation for their work, the gain for the HIC collaborators was the satisfaction of expanding women's oncology services in a country in dire need of such.…”

“…Working in Africa over the past two decades with the sole intent of building gynaecologic and breast oncology capacity, we strongly condemn the negative aspects of parachuting. Instead, we embrace the activities exhibited by our constructive approach (positive parachuting) to capacity building, as per our work in the DRC, Malawi and Zambia [9][10][11][12][13][14][15][16]. Our capacity building activities in these countries have always been performed with local experts as peers, lead authors and co-authors [9][10][11][12][13][14][15][16].…”