Gynecologic Oncology Sub-Specialty Training in Ghana: A Model for Sustainable Impact on Gynecologic Cancer Care in Sub-Saharan Africa

Abstract

African women have double the risk of dying from cancer than women in high-income countries. In Ghana, most women with gynecological malignancies present with advanced-stage disease when treatment is less effective. Barriers to improved cancer outcomes include the availability of cancer screening, affordability of treatment, and access to gynecologic oncology specialists. In response to a paucity of gynecologic oncology providers, an in-country fellowship training program was established at Komfo Anokye Teaching Hospital (KATH) in 2013. Historically, Ghanaian resident physicians were sent to other countries for fellowship training and were unlikely to repatriate. The establishment of an in-country training program not only addresses the challenge of “brain drain,” but also builds local capacity in gynecologic oncology education and emphasizes culturally relevant and accessible healthcare. The four-years gynecologic oncology fellowship program at KATH was developed as part of a longitudinal multi-decade partnership between the University of Michigan and academic medical centers in Ghana. The fellowship trains obstetricians and gynecologists to provide subspecialist clinical and surgical care to patients with gynecologic malignancies. Fellows collaborate with the radiation, oncology and pathology departments, participate in monthly inter-institutional tumor board meetings, conduct research, advise on health policy issues, and train subsequent cohorts. This fellowship is representative of emerging twenty-first-century trends in which subspecialty training programs in low-income countries are strengthened by international collaborations. Providing specialized training in gynecologic oncology can help develop and maintain resources that will improve clinical outcomes for women in low-resources settings.

Incidence, Treatment and Outcomes of Cervical Cancer in Low- and Middle-income Countries

“…Although few patients are diagnosed with early stage disease and qualify for surgical management, it is estimated that 93% of sub-Saharan Africa's population does not have access to safe, timely and affordable surgery, including fertility-sparing surgeries and radical hysterectomy. Ideally, a surgeon with training in oncological resections ensures the best oncological outcomes, but some of these surgeries are being carried out by general gynaecologists or surgeons without specialised training [27]. It was observed in a study that 12% of cervical cancer patients at public referral hospitals in Kampala, Uganda were eligible for a hysterectomy.…”

Building PRM in sub-Saharan Africa

“…International educators dedicated their time to train interested physicians in sub-Saharan countries to become PRM experts and help construct sustainable programs. This model of international partnership between high-income and LMICs has been described by other medical specialties as well ( 12 , 13 ).…”

Epidemiological and Histopathological Characteristics of Gynecological Cancers in Somalia

“…The higher rate of cervical cancer in SSA, including Somalia, is attributable to the fact that this region has no organized cervical screening and vaccination programs, poor sanitary conditions, multiple partners, high prevalence of sexually transmitted diseases (STDs), high parity, and immune suppression due to malnutrition and Human Immunode ciency Virus (HIV). In addition, lack of knowledge of the disease, lack of early detection, and effective management of precancerous lesions are also factors to consider (3,4,6,8,12,13,17,18). Cervical cancer, only cancer that is nearly entirely preventable and curable if detected early, primarily affects women in their middle years (30 to 50 years) (19).…”