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South Wales Sierra Leone
South Wales to Sierra Leone Cancer
Cancer
care
link Care Link
Richard Adams
Reader & Honorary Consultant in Clinical Oncology,
Cardiff Uni & Velindre Cancer Centre
South Wales Sierra Leone
Cancer Care Link
Cancer in Africa
A neglected critical public health problem
Health Problem in Africa
 Cancer causes more deaths than AIDS + malaria + TB
 2008 World Global Cancer declaration described
cancer in developing countries as ‘an impending disaster’
 2/3 cancer deaths in developing countries
 WHO est (2010)no of cancer deaths in developing world:
6.7 million in 2015; 8.9 million in 2030
 Survival Poor
 Lack of quality data for cancer control planning
South Wales Sierra Leone
Cancer Care Link
Cancer Prevention, Treatment & Palliation
Workshop Freetown Jan 2010
An Afro- Welsh Consensus meeting – 46 delegates
Memorandum of Understanding
South Wales Sierra Leone
Cancer Care Link
South Wales Sierra Leone
Cancer Care Link
Education
Undergraduate
and post
graduate
Cancer
prevention
Cancer
Registry
Cancer
Care in
Sierra
Leone
Affordable
treatable
cancer
Palliation
and
symptom
control
Linking with other groups
• Finding others
– Word of mouth
– Long standing relations
– Wales 4 Africa
– www.
• Developing ideas in partnership
• Keeping in touch
South Wales Sierra Leone
Cancer Care Link
COMAHS
Connaught Hospital, Freetown
Ministry of Health & Sanitation, SL
South Wales Sierra Leone
Cancer Care Link
Cancer
Registry
Cancer Registry
Support
– Provision of software –
Connaught & later SJOG
– Training (VIJI)
– Linking with WCISU
– Technician (MoHS)
– Dr Koroma visit to UK 2012
– Microscope with digital camera
– Microtome
100 yr old microtome
South Wales Sierra Leone
Cancer Care Link
Cancer
Registry
Strengths
- Strong Communication
- Links – VIJI; WCISU (only linked registry in World)
- WHO recognition
Challenges
– One Pathologist in public sector Dr “Owizz” Koroma
– Technician leaving
– Hierarchy
• only Dr Koroma adding entries
• only pathologist & forensic
delay;
• results from one centre
South Wales Sierra Leone
Cancer Care Link
Affordable
treatable
cancer
Affordable Treatable Cancer:
Burkitt’s lymphoma
Commonest malignancy in children
Rapidly growing related to
EBV infection & malaria risk
60% cure shown in other African
countries with ‘affordable’ chemotherapy.
Est 100 cases per year in Sierra Leone
(0.8-1.8/100,00 in W Africa)
Child with advanced
Burkitt’s Lymphoma .
South Wales Sierra Leone
Cancer Care Link
No / limited treatment in Sierra Leone
Affordable
treatable
cancer
Burkitt’s Lymphoma
Aim – Establish centre of excellence for treating Burkitt’s
Adapting - location
• Connaught Hospital
• Childrens’ Hospital Abertawe Bro Morgannwg link
• St John of God Hospital, SJOG Lunsar
Cooking for the patients, SJOG
South Wales Sierra Leone
Cancer Care Link
Affordable
treatable
cancer
Burkitt’s Lymphoma
Establish centre of excellence for treating Burkitt’s
Learning from Others / Prior Experience
• Experience in Uganda
• UHW link
• IARC - Ian McGrath / Ngoma
• Malawi
– Minimising side effects
• Barcelona link
– Ensuring good follow up
– Sustainable drug supply
Drug trolley, SJOG
South Wales Sierra Leone
Cancer Care Link
Affordable
treatable
cancer
•
•
•
-
Burkitt’s Lymphoma
Practical Approach
Treatment algorithms - adaptation
Patients stay in for treatment / use of mobile phones
Listening to partners
Ambulance
Cultural beliefs
Support
Assessment of needs – fridge, preparation areas, staff
Initial teaching
Follow up teaching
Sensitisation of local chiefs & community
Welsh volunteers in country
South Wales Sierra Leone
Cancer Care Link
Affordable
treatable
cancer
•
•
•
•
Adjusting to
challenges and changes
New partners
Hierarchy
Change in personnel
Ebola…
South Wales Sierra Leone
Cancer Care Link
Ebola
Palliation
and
symptom
control
Palliation & Symptom Control
Desired Outcomes
1. Dedicated Cancer ward (VIJI) with cancer care nurses &
Palliative care team in Connaught, Freetown
2. SJOG – lead team, all trained – mobile unit
3. Inclusion in undergraduate curriculum
Connaught
ward piccy
South Wales Sierra Leone
Cancer Care Link
Palliation
and
symptom
control
Palliation & Symptom Control
Strengths
• Affordable
• Links
Hospice Africa, APCA, Shepherds Hospice
Challenges
• Principles not currently taught
• Drug supply
• Morphine fear
South Wales Sierra Leone
Cancer Care Link
Palliation
and
symptom
control
Access to adequate pain control
a recognised problem…….
Morphine storage in a
Sierra Leone Hospice




80% present advanced disease & require pain control
< 10% receive adequate pain control
Majority cancer patients die in severe pain
March 2015: only analgesic in Connaught pharmacy was diclofenac
South Wales Sierra Leone
Cancer Care Link
Education
Undergraduate
and post
graduate
Education
• Medical & Pharmacy Curriculum • partner links (VIJI, Connaught, Cardiff Uni)
• Short course in Cancer Care for qualified staff
• Nursing School at SJOG
• Community education programmes – link with other projects
• Case Conferences
South Wales Sierra Leone
• Microscope with camera
Cancer Care Link
Cancer
prevention
Cancer Prevention
Education
• Cervical Cancer
– GAVI
• Hepatitis B
– WHO
• Smoking
South Wales Sierra Leone
Cancer Care Link
Summary
Desired Outcomes
• Cancer Registry with reliable data
• Centre of Excellence for treating Burkitts
Lymphoma
• Appropriate symptom control & palliation in
SJOG & Connaught
• Undergraduate & post graduate courses in
cancer care for SL
• Support of prevention initiatives
Summary - Challenges
•
•
•
•
•
Ebola
Hierarchy
Changing personnel
Logistics
Communication
Summary - Strengths
-
Collaboration
Communication
Adaptive
Long Term Strategy
Realistic /practical approach
Listen / responsive to partner needs
Thank you for listening………….Any questions???
South Wales Sierra Leone
Cancer Care Link
Beautiful beaches slide