ASCO-AMPATH Oncology Institute Host MCMC in Eldoret, Kenya, February 14-17, 2012
By F. Chite Asirwa MD, Director, AMPATH Oncology Institute, Visiting Asst. Professor of Medicine, Indiana University
Visiting Faculty, Moi University School of Medicine
The Academic Model Providing Access to Health care (AMPATH) is a collaboration between Moi University (Kenya), Moi Teaching and Referral Hospital (Kenya) and several North American institutions, Indiana University being the anchor institution. Indiana University has collaborated with Moi University for over 20 years, initially concentrating their efforts in HIV/AIDS prevention and treatment. However, over the past 10 years more focus has been given to the inclusion of non-communicable diseases.
AMPATH Oncology Institute (AOI), an affiliate of AMPATH, is dedicated to promoting Oncology education, services and research and facilitating the professional expertise among its members towards excellence in cancer prevention, treatment and palliative care.
It is with this mission in mind that we approached the American Society of Clinical Oncology (ASCO) to explore opportunities for working together. We noted that ASCO’s Multi-disciplinary Cancer Management Courses (MCMC) offered a great platform for collaboration due to its dedication to improvement of the quality of cancer patient care globally, especially in the low and middle income countries.
In Kenya, with a population of 40 million people, there are only 5 medical oncologists and even fewer radiation oncologists all except one of whom reside in Nairobi (Kenya’s capital city). Surgical oncologists are rare as well. There are no national cancer screening programs and more than 80% of patients present with advanced cancers. The catchment area for AOI is 20 million people and there is no radiation machine at the MTRH, one of the two tertiary public referral hospitals in Kenya, serving this vast area.The Eldoret MCMC
In collaboration with ASCO, AMPATH contacted and invited the faculty for the MCMC. ASCO facilitated the attendance of Prof. Higinia Cardenes (Radiation Oncologist, Indiana University), Prof. Barry Rosen (Gynecologic Oncologist, University of Toronto) and Prof. Hugo Villar (Surgical Oncologist, Arizona Health). We were also able to involve the American Society of Clinical Pathology (ASCP) whose pathologists, Dr. Micheal Wilson and Dr. Drucilla Roberts, were sponsored to the event. The Indian Society of Oncology was represented by Dr. Dinesh Pendarkar (Medical Oncologist) and Dr. Savant (Surgical Oncologist). Our own local experts who were faculty for the conference included: Prof. Nicolas Abinya (Medical Oncologist, University of Nairobi), Dr. Alice Musibi (Medical Oncologist, University of Nairobi), Dr. Naftali Busakhala (AMPATH Co-director and Internal Medicine Physician), Dr. Evangeline Njiru (Internist), Dr. Lugaria (Surgeon), Dr. Chumba (Pathologist), Dr. Patel (Immuno-pathologist), Dr. Zipporah Ali (Palliative care), Dr. Orango Omenge (Obs/Gynecologist), Dr. Erin (Obs/Gynecologist), Indiana University Simon Cancer Center’s director, Prof. Patrick Loehrer and Prof. Greg Gramelspacher (Director, Palliative care) were amongst the faculty at the MCMC. In addition, we invited Prof. Akin Abayomi, a hematopathologist from Stellenbosch University in South Africa. Other presenters included Pamela Were (RN, MTRH), Euyoung Choi (MSW, AOI), and Peter Kamau (RN, AMPATH). Faculty and presenters led various group sessions, case discussions and practical sessions.MCMC attendance
The course averaged 250 attendees on a daily basis over three days. The fourth day, Saturday, February 18, there was a skills training workshop. Three groups were identified for various skills training: pathology staff, clinical staff and surgical staff.
Those who attended came from all over Kenya, from both rural and urban centers. The attendees were health care workers who treat cancer patients: nurses, pathologists, surgeons, internists, radiologist and radiation oncologists, oncologists, social workers, palliative care specialists, immunologists, gynecologists, medical officers, lab technicians and others.
The role of multidisciplinary interactions in cancer management was emphasized throughout the course.MCMC format
The MCMC faculty met for preconference activities on February 14 including a tour around the AMPATH facilities and a meet-and-greet with the leadership of AMPATH. They also went to some of the AMPATH satellite clinics. AMPATH has more than 40 clinics within the rural community of Western Kenya to ensure close proximity of its services to the rural poor.
The format of the course included daily pre-test and post-tests, short topical power-point presentations, break-out group discussions, plenary reporting sessions, presenter panel sessions, audience interaction with the use of an audience response system, case-based discussions, direct question and answer sessions and informal satellite sessions. Other creative presentations were made in the form of role plays – for example, one of the palliative care sessions on “breaking bad news” was presented as a role play.Some insights
There is no school in Kenya currently teaching oncology nursing. Oncology nursing is a vital component of a successful cancer program and an area of great need in Kenya. Another area of need is pathology services. Our pathology department has only 4 pathologists that serve the catchment area of 20 million people. It is little wonder that sometimes the turnaround time of specimen reads is often longer than usual. The impact of this on the quality and promptness of care surfaced during case discussions. Prof. Abayomi (RSA), Dr. Wilson and Dr. Roberts (ASCP) have offered to work closely with Dr. Chumba (AMPATH head of pathology services) and his team to improve this situation.Gains Made
As a result of the MCMC, AOI plans to establish the AMPATH Breast Clinic (ABC), a clinic for clients with any breast-related concerns or those presenting for screening. Prof. Hugo Villar has offered a laptop computer to be used in this clinic. We will be conducting this clinic as the first multidisciplinary clinic at the hospital in conjunction with the surgeons, pathologists, radiologists, oncologists and others. Towards this end we are looking to acquire at least one ultrasound machine and core needle biopsy needles. We will begin this initiative in April 2012 with the launch our breast cancer patient support group. Thirty breast cancer survivors have signed up for the event.
The pathology team has taken the lead on the establishment of a clinic-pathological conference to compliment the ongoing AMPATH multidisciplinary tumor board meetings, which have been happening for over a year. Our pathology team will tap into the global experiences of the American Society of Clinical Pathology (ASCP) to re-organize our pathology department led by our chief pathologist, Dr. Chumba.
We also envision increased training of our surgeons in various breast (and other cancer) surgeries and improvement of our pathological staging systems.
AMPATH has made a commitment toward improving the referral patterns by working with the centers in the catchment area that refer patients to us, ensuring that patients are seen with early disease for a chance at a cure. We will continue with our breast cancer and cervical cancer screening programs, where last year we screened 3,000 rural women for breast cancer with Clinical Breast Exam (CBE) and 8,000 women for cervical cancer with Visual Inspection and Acetic acid method (VIA), with appropriate timely referrals for those with abnormalities detected and favorable outcomes.Future Plans
As we forge forward in cancer care, the challenge is sustainability of the current achievements and building new ones. Our Kenyan Minister of Medical Services, Prof. Anyang’ Nyong’o aptly put a request to ASCO to come back to Kenya for another MCMC next year, in order to strengthen the current gains and catalyze new ones.
We also would like to strive to improve cancer research training at AMPATH to boost our research contributions to patient care. In addition, we are in the process of creating a robust patient registry and will continue to encourage integration of palliative care at all levels of patient care.Appreciation
I would like to sincerely thank ASCO for granting us this opportunity and especially Vanessa Eaton, the Program Manager, ASCO International Education, for tirelessly working with us to ensure the success of this MCMC from the initial planning meetings to the completion of the event. Equally vital was the role played by the Program Assistant, International Affairs, Rachel Pensack-Rinehart. Their support and enthusiasm is an embodiment of ASCO’s MCMC dedication to cancer care for all.
I would also like to thank all the faculty that contributed to this event, all the local organizers for their hard work, all the attendees for their active participation and great insights and most importantly our patients, without whom, we could not have conceptualized this MCMC.
At AOI we believe in the motto, “Care leads the way.”
View photos from the MCMC Kenya here