By Dorothy Lombe, MD
I am a radiation oncologist from a country where we only have one cancer centre offering radiotherapy and I will beat cancer. This bold statement often evokes a look of panic in people’s eyes that says "duck fanatic!" However, if the conversation is allowed to go on, my conversation partner will realise why I say cancer is beatable even where resources are thin.
I am fortunate to have been a recipient of the Conquer Cancer International Development and Education Award in 2016 and now the Long-term International Fellowship for 2018-2019, allowing me to interact and visit with mentors from well-resourced environments. There are a couple of important lessons I have learnt from these interactions that have culminated into my bold statement. It does not involve copying and pasting what I see, pressuring my government to match the top-of-the-range facilities and equipment. That is simply not feasible or sustainable. It is about taking knowledge and applying my experience to innovate interventions that work for my patients.
In summary, this is what I have learnt on who "I am" and what "I will" do: The magnitude of resources is irrelevant but the capacity to manage them is what matters. The three pillars of cancer control are named prevention, treatment, and palliation, and I believe the ability to beat cancer lies in harnessing these pillars and managing the situation before you. Prevention and early detection are really the best cost-effective measures we can take but perfecting them in low-resource environments will take some work.
Many a clinic day I am faced with three-quarters of the cases coming in as locally advanced and incurable. The first intervention, which costs the system nothing but means everything to the patient and their family, is my team's empathy and respect for their being. I have come to respect that beating cancer is different from curing cancer. Palliation in its holistic sense of taking care of the physical, spiritual, and mental well-being and reaching a point where the patient and their family understand what is happening are my formula of beating this beast. Yes, my patients may die, but they will not die in pain and without dignity.
A second lesson that I have quickly learnt from my mentors is no matter the environment, research must be part of practice to elicit patterns of disease and outcomes of treatment. Always ask, "Why?" and, "How can I do better with what I have?" I remember a younger me always waiting to be awarded research grants that are so well advertised yet unreachable. Yes, funding does help us, but we can still put our toes in the pond with good systematic record collection with a pen and paper so that when the funding does come eventually, we will be well prepared. It is especially important for local specialists to take ownership of the research process and participate in dissemination of results and conversations on the global forum, as subsequent international guidelines may not be inclusive. Meticulous record-keeping and protocols are the first step to getting into the arena of big data and they are low- to no-cost interventions simply requiring realignment of existing personnel in an already funded system.
My stance does not demean the need for less-resourced nations to match up with the latest technologies. It encourages a silver lining around a cloud. So, on this note, I end by saying again I am a radiation oncologist from a country with one radiation therapy centre for 17 million people, and I will beat cancer in Zambia.
Dr. Lombe is a clinical and radiation oncologist at the Cancer Diseases Hospital in Zambia. During her Long-term International Fellowship year, she is training at BC Cancer Agency, Canada, under the mentorship of Dr. Juanita Crook. She is a member of ASCO’s Resource-Stratified Guideline Advisory Group. Follow her on Twitter @lombe_dorothy.