Oct 25, 2012
Agir Ensemble (“Working Together”) is a nonprofit organization in the Democratic Republic of the Congo (DRC) that is engaged in the fight against cancer. In the interview that follows, Mateus Kambale Sahani, MD, Director of Agir Ensemble’s Health Department, shares his perspectives on cancer in the region.
AC: What is the current state of cancer care in the DRC?
Dr. Sahani: Cancer in the DRC has reached a catastrophic level; there are myths, fears, and misunderstandings, and the poor skill levels of health care providers contribute to the situation. A cancer diagnosis often means death, and almost all health care professionals and stakeholders don’t know that many cancers can be prevented and/or treated. A survey conducted by Agir Ensemble in 2010 showed that more than 95% of medical doctors and nurses didn’t know that cervical cancer can be prevented and that cryotherapy exists for treatment of cervical intraepithelial neoplasia to prevent cervical cancer. The results of this survey were presented and published at the International Gynecologic Cancer Society biennial meeting in Prague in October 2010.
In the DRC, there are no cancer services available; no chemotherapy, no colposcopy services, no mammography, and no palliative care services. In 2008, I lost a colleague, a medical doctor, who died of advanced breast cancer. She had no access to mammography services, which resulted in a late diagnosis, nor could she be treated, because the country lacked the necessary medicines.
The DRC has a population of 75 million people—60% of whom are women. The most common cancers in prevalence and mortality for women are cervical cancer and breast cancer, yet there is no access to cervical cancer screening, the HPV vaccine, and mammography. The most common cancer in prevalence and mortality for men is liver cancer, followed by prostate cancer.
AC: What are some of the challenges faced by oncologists in the region?
Dr. Sahani: Agir Ensemble is the only cancer organization in the country, and unfortunately there are no oncologists or specific oncology units in hospitals. All patients with cancer are placed together with other internal medicine, pediatrics, OB/GYN, or surgery patients. In terms of treating cancer, surgery is the only viable option, and this is only possible when patients present with an early-enough diagnosis. The main challenge is that almost all patients (99%) present with a late-stage disease, and at that point it is too late.
AC: What led you to pursue oncology as a career?
Dr. Sahani: When I saw that no one in the region had an interest in oncology and that people were dying without any assistance, even medical doctors; when I saw women dying from cervical cancer, a preventable disease, and nothing was being done; when I saw that many doctors didn’t know that some cancers can be prevented and how to proceed—this both revolted me and provoked me to undertake a strong action against cancer in the DRC. I knew it would be a difficult mission in a very big country, but I also knew that if an oncologist didn’t speak about cancer, no one else would pay attention to it. So, I applied for Agir Ensemble to become a member of the Union for International Cancer Control. I also started an Agir Ensemble oncology clinic in the DRC, where we also treat patients who need other services. Our current priorities are to set up a colposcopy unit, mammography unit, and smoking-cessation service. The main challenge to achieve this mission is not having access to funding.
AC: You recently were awarded ASCO’s International Development and Education Award (IDEA). What impact will this award have on your professional development and your ability to affect care in the DRC?
Dr. Sahani: This award, and especially its extended tour program in New York (Mount Sinai School of Medicine), has helped me advance my skills in colposcopy, mammography, and surgery in oncology. Still, because these programs are not available in the DRC, we will need further assistance—specifically, by means of a colposcopy machine, adjuvant equipment, and a mammography unit. My IDEA mentor, Linus T. Chuang, MD, of Mount Sinai School of Medicine, has been contributing to these efforts.
AC: What do you see as the role for organizations such as ASCO to support cancer research and cancer care in your region?
Dr. Sahani: Eighty percent of cancer cases and deaths are in developing countries such as the DRC, and if nothing is done today, this number will triple. Specifically, in my country, where few services are available and patients with cancer often cannot be treated, there are few to no cancer survivors.
I would like to see ASCO help us initiate programs related to colposcopy, HPV vaccines and awareness, breast cancer prevention and early detection, mammography, and smoking cessation and awareness. We currently have project plans for these programs, but no funding. I would also like to see ASCO help us obtain equipment, help us participate in clinical trials to allow DRC patients to gain access to cancer treatment, and hold training for doctors here.