Apr 17, 2013
ASCO International, in collaboration with other organizations, offers Multidisciplinary Cancer Management Courses (MCMC) to improve cancer care globally through the promotion of interdisciplinary cancer management. This past January, ASCO collaborated with AMPATH to conduct workshops in Eldoret, Kenya. In the following interview, MCMC course organizer Fredrick Chite Asirwa, MD, MBChB, and course participant Evangeline W. Njiru, MD, discuss the program and the state of cancer care in Kenya.
AC: How would you describe the current state of cancer care in Kenya?
Dr. Asirwa: Kenya has a population of 42 million people with five medical oncologists, four radiation oncologists, and even fewer surgical oncologists. Radiation therapy is only available in the capital city of Nairobi, and all patients seen outside Nairobi have to be booked for the only two machines available at the Kenyatta National Referral Hospital in Nairobi.
Some private hospitals in Nairobi also have radiation therapy units, but they are mostly out of reach for the majority of the poor. All payments for cancer care are out of pocket and unaffordable; no existing public insurance programs cover these. The Cancer Prevention and Control Act of 2012 was passed just last year, but has not been implemented yet.
Currently, I am a member of the Kenya Cancer Experts Committee appointed by the Ministry of Health, and we are in the process of finalizing the cancer management guidelines for Kenya. This will help to educate health care professionals on general cancer management and prompt referral patterns.
Priority areas of need in terms of cancer care are: training of various cadres of cancer professionals; improvement of pathology services; improvement of the cancer care infrastructure; and increasing public awareness of cancer and risk modification, including prevention measures.
Dr. Njiru: In Kenya, the public only has access to two public hospitals for cancer treatment—Kenyatta National Hospital, in Nairobi, and Moi Teaching and Referral Hospital, in Eldoret. Radiotherapy facilities are only available at the capital city, Nairobi, with only the Kenyatta National Hospital being available to the low-income earners, who form the bulk of the population. Many challenges face Kenyan patients with cancer, starting with diagnosis to treatment and palliative care. These challenges involve not only access to care but also availability of resources, infrastructure, and personnel. Many patients are thus diagnosed late because of these challenges, making treatment often more palliative than curative.
There are a few screening programs available. For instance, Moi Teaching and Referral Hospital offers cervical cancer screening, but others are few and far apart and not readily available to the majority of Kenyans. There are some patient support groups and advocacy groups—for instance for breast cancer—but many are near towns, and thus do not have much of an impact on the largely rural Kenyan population.
Health financing in Kenya is only 6% of the national budget contrary to the Abuja Declaration, which requires a government to dedicate 15% of its budget to health. Kenya is a signatory to this Declaration. Obviously cancer care will suffer, as will other sectors of health, with such budget constraints.
Great strides have been made recently, especially with the establishment of the Cancer Prevention and Control Act of 2012 (though this is yet to be operationalized), but much more needs to be done in cancer care, starting with screening programs, to accurate diagnosis, timely and effective treatments, follow-up programs, and palliative care.
AC: What were your impressions of the recent MCMC event?
Dr. Asirwa: This course is very useful and appropriate for our settings. The emphasis on multidisciplinary cancer management is vital to quality cancer care. This year we also had a Leadership Skills Training Workshop that was excellent and geared toward the "Train the Trainers" program. We are trying to create more leaders who can then take the teachings from these conferences and implement them in their spheres of influence.
Dr. Njiru: This course was an eye-opener to many who attended on what multidisciplinary approach to cancer care is all about. Since the course brought together health professionals from all over Kenya and beyond our borders, including Ethiopia, it allowed for the creation of networks where patient care, consultations, and referrals can be done even better; this will definitely improve outcomes for patients with cancer.
The Leadership Skills Training Workshop was very useful since it helped participants identify their strengths and weaknesses and also practice presentation skills. The group sessions in which members identified an area in which they could implement some cancer-related activity allowed members to practice their listening skills, share ideas, critique each other constructively, and finally come up with an activity that everyone agreed upon.
AC: What outcomes do you expect from this MCMC?
Dr. Asirwa: An important outcome will be getting tissue biopsies for diagnosisfor all cancers before planning care—we are hoping for 100% uptake. It's also important to involve multidisciplinary cancer teams in creating an optimal cancer care plan—we hope for 100% case discussions prior to care.
Dr. Njiru: Better communication among peers and more consultations between the team players, which will translate to better patient care and outcomes and thus more patient satisfaction.
AC: You both participated in the Train the Trainers course. What were some takeaways from this training?
Dr. Asirwa: The course stressed the important role of the trainer in the uptake of the information that he or she is passing along to trainees and the various ways that one can maximize trainer-trainee interactions to improve output and retention by trainees.
Dr. Njiru: Being a trainer involves good listening skills and also being able to help trainees focus on what needs to be done. The trainees also had a lot to offer, and I walked away challenged and motivated to better myself as a leader.
AC :Is there anything else you would like to share?
Dr. Asirwa: It's been great having ASCO, the American Society for Clinical Pathology, and the Indian Society of Oncology represented and very active at both of our conferences in 2012 and 2013.
Dr. Njiru: Having the MCMC training for two years in a row in Eldoret was wonderful, and it was humbling to think that ASCO, the Indian Society of Oncology, and the presenters from South Africa thought well of us and were willing to come a second time. We are honored!