Crossing an Ocean to Care for Patients with Cancer

Aug 29, 2012

Kenneth D. Miller, MD, of the Alvin and Lois Lapidus Cancer Center at Sinai Hospital, Maryland, had been working as an oncologist in a community practice when his wife, Joan Miller, was diagnosed with leukemia. “Life and health can change in a sunset,” Dr. Miller said. “For both of us, it was a time to evaluate our lives. There were things we wanted to do as a family to help improve the world beyond our own community.” After Joan’s successful treatment for leukemia (and later, breast cancer), Dr. Miller returned to an academic setting to further contribute to research and teaching, which led to an opportunity to contribute to cancer care in the developing world. He has made four volunteer trips to locations in East Africa, often accompanied by his wife or one of his three daughters, first to Uganda with Yale Medical School and later to Ethiopia with ASCO and Health Volunteers Overseas (HVO) as a member of the International Cancer Corps.

AC: What kind of work did you do on your first trip to Uganda?
Dr. Miller:
I was the first oncologist to go on the trip with Yale. I was in Uganda for a month and made rounds with the oncologists there, taught residents, did a small research study on women with breast cancer, and provided care for patients. I went back the next year as well.

AC: What surprised you about the experience?
Dr. Miller:
That was my first time volunteering outside the U.S. and my first trip to Africa. I was worried about going, and worried about my daughter who went with me. I was surprised that we felt very safe there. People were extremely friendly. It was a real reminder that doctors and patients around the world are very much the same—we are much more similar than we are different.

It was a pleasure to work with the bright, dedicated oncologists, residents, and interns. Even though Uganda is a resource-poor country, the doctors were very well-trained and up-to-date in diagnosis and treatment—they are able to do a great job with far less technology and diagnostic testing than we have in the U.S.

AC: How did your involvement continue when you were back in the United States?
Dr. Miller:
When I got back, I found out that Yale was selling a Mammovan (a mobile mammography center). I bought it and got it shipped for free to Uganda by a group called DOC2DOCK, where it now provides screening and education in breast and cervical cancer. Dana-Farber also retired a Mammovan thatwe were able to ship over. It’s a great feeling that these vans have a second life serving women in Africa.

AC: When you learned that ASCO and HVO would be organizing a trip to Ethiopia, were you immediately interested?
Dr. Miller:
Yes. It’s difficult to develop and sustain programs in low-resource countries, so it was an exciting opportunity to work with ASCO and HVO, which have the organizational skills and the commitment to make such a program successful.

AC: What were your most memorable experiences in Ethiopia?
Dr. Miller:
I vividly remember the patient visits, where I was struck by the personal toll of cancer. Many of the patients were young, supporting a big family, and had very advanced cancer without the resources to fight that battle. The disparity between Africa and the United States is so profoundly large. I saw a patient today at our hospital [Sinai] who is receiving a chemotherapy drug that costs $5,000 per injection—that would pay for yearlong courses of treatment for eight to 10 patients in Ethiopia. It’s not wrong that our patients in the U.S. have access to care, but it’s truly sad that others do not.

There were hopeful moments, also, because oncology is practiced one patient at a time. Ethiopia has long-term survivors and patients being treated for breast cancer, lymphoma, and colon cancer who will be cured. It’s very exciting.

AC: Can you describe the workforce shortage you observed?
Dr. Miller:
There were two oncologists for 30 million people in Uganda and four oncologists for 87 million in Ethiopia. It’s unfathomable until you see it with your own eyes. We can help by promoting training programs for oncology through partnerships with universities and medical schools in Africa and developing twinning programs in which U.S. hospitals are matched with African hospitals. U.S. oncologists could make annual visits to their twin program to provide training and patient care, and African oncologists could visit U.S. institutions to gain further experience and training.

There’s evidence in East Africa of the wonderful impact of public health interventions to fight HIV. Public education, awareness, and screening may have an impact on outcomes in cancer, simply by leading to earlier diagnosis and treatment, until the infrastructure and workforce are in place to treat the more advanced cases.

AC: Are you planning any future volunteer trips?
Dr. Miller:
I’m planning a trip for this fall. I hope to spend two weeks in Uganda and two weeks in Ethiopia.

AC: Any advice for an oncologist interested in volunteering in a developing nation but concerned about risks?
Dr. Miller:
There are so many reasons to go. In some ways, I had more impact in four weeks in Africa than in a year in the United States. Your “impact per day” in terms of teaching and patient care is very high. The teaching experience is especially gratifying. As a doctor and a scientist, it’s also incredibly interesting to observe the natural history of cancer and to see many more kinds of cancer than I would typically encounter in my practice. There are wonderful opportunities for research collaborations. So many people in need of care in Africa could benefit from participation in clinical trials and would help us all learn more about cancer.

It’s also been a great adventure. Although medical resources are limited, East Africa is culturally very rich. My family and I have toured Uganda and Ethiopia, experienced the safaris and religious sites, and made new friends that we stay in touch with.

In my experience, the rewards of volunteering far outweigh the challenges and concerns.

An expert in cancer survivorship, Dr. Miller is the Chief of Medical Oncology at the Alvin and Lois Lapidus Cancer Center at Sinai Hospital.
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