Even Cancer Is Capitalist! Lessons from my visit to AORTIC’17, Africa

The 11th AORTIC conference took place in Kigali (the capital of Rwanda) – a beautiful small country in east central Africa.

Onco.com was a new entrant to the event, and we participated to introduce ourselves as an enabler to the objectives of AORTIC through our services to provide online cancer treatment advice from our global panel of experts.

Dr. Amit (One of Onco.com’s co-founders and an oncologist himself) and I embarked on the journey to Kigali. Before this trip, my sole reference to this country was the movie Hotel Rwanda, and its terrible ethnic genocide of 1994.

We had planned to meet some doctors – both local and from other African countries, oncologists as well as general physicians. But little did I know that the next seven days will forever change the way I look at that country, the sub-Saharan region, and the entirety of Africa!

Information = Luxury

While AORTIC was an assembly of the who’s who for cancer care in Africa, I was amazed at the knowledge gap that existed among those ‘decision makers’.

Many were only aware and seemed concerned about traditional chemotherapy or radiation therapytreatments. Very few of them seemed to be bothered about the latest advancements, say in CAR T-Cell Therapy, or in other clinical trials taking place around the world.

Having said that, I understand the rationale behind it: Treatments evolve. Just like the humans who deliver them. But the realization that struck me hard, was that this information dissemination could also vary significantly across geographies.

Considering its expanse, there are only a few oncologists in Africa, and most of them practice in a handful of cities. For example, Rwanda has only two big cancer care centers and fewer than ten cancer specialists. Therefore, cancer care is resource starved, and confined to these few cities. The remainder of the continent manages with non-specialists, which often leads to fatal delays in getting access to the right treatment. The worst part? Many patients are never exposed to the right treatment options.

Cancer Care Varies Depending On Social Strata

This sounds obvious, right? Of course, the quality of treatment will depend on affordability! However, the problem becomes complex due to combination of factors such as access to the latest treatments at state level, affordability of the patient and sometimes even ‘who you know’.

To top it all, treatment in many countries is limited to chemotherapy as they either cannot afford or do not appreciate the importance of complimentary treatment therapies in cancer.

Few will disagree that this sets the treatment culture on a wrong path. There are instances of some “medical tourism” companies leveraging this situation and growing with the sole motivation of extracting as much money as possible from patients. Sadly, the patient, who is supposed to be the original intended beneficiary, becomes the last one!

Money Matters

Since only a very small percentage of patients (typically less than 10%) can afford to travel for their treatment, a vast majority depends on their own country’s healthcare infrastructure. Because of this selection, naturally, most of the remaining patients cannot afford expensive treatment therapies. They rely upon government-managed hospitals that are already facing an acute shortage of trained staff and equipment.

On the flip side, this also means that these patients do not follow standard recommended treatment protocols. For example, a diagnosed patient might start with chemotherapy from a district hospital, followed by radiation therapy from country’s biggest hospital. If those treatments fail, he/she must then make a hard choice – to leave the country, for which most of them will inevitably travel to Lagos, South Africa or India. However, for many patients, this could be too late as their cancer might have advanced and/or side effects would have taken over. Their treatment could have been managed much more effectively, had they chosen the right treatment at the very beginning. Information Gap causing significant pain!

The Governments Are Taking Some Action

Okay, there is a silver lining.

I met many Health Ministry Officials, Hospital Board Directors, and Government Oncologists, who were optimistic about the upcoming cancer treatment centers in their respective countries. For example:

• Tanzania is all set to unveil its improved treatment guidelines and receive training from American and Swiss organizations .
• Uganda plans to open four new public cancer clinics.
• Rwanda is gearing up to open its first radiotherapy center.
• On the second day of the conference, NCCN also released a new set of harmonized guidelinesspecific to Sub-Saharan Africa, which is a welcome move.

Patients will certainly benefit from these remarkable developments. What remains to be seen is – how soon, and to what extent.

Besides the government and non-governmental agencies, there are also crusaders who are making their impact felt. For example, we met Kwanele Asante who is a breast cancer survivor, and effectively vocal about improving cancer care at the grass root level with the help of education.

There were organizations presenting their work on Oncogenetics and molecular biology. We also met a bunch of smart students from UCLA who are working on cancer specific epidemiology studies in Africa. AORTIC proved to be a promising event, as introduced by Rwanda’s first lady in her motivational address: ‘We can win this battle against cancer, one life at a time’. I can confidently say that delegates went back with a stronger resolve to provide world-class, affordable and quality cancer care for patients in Africa.

Rwandans Are Awesome!

Last but not the least, Rwanda was a welcome surprise. It is gracefully shunning all the negative stereotypes associated with that region. People in Kigali were very warm, the infrastructure was truly solid and the climate couldn’t have been better. It is truly humbling, considering the country was virtually reborn after the genocide a little more than 20 years ago! Thank you, you were a great host.

Thank you AORTIC, for the amazing experience! It was a one-of-a-kind event that brought everyone related to cancer care in Africa under one roof. It was an enriching platform, and I am looking forward to the next phase, i.e. closely working with the stakeholders we met in Africa with a single motto – Let’s Solve Cancer Together!

Thanks For Reading!