by ecancer reporter Janet Fricker

A charity to empower people in Sierra Leone with knowledge about preventing cancer is appealing for western support to help raise funds to expand the services and for a volunteer to provide a European liaison point.

In Sierra-Leone, a country located on the West coast of Africa between Guinea and Liberia, two thirds of the population lives in extreme poverty despite enormous natural mineral wealth.

The financial problems stem from the civil war (1991-2002), which resulted in the death of some 50,000 people and devastated the country’s infrastructure. The country’s health service, and in particular its fledgling cancer service, has been especially hard hit.

With multiple other health challenges, including high levels of infant mortality and epidemic outbreaks of diseases including yellow fever, cholera, lassa fever and meningitis, it has been hard for cancer to garner much attention.

The result is that Sierra Leone has one of the most primitive cancer services in the developing world.

“In Sierra Leone today no modern equipment is available for the screening, and treatment of cancer patients, and palliative care barely exists,” says Joseph Bundor Tarawally, the director of the Crusader’s Club Ministry. Additionally no specialist wards currently exist in hospitals where cancer patients can receive treatment, although there are plans to develop a ward specifically for cancer patients at the Connaught Hospital.

In breast cancer, for instance, few women have access to mastectomies or drugs like tamoxifen or cyclophosphamide based chemotherapy. And when disease progresses, as it inevitably does with the lack of treatment, palliative care is virtually nonexistent, with limited access to pain control drugs such as morphine.

Most striking is the fact that cervical cancer represents the most common cancer in Sierra Leone, with many women dying due to lack of knowledge about the disease. “Their deaths would have been prevented with implementation of HPV vaccination programmes and screening, but no such initiatives are in place so that women present too late to be treated by surgery and we have no equipment for radiotherapy,” he says.

A national Cancer Registry introduced to Sierra Leone has shown cancer levels to be on the rise. “Undoubtedly this is due to increases in levels of smoking, physical inactivity and drinking excessive amounts of alcohol. All of which underlines the fact people need to be educated about risks to help them change their habits,” says Bundor Tarawally.

In 2010 the Crusader’s Club Ministry, which until then had largely undertaken spiritual work such as distributing bibles, first branched out to develop educational programmes around cancer. This was still very much in line with the Ministry’s remit to work with marginalized and under privileged people, especially women, HIV/Aids patients, children, the elderly and the disabled.

Bundor Tarawally was inspired to undertake this change of direction after attending the African Organisation for Research and Training in Cancer (AORTIC) Congress in Dar Es Salaam, Tanzania, in 2009, where he learnt about cancer prevention and screening. “In Sierra Leone people are traditionally more afraid of HIV/Aids than cancer. What struck me was how little people in my country knew about cancer and that we urgently needed to teach them about prevention and symptom awareness. Without such vital information they wouldn’t stand a chance,” says Bundor Tarawally.

On return he started to train a team of “outreach” advocates to deliver presentations in schools, colleges, health institutions and the community. “Our aim has been to target everyone since cancer affects all age groups and sectors of society. Our programme takes no account of people’s faith and is available to all,” he says.

Presentations, which typically last 40 minutes, cover topics including what cancer is, the different types of cancer, causes, warning signs to look out for, treatments and prevention. Content can be tailored for the audience, with the messages simplified according to the age group and often delivered in the local language ‘krio’.

“The most important messages that we want to get across are to avoid tobacco, reduce alcohol intake, eat plenty of fruits and vegetables, exercise every day, avoid environmental pollutants and drink fresh clean water,” says Bundor Tarawally.

For any initiative to work in Sierra Leone, educational programmes need to recognise that two thirds of the adult population are illiterate. For this reason much use has been made of visual imagery, particularly illustrations showing the devastating impact of tobacco on the lungs and head and neck. “For most of our audience this information is completely new. We can count sessions a real success if people go back to their communities and pass on the information by word of mouth to their family and friends,” says Bundor Tarawally.

To spread the message to a wider population, the Crusader’s Club Ministry has organized two “Maximising Life Campaigns” involving street marches displaying banners with slogans on cancer prevention. “The goal here is to get prevention messages across to people who haven’t had the chance to attend our sessions. This spreads the message faster and wider,” says Bundor Tarawally. The campaign, which was run with The Max Foundation, had an additional remit to reduce the stigma and isolation experienced by people living with cancer.

So far Bundor Tarawally and his team have managed to reach out to around 8,000 people in Sierra Leone, but realise that this represents a fraction of the six million population. “There is still much work to be done,” he says. With new donor support they now hope to expand the initiative, developing workshops for training more advocates, printing educational leaflets and posters, and launching TV and radio publicity campaigns. Ultimately their ambitions include funding screening programmes, and setting up day centres where cancer patients can be treated with the latest drugs and equipment.

But they recognize that they cannot go it alone, and that for efficient fund raising they now need to make contact with sympathetic “friends” located in Europe who can help coordinate fund raising initiatives and spread the word. “Having someone help us in the West would really help raise our international profile and achieve our dreams,” says Bundor Tarawally.

Donations can be made to the Crusaders Club Ministry Saving Account number 920807, Sierra Leone Commercial Bank, Siaka Stevens Street, Freetown, Sierra Leone.

Anyone wishing to volunteer their help should contact:

Joseph Bundor Tarawally
--89a  kissy Bye Pass Road , Kissy Freetown , Sierra Leone, West Africa

Tel 00232-77-519301

www.crusadersclubministry.com