If you ask me about cancer in Africa I would say that most of the cancer patients in Africa who access services in the hospital, which is only about 10%, present to hospital with advanced disease.

Why is this particularly the case?

There are a lot of barriers and some of the barriers are due to the patients themselves, some of the barriers are due to the systems, health service systems, and some of the barriers are due to economic factors. Now, patients may discover that they have a problem but they don’t report to the hospital. Or they want to report to the hospital but due to the distances involved and the fares needed to travel to the hospital and they don’t have money then it will take them up to six months or one year before they go to the hospital. When they reach the hospital they will find that there are some other problems in the system. For example, they may have to wait for the diagnosis to be made; it may take up to two or three months before a pathology report is back for them to be able to be treated as cancer patients. The other thing is if you have one treatment machine you cannot treat all the patients on time then they will have to be on waiting lists. In some countries in Africa the waiting lists are up to six months. With cancer six months is a very, very long time to wait.

The other thing that I have seen in Africa is lack of human resource. Cancer needs a multidisciplinary approach in the treatment. You need to have the surgeons, you need to have the radiation oncologists, you need to have the medical oncologists, you need to have nursing oncology and the other supporting staff. These are not enough. If you are a radiation oncologist but you don’t have a good surgeon who can do the surgery before the radiation you are stuck. If you are a radiation oncologist but you don’t have a good medical physicist you may not be able to deliver the radiotherapy that you want to deliver. After you have treated the patient you need some nursing care, if you don’t have the nursing care, especially after surgery, most of the patients will probably lose their life, not because of the surgery but because of lack of post-operative care. So human resource is very important because then that will ensure that patients get the right treatment.

Why are collaborations important?

Collaborations in cancer can be in three areas. It could be in the care of patients, cancer care service, it can be in the education, training of human resource, and it can be in research. Let’s start with training because I said a shortage of human resource is one of the biggest problems. If you have collaboration it means that areas where you have a shortage of expertise you can get people from other institutions to be able to work with you in the training programme, education programme. Now, with information communication technology you don’t have to send people outside the country for training because, one, it’s very expensive and, two, when they go out they may not come back to serve the patients in the country where they were sent from.

So with information technology now you can use many platforms to train people in their own countries. You could use telemedicine, you can arrange to have meetings, visual meetings, you can have even the training modules put in the cloud so that people can access them with their computer at any time wherever they are. So information and communication technology has helped very much to be able to train people remotely. For people who are very busy it’s easy for them to see what they can do where they are rather than asking them to travel all the way to a different country for some time to train people. For the people who are in their country it’s easy to train many more than to send one or two because of the expenses involved. So you could have a class in Tanzania in Dar es Salaam and you could have a teacher here in Harvard taking that class because it’s easy nowadays to communicate. So that is in training.

Now, when you come to research research is very important and you need to have local research to inform policy making and to come up with solutions that address local problems. What has been happening is most of the data and research that we have is not locally generated. So sometimes we make decisions based on data that is not our own and that has its own problems. But research is not cheap. Research needs to have people who have the capacity to do research. So there is a need for capacity building in research, there is a need of resources for conducting research. Most African governments have competing priorities such that there’s very little money left for research. With collaborations and having funding organisations which are willing to fund research projects globally as long as your proposals are up to the standard and that the research team is capable to undertake the research, then it’s easy to reach those standards if you collaborate with people who already have experience in research and also can help build the capacity of local people to do research. So collaboration in research is very important. One, you can get resources; two, you can build the capacity to do research.

Can you tell us about the C4 project?

The C4 project is a project that is going to have a big impact in that it can train doctors, nurses and other health professionals like medical physicists while they are still there using the technology that we have. You have lecturers who are willing to spare their time to teach and the teaching materials are stored in the cloud and people can access it easily with just a password. So if they get a lecture after the lecture the lecture notes will always be available so they can get them, the lectures, and continue to learn. Then they can have examinations after that.

The practical aspects, a few centres in Africa can be designated for the practical part of the training but for the theoretical that is going to be easy because the teaching materials will be available and accessible.

Is it a long-term collaboration?

It is a long-term thing. Training is an ongoing activity because if you train people today there will come a time when these people are no longer working, you have young ones coming in and the ones that were trained will be trainers and things like that.

Is there anything you’d like to add?

There are times when people think that solutions that are working in developed countries are the same solutions for a developing country but that is not true. That’s probably one of the things that we face in that you may have treatment guidelines, for example. To be able to practise oncology properly you need treatment guidelines so that all the patients could have the same kind of treatment. These are treatment guidelines that have quality assurance, that are the right standards. So if you have your treatment guidelines in the US and these guidelines you could access them through the internet and you think that people in Africa can just access them and use them that’s not right. It’s not going to work because the environments are totally different. The resources available to be able to give those treatments are different. So you could have treatment guidelines prepared here, working very well here, but for Africa one would need to adopt and prepare guidelines that work in that kind of environment.