Establishing women's cancer care services in a fragile, conflict and violence affected ecosystem in Africa.

Groesbeck Preer Parham,Kabongo Mukuta Mathieu,Ronda Henry-Tillman,Mulumba Kapuku Sylvain,Mukanya Mpalata Anaclet,Leeya Pinder,Louis Kanda,Maya M Hicks,Alex Mutombo,Tankoy Gombo Youyou,Mirielle Kanda,Kapuku Sylvain,Michael L Hicks

doi:10.3332/ecancer.2021.1231

Abstract

BackgroundThe majority of the world’s poorest women (income < $1.90/day) reside in fragile, conflict and violence (FCV)-affected countries, like the Democratic Republic of the Congo. Health services in these settings have traditionally focused on immediate relief efforts, communicable diseases and malnutrition. Recent data suggests there is need to widen the focus to include cancer, as its incidence and mortality rates are rising.MethodsEmploying competency-based learning strategies, Congolese health professionals were trained to perform same-day cervical cancer screening and treatment of precancerous lesions of the cervix; same-day clinical breast examination and breast ultrasound diagnostics; surgical treatment of invasive cancers of the breast and cervix; and infusion of cytotoxic chemotherapy. Outpatient breast and cervical cancer care clinics, a chemotherapy suite and surgical theatres were outfitted with equipment and supplies.ResultsCombining local and regional hands-on training seminars with wise infrastructure investments, a team of US and Zambian oncology experts successfully implemented a clinical service platform for women’s cancers in a private sector health facility in the Democratic Republic of the Congo.ConclusionWe forged a novel partnership between oncology health professionals from Africa and its Diaspora, international philanthropic organisations, a cancer medicine access initiative and an established African cancer centre to build women’s cancer services in a FVC-affected African setting.

Highlights

Two billion people live in areas plagued by violence and conflict, among whom are the majority of the global poor and a third of the world’s women [1, 2]
Cancer care services for women residing in these resources-constrained settings must address the following needs: (A) health promotion messages that consider the social, cultural and religious norms that impede the acceptance of allopathic cancer care; (B) clinical infrastructures for screening, early detection, diagnosis and treatment; (C) workforce development that includes oncology specialists, ancillary health professionals and technicians and (D) access to high-quality, low-cost cancer medicines and opioids
Stakeholders attending the Consensus Meeting listed the following as major barriers to the implementation of women’s cancer care services in the Democratic Republic of the Congo (DRC): (1) low levels of cancer awareness among health professionals and the general population; (2) lack of trained oncology human resources of all types, including ancillary personnel; (3) lack of financing and unreliable systems for the procurement, storage and dispersal of equipment and supplies; (4) poor access to affordable cancer medicines and (5) properly outfitted clinics and surgical theatres (Table 1)

Summary

Introduction

Two billion people live in areas plagued by violence and conflict, among whom are the majority of the global poor (income < $1.90/day) and a third of the world’s women [1, 2]. By destabilising the political institutions that help to ensure basic human rights and freedoms [4], war and conflict create the social conditions (extreme poverty, food shortages, lack of safety, overcrowded and unsanitary living arrangements) that result in disease and death within the countries in which they occur [5]. The majority of the world’s poorest women (income < $1.90/day) reside in fragile, conflict and violence (FCV)-affected countries, like the Democratic Republic of the Congo. Health services in these settings have traditionally focused on immediate relief efforts, communicable diseases and malnutrition.

Methods

Results

Discussion

Conclusion