South Wales Sierra Leone South Wales to Sierra

South Wales Sierra Leone South Wales to Sierra Leone Cancer care link Care Link Richard Adams Reader & Honorary Consultant in Clinical Oncology, Cardiff Uni & Velindre Cancer Centre

South Wales Sierra Leone Cancer Care Link

Cancer in Africa A neglected critical public health problem Health Problem in Africa Ø Cancer causes more deaths than AIDS + malaria + TB Ø 2008 World Global Cancer declaration described cancer in developing countries as ‘an impending disaster’ Ø 2/3 cancer deaths in developing countries Ø WHO est (2010)no of cancer deaths in developing world: 6. 7 million in 2015; 8. 9 million in 2030 Ø Survival Poor Ø Lack of quality data for cancer control planning

Cancer Prevention, Treatment & Palliation Workshop Freetown Jan 2010 An Afro- Welsh Consensus meeting – 46 delegates Memorandum of Understanding South Wales Sierra Leone Cancer Care Link

South Wales Sierra Leone Cancer Care Link Education Undergradua te and post graduate Cancer preventio n Cancer Registry Cancer Care in Sierra Leone Affordabl e treatable cancer Palliation and symptom control

Linking with other groups • Finding others – Word of mouth – Long standing relations – Wales 4 Africa – www. • Developing ideas in partnership • Keeping in touch South Wales Sierra Leone Cancer Care Link

COMAHS Connaught Hospital, Freetown Ministry of Health & Sanitation, SL South Wales Sierra Leone Cancer Care Link

Cancer Registry Support – Provision of software – Connaught & later SJOG – Training (VIJI) – Linking with WCISU – Technician (Mo. HS) – Dr Koroma visit to UK 2012 – Microscope with digital camera – Microtome South Wales Sierra Leone Cancer Care Link 100 yr old microtome

Strengths - Strong Communication - Links – VIJI; WCISU (only linked registry in World) - WHO recognition Challenges – One Pathologist in public sector Dr “Owizz” Koroma – Technician leaving – Hierarchy • only Dr Koroma adding entries • only pathologist & forensic delay; • results from one centre South Wales Sierra Leone Cancer Care Link

Affordable Treatable Cancer: Burkitt’s lymphoma Commonest malignancy in children Rapidly growing related to EBV infection & malaria risk 60% cure shown in other African countries with ‘affordable’ chemotherapy. Est 100 cases per year in Sierra Leone (0. 8 -1. 8/100, 00 in W Africa) Child with advanced Burkitt’s Lymphoma. South Wales Sierra Leone Cancer Care Link No / limited treatment in Sierra Leone

Burkitt’s Lymphoma Aim – Establish centre of excellence for treating Burkitt’s Adapting - location • Connaught Hospital • Childrens’ Hospital Abertawe Bro Morgannwg link • St John of God Hospital, SJOG Lunsar Cooking for the patients, SJOG South Wales Sierra Leone Cancer Care Link

Burkitt’s Lymphoma Establish centre of excellence for treating Burkitt’s Learning from Others / Prior Experience • Experience in Uganda • UHW link • IARC - Ian Mc. Grath / Ngoma • Malawi – Minimising side effects • Barcelona link – Ensuring good follow up – Sustainable drug supply Drug trolley, SJOG South Wales Sierra Leone Cancer Care Link

Burkitt’s Lymphoma • • • - Practical Approach Treatment algorithms - adaptation Patients stay in for treatment / use of mobile phones Listening to partners Ambulance Cultural beliefs Support Assessment of needs – fridge, preparation areas, staff Initial teaching Follow up teaching Sensitisation of local chiefs & community Welsh volunteers in country South Wales Sierra Leone Cancer Care Link

Adjusting to challenges and changes • • New partners Hierarchy Change in personnel Ebola… South Wales Sierra Leone Cancer Care Link

Ebola

Palliation & Symptom Control Desired Outcomes 1. Dedicated Cancer ward (VIJI) with cancer care nurses & Palliative care team in Connaught, Freetown 2. SJOG – lead team, all trained – mobile unit 3. Inclusion in undergraduate curriculum Connaught ward piccy South Wales Sierra Leone Cancer Care Link

Palliation & Symptom Control Strengths • Affordable • Links Hospice Africa, APCA, Shepherds Hospice Challenges • Principles not currently taught • Drug supply • Morphine fear South Wales Sierra Leone Cancer Care Link

Access to adequate pain control a recognised problem……. Morphine storage in a Sierra Leone Hospice Ø Ø 80% present advanced disease & require pain control < 10% receive adequate pain control Majority cancer patients die in severe pain March 2015: only analgesic in Connaught pharmacy was diclofenac South Wales Sierra Leone Cancer Care Link

Education • Medical & Pharmacy Curriculum • partner links (VIJI, Connaught, Cardiff Uni) • Short course in Cancer Care for qualified staff • Nursing School at SJOG • Community education programmes – link with other projects • Case Conferences South Wales Sierra Leone • Microscope with camera Cancer Care Link

Cancer Prevention Education • Cervical Cancer – GAVI • Hepatitis B – WHO • Smoking South Wales Sierra Leone Cancer Care Link

Summary Desired Outcomes • Cancer Registry with reliable data • Centre of Excellence for treating Burkitts Lymphoma • Appropriate symptom control & palliation in SJOG & Connaught • Undergraduate & post graduate courses in cancer care for SL • Support of prevention initiatives

Summary - Challenges • • • Ebola Hierarchy Changing personnel Logistics Communication

Summary - Strengths - Collaboration Communication Adaptive Long Term Strategy Realistic /practical approach Listen / responsive to partner needs

Thank you for listening…………. Any questions? ? ? South Wales Sierra Leone Cancer Care Link Beautiful beaches slide