Rwanda Oncology Doctor: Global Community Must "Reduce the Disparities in Cancer Care"
Dr. Cyprien Shyirambere is the oncology program director for Inshuti Mu Buzima, as Partners In Health is known in Rwanda. He leads the bustling, vital Cancer Center of Excellence at PIH-supported Butaro District Hospital in the country's mountainous north. Many patients, family members, and caregivers travel to Butaro from across Rwanda or from surrounding countries such as Burundi and the Democratic Republic of Congo, where high-quality cancer care is scarce or nonexistent, to receive lifesaving treatment at the hospital. In recognition of World Cancer Day on Feb. 4, Dr. Shyirambere talked about what's new in Butaro, and how global action is needed to reduce vast disparities in cancer care around the world.
Q: Butaro District Hospital recently opened its Cancer Support Center, providing a place to stay during extended treatment for patients who live far away and their families. How is the Support Center working out so far? How is it affecting cancer care at Butaro District Hospital?
The 68-bed Butaro Oncology Support Center is open six to seven days a week, and accommodates cancer patients who come to Butaro as ambulatory chemotherapy patients, and outpatients. The average stay is two nights. Patients receive free meals, laundry, and nursing care, as well as counselling services by a qualified clinical psychologist, to help them cope with the disease. Since opening last August, the center has seen about 5,500 patient visits. With a nice view of the mountains in Burera District, it offers a dignifying environment and brings hope to our patients’ faces.
This center has improved the way we provide care to our patients, since it has decongested oncology wards and decreased burdens for patients, many of whom used to pass nights in the cold outside the hospital because they had nowhere to stay.
Q: Rwanda Military Hospital in Kigali now offers radiotherapy, which previously could not be accessed anywhere in Rwanda. Has that made a difference in treatment and referrals at Butaro District Hospital? What does it mean for cancer care in all of Rwanda?
The radiotherapy center at Rwanda Military Hospital has two state-of-the-art linear accelerator machines, which is a huge step towards cancer control in the country and the entire East African region. More than 50 percent of cancer patients need radiation therapy at some point of their treatment, either for curative intentions or as part of palliative care, to control symptoms and improve quality of life.
No country can achieve access to cancer care without planning for access to radiotherapy. More Rwandans and patients from neighboring countries now can access radiotherapy services, which previously was impossible for the majority of them.
Q: Has the hospital begun interacting with UGHE students? What has been happening, and are there plans for an expanded relationship in the future?
So far, the interactions between UGHE students, Inshuti Mu Buzima—as PIH is known in Rwanda—and Butaro District Hospital have been focused at the community level, to give students a sense of the social and economic determinants of health, and how community health workers are involved in the health care system.
There is a plan to expand the hospital to meet accreditation standards to become a teaching hospital for UGHE. In 2021, if all goes well, UGHE medical students will start doing clinical rotations in the hospital, and we hope our physicians will be involved in teaching those students.
Q: What’s new at the Butaro Cancer Center of Excellence? What challenges and successes have you seen lately?
New at the Butaro Cancer Center of Excellence:
- Digitalization of data from our women’s cancer early detection program, in Open MRS (Open Medical Records System, an electronic, open-source medical record platform)
- Pilot project to implement a patient navigator program, to reduce delays in care and abandonment of treatment, initially focusing on patients with Wilms’ tumor (a rare kidney cancer that primarily affects children)
- Cultivating a culture of quality improvement, using quality improvement champions
- Continuous medical education program for oncology clinicians, in collaboration with the Dana-Farber Cancer Institute’s Center for Global Cancer Medicine
- Limited access to modern imaging technology, such as CT scans; limitations with pediatric oncology surgery and intensive care
- Survival rates are still low, compared to high-income countries, and some drugs needed to improve that rate are still unaffordable
- Limited space to accommodate growing numbers of cancer patients
Q: What else would you like to talk about on World Cancer Day, that I haven’t asked about?
On this World Cancer Day 2020, I stand with thousands of cancer patients around the world and their families. I salute efforts to address this growing burden and I urge the global community to reduce the disparities in cancer care, in order to achieve universal health coverage.