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

South Wales Sierra Leone Cancer Care Link

Cancer in Africa A neglected critical public health problem Health Problem in Africa  Cancer causes more deaths than AIDS + malaria + TB  2008 World Global Cancer declaration described cancer in developing countries as ‘an impending disaster’  2/3 cancer deaths in developing countries  WHO est (2010)no of cancer deaths in developing world: 6.7 million in 2015; 8.9 million in 2030  Survival Poor  Lack of quality data for cancer control planning South Wales Sierra Leone Cancer Care Link

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

Cancer Care in Sierra Leone Cancer Registry Affordable treatable cancer Palliation and symptom control Cancer prevention Education Undergraduate and post graduate South Wales Sierra Leone Cancer Care Link

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 South Wales Sierra Leone Cancer Care Link Ministry of Health & Sanitation, SL

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

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 ( /100,00 in W Africa) No / limited treatment in Sierra Leone Child with advanced Burkitt’s Lymphoma. South Wales Sierra Leone Cancer Care Link Affordable treatable cancer

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

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

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 Burkitt’s Lymphoma South Wales Sierra Leone Cancer Care Link Affordable treatable cancer

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

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 South Wales Sierra Leone Cancer Care Link Connaught ward piccy Palliation and symptom control

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

Access to adequate pain control a recognised problem…….  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 Morphine storage in a Sierra Leone Hospice South Wales Sierra Leone Cancer Care Link Palliation and symptom control

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 Microscope with camera South Wales Sierra Leone Cancer Care Link Education Undergraduate and post graduate

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

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

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