Shilpen Patel MD, FACRO Associate Professor Departments of Radiation Oncology & Global Health University of Washington Founding Board Member Radiating Hope Director of Radiation Oncology RAD-AID International

CANCER IN DEVELOPING COUNTRIES:  Quick facts:  7 out of 10 cancer deaths globally occur in developing countries  Cancer kills more people than HIV/AIDS, Malaria, and Tuberculosis combined  Developing countries make up roughly 85% of the world’s population, and possess only one third of the world’s radiation equipment.  Developing countries lack availability to radiation equipment and the equipment they do have is usually outdated and insufficient 1. Salminen E, Anacak Y, Laskar S, et al: Twinning partnerships through International Atomic Energy Agency (IAEA) to improve radiotherapy in common paediatric cancers in low- and mid-income countries. Radiother Oncol 93:368–371, International Atomic Energy Agency: Design and implementation of a radiotherapy programme: Clinical, medical physics, radiation protection and safety aspects. [IAEA-TECDOC-1040.] Vienna, Austria, International Atomic Energy Agency,1998.

INCIDENCE  The number of new cancer cases per year is estimated to be 15 million in 2015, of which two-thirds occurs in developing countries. “It is not an exaggeration to say that cancer represents an imminent crisis for developing countries.” IAEA Director General Yukiya Amano 3. Ferlay J, Shin HR, Bray F, et al: Estimates of worldwide burden of cancer in 2008: GLOBOCAN Int J Cancer 127: , Farmer P, Frenk J, Knaul F, et al: Expansion of cancer care and control in countries of low and middle income: a call to action. Lancet 376: , Tanzania Africa, 2010

BY THE NUMBERS: US:  Approximately 1 machine for 105,000 people  2% of machines are cobalt  Africa:  1 machine for 4.8 million people  48% of machines are cobalt  South America:  1 machine for 640,000 people  39% of machines are cobalt  Nepal:  1 machine for 6 million people  40% of machines are cobalt Figure from IAEA ( DIRAC

AFRICA:  Rwanda:  No machines  Uganda:  1 machine per 33,000,000  Tanzania:  1 machine per 14,000,000  Sudan:  1 machine per 7,000,000  Mali: No machines  Senegal:  1 machine per 13,000,000  Ghana:  1 machine per 1,000,000  Ethiopia:  1 machine per 70,000,000  South Africa:  1 machine per 1,000,000 International Atomic Energy Agency: DIRAC (Directory of Radiotherapy Centres). Updated February Available at: Accessed July 21,

 Mission: to provide and update radiation equipment in developing countries and advance cancer care in those countries.

PROJECTS:  Radiation Therapy Project  Saves cancer patients in developing countries  Thousand upon thousands of lives are saved with one machine  Prayer Flag Project  Involves people locally giving hope and strength to them  Allows survivors to ‘Pass Along a Cure’  Mountaineering Project  Allows people to climb for cancer  Allows cancer survivors to become ‘super-advocates’

RADIATION THERAPY PROJECT  We accept used machines and donated radiation therapy equipment  We provide a tax deduction for these machines  Most machines are valued at 200,000 up to 1 million dolalrs  We then refurbish and ship the machines  Partnering with:  Physicians  Clinics and Hospital  Radiation equipment manufacturers  Non-profit organizations  We then train the physicians and provide ongoing support and partnerships Panama City, Panama

RADIATION THERAPY PROJECT  Partnering countries:  Panama-  Brachytherapy equipment  Value $150,000, RadHope 0  Chile-  Children’s Cancer Hospital- Toys  Value $500, RadHope 0  Honduras-  Two radiation therapy machines  Value $400,000, RadHope 0  Peru-  One radiation Megavoltage machine  Value $1 Million, RadHope 0  Ethiopia-  Hospital equipment and hygiene kits  Senegal-  Radiation Machine and supplies  Value$ 750,000, RadHope $80,000  Madagascar-  Radiation Machine  Value $1 mil, RadHope 0  Tanzania-  Radiation center  Value$2 million, RadHope 0  Ukraine-  Radiation Machine  Value $1.5 million, RadHope 0

SENEGAL PROJECT:  Currently there is one Radiation Oncology Center in Senegal Africa  The Institut Curie de L’Hopital Aristide Le Dantec, located in the city of Dakar.  Senegal is a country of over 13 million people which currently has only one radiation machine Radiation Clinic, Senegal Africa

SENEGAL PROJECT: The Institut Curie: -Cobalt -No HDR -Simulator Facutly: -2 Rad Oncs -3 physicists -3 therapist -no nurse Goal: implement HDR brachytherapy Radiation Clinic, Senegal Africa

SENEGAL PROJECT: Most common cancer: -40% cervical Tx for cervical cancer: -External beam, 45 Gy -Boost with external beam -surgery Outcomes: mostly palliative

SENEGAL PROJECT: ARRIVAL OF THE HDR MACHINE

SENEGAL PROJECT: OUTREACH

CONCLUSIONS Much work needs to be done Both equipment and training is needed We need to do more with less money Critical need is for a true collaboration of: The Ministry of Health and the Government The donor community The local medical providers The people themselves Non government organizations/Non profits