By JESSIE NGOMA -SIMENGWA –
The World Health Organisation (WHO) has observed that cancer is one of the leading causes of mortality worldwide.
Despite the attention and intervention in early diagnosis, treatment and prevention which the Non Communicable Disease (NCD) has received, it has emerged as a health challenge with a mortality increase in Africa.
Zambia is one of the Sub-Saharan countries which have seen the incidence, burden and risk for cancer related mortality.
Cancer is defined as a collection of diseases that involve abnormal cell growth.
It has the potential to affect or spread to other parts of the body.
This month, the world celebrated World Cancer Day which fell on February 4 under the theme “I Am And I Will.”
The theme was a clarion call for everyone’s commitment to take positive action.
For Merck Foundation, the celebrations came at the right time as the foundation has acted by partnering with African first ladies and ministries of Health through training oncologists in Zambia and other African countries.
Launched in 2016, the Cancer Access Programme trained oncologists by Merck Foundation are among the first multidisplinary cancer care team in Zambia.
In a speech made available from Merck Foundation to mark World Cancer Day for 2021, the organization celebrated with Zambia’s First Lady Mrs Esther Lungu – together with the Ministry of Health in Zambia, through providing scholarships of Oncology Fellowship training to build cancer capacity.
Mrs Lungu is also an ambassador for Merck More than a Mother Campaign in Zambia, which is aimed at breaking the stigma associated with infertility.
The aim of the training provided by Merck is to increase the limited number of trained oncologists so as to improve patients’ access to quality and equitable care in Zambia and the rest of Africa.
“The philanthropic arm of Merck KGaA Germany has through the fellowship provided scholarships of one and two years with master’s degree of three years for eight doctors to be the first oncologists and first cancer team in Zambia,” said Merck Foundation Chief Executive Officer Senator Rasha Kelej.
Senator Dr Kelej said additionally, Merck Foundation has made history by providing the first surgical oncologist, Pediatric Oncologist Haemato – who is an oncologist and gynecology oncologist.
She said Merck Foundation strives to make the African healthcare professionals highly competent and fully independent by providing the best in class.
“I am proud of our success to reshape and advance the public cancer care sector and to increase the limited number of oncologists by more than 70 new oncologists to be the first in 24 countries in Africa, including Zambia,” Dr Kelej said.
She further said the multidisciplinary oncology care teams in many African countries consist of medical, surgery, pediatrics, gynecology, radiation oncologists, nursing, pathologist and radiology technicians.
She said the foundation’s key objective is to provide quality and equitable care to patients who never had anyone to care for them before.
“As such, we at Merck have scaled up and strengthened activities in more countries because we are committed to cancer care landscape transformation in the continent,” Dr Kelej said.
Despite the disease being preventable and curable when diagnosed at an early stage, the human capital and other requirements come with high costs in Zambia.
Currently, the Cancer Diseases Hospital (CDH) is the only effective cancer treatment centre that provides radiation and therapy in Zambia, with other hospitals only managing to detect.
“Furthermore, the foundation has also provided scholarship to 87 Zambian doctors in different specialties such diabetes, sexual and reproductive health medicines, fertility specialty and many others,” Dr Kelej explained
One of the beneficiaries of the Merck Foundation based at the Cancer Disease Centre in Lusaka called for more awareness of people to seek early treatment.
Pediatric Medical Oncologist Mulindwa Makasa said the fellowship has also enhanced their skill in treating children, which has also enabled them to improve their collaboration in research and education.
“The training has been very beneficial as it has offered us a platform to impart the knowledge on cancer with training nursing and medical students,” Dr Makasa said.
Dr Makasa, who has been working with the CDH since his training from 2017 to 2018 from Tata Memorial Centre in India, said every year, the hospital in Zambia attends to about 150 to 200 cases of children with cancer.
But he said this is not a reflection of what is on the ground as some children die at a local health facility or at home before they ever get a chance to be treated.
“Children too do have cancer and sometimes the presentation of cancer in children may be like any other illness of a child and by the time it dawns on the family, the cancer would have progressed to a level where it is not manageable,” he explained.
He said about 4 million children globally experience cancer and about 80 per cent of them are in low and middle income countries, a burden which he said was part of the world.
Dr Mulindwa noted that it is important to know that there are known differences between cancer in adults and childhood cancer and one major difference is that where as there is evidence in adult cancer when you screen, it improves the pickup and survival rate, the same is not known for childhood cancer, so there are no established ways of screening in childhood cancers to target specific cancers that are known to work.
He said what works better in children is a whole service improvement and this depends on how best children are generally looked after, thus the need for people to be made aware of particular signs in children and refer them.
However, one similarity is that early diagnosis for both adults and children leads to better outcomes.
Further, whereas cancers in adults will present in an early stage, with children, it may present in 80 per cent of cases in an advanced form in that adults report faster when they are sick, while with children particularly those under five – dependent on their care givers to pick up a problem.
However, Dr Mulindwa said the good news is that generally, the drugs used to treat cancer have seen childhood cancer respond very well compared to adults, a situation that has contributed to their improved survival.
He said in high income countries like the United States (US) where this improvement has happened, survival generally in childhood cancer may be as high as 80 per cent.
“This in Zambia is what we are looking for and aiming at. If services are improved in the care of children and in trying to achieve this, we have been fortunate to be selected as a focus country under the WHO Global Initiative of Childhood Cancer which aims at improving childhood cancer survival from less than 20 per cent currently to about 50 per cent.
Another beneficiary of the fellowship Dr Kasiba Mwala said the surgical oncology training programme he underwent has added more skills in treating surgical problems in cancer.
“It has given me more skills in breast cancer diagnosis and surgical treatment such as mastectomy, a surgery to remove breast tissue as a way to prevent or treat breast cancer. To achieve mortality reductions, it is important to note that adequate facility and human resource training is strengthened,” the oncologist said.
Dr Mwala said similarly, prioritizing infrastructure for cancer treatment in developing countries, coupled with their maintenance, is key.