I’m a cancer epidemiologist, I work mostly in public health, I’m not behind the computer running numbers. My expertise, my interest, and what I do at GFC, is that it starts with a person, with education, with awareness – I don’t really like the word awareness, I like more education, information – all the way up to the diagnostics and when the person becomes a patient and it goes into the healthcare facility. It covers basically my interests are the two first pillars. I think that they are key, with breast cancer in particular, we don’t have a precursor of breast cancer that we can actually identify and then prevent breast cancer from developing. By the time that we see that there is breast cancer, even if it’s just with an MRI or with a mammography, breast cancer is already there. The only way to actually have an impact in the disease is if you go throughout everything, throughout diagnostics and treatment. That’s why this first phase is where you lose a lot of people because of financial problems, because of access issues. So I really like that piece. 

GFC works a lot on supportive care, supportive care goes from health literacy to peer support to psychosocial support. It is anything that helps basically mitigate the secondary effects of any kind of breast cancer or cancer. 

My role at GFC, I’m a health systems person, I like to see the whole system. My role is to make sure that the programmes that we implement at GFC, they’re anchored in the healthcare system, that they’re not just, ‘Okay, we’ve got a grant to run this for six months, then we’ll figure it out.’ No. Whenever we start the programme, just making sure that has the support from the locals, that it is embedded in the local structure. 

GFC has had a long tradition of running peer support programmes. These programmes are really good in places where there is not a lot of mental health and psychosocial support from the health system itself. So there is a shortage of mental health professionals, so then what you do is that peers can support each other – somebody that had breast cancer can support a woman or a man that is going through breast cancer. But this is not as straightforward as one might think because we all have good intentions but we all know what happens, people have opinions, people might give medical advice, and this is not what a peer support should consist of. 

We’ve run a trial with an NIH grant that has given us scientific results that peer support works. We’ve built a toolkit with the materials used to train the peers, the mentors and the peers, we’ve developed a toolkit. Now what we’re doing is that we are working with organisations around the world that want to implement peer support using the toolkit. We’re not working with organisations that, again, work in isolation, so we have started the training in Rwanda and it’s an NGO that will run the programme. The training is still run by GFC and by the documents. It’s not that we’re going to Rwanda to train, it’s that a bunch of documents that are being used and at the same time we are recording the adaptations that need to be done, the feedback from the people that are being trained that maybe this is not the right way to say things in Rwanda, this is maybe not appropriate for this. My point is that we make sure from the beginning that training is being implemented by somebody that has a structure and that works in the country, that works within the parameters of the national cancer control strategy, otherwise we wouldn’t be doing it. 

The toolkit itself, it does have, in addition to the training of the peers which is really important, it has an initial model of how to anchor these into your health system. So what are the key points that you need before you implement that programme, what are the key points that an organisation, a checklist, has to make sure that they have. It could be Ministry of Health support, it has to be embedded within a hospital, or it has to have some kind of supervision by an oncologist or several oncologists, it has to have a healthcare professional overseeing the whole thing. There are all these checkpoints that we would not start engaging and making the toolkit available to that organisation if we didn’t meet those, if we didn’t check that the fifteen points or ten points, making sure that this will remain, and that is within the parameters, and it’s what the Ministry wants to do and that they’re supportive. So there is not an actual recipe, but mostly it’s to try to make sure that everything is run according to and it fits the strategy of a specific context.