Running a cancer hospital in rural Cameroon

Dennis Palmer - CIMP Program Director, Mbingo Baptist Hospital, Cameroon

We have a collaboration that has been developing over the last several years. We have an advisory group that has evolved to help us to put radiation therapy at our hospital. Professor Ngwa is part of that group, he is actually from Cameroon, not from very far away from where our hospital is located so he has a personal interest in it and has been very supportive of this project and helping us to make progress with it. We have a group of about probably seven or eight people with different specialties – we’ve got two civil engineers, we’ve got a nuclear physicist, we’ve got three radiation oncologists and a medical physicist that are all part of the team that helped. So we’re at the level where we have designed the bunker that the linear accelerator goes into, we’re just about ready to submit that for approval to the authorities in Cameroon. We have a donated used linear accelerator sitting in Wales in England. So that’s ready to ship out. So we made good progress and a lot of that is due to the collaborations that we get through this meeting and the people who come here.

What collaborations do you achieve through GHCS?

Training, so we have one young man from our hospital who is in Germany at the University of Mannheim training in medical physics. It was through the collaboration with the people here that we were able to send him. We have scholarship funds that come through our contacts here to train. So I have one of our young physicians able to be going to Stellenbosch on a scholarship that’s connected to what they do, the people that are here that have helped us with that.

So you meet people and get ideas about how you can progress with the project. It’s a very complicated project and for someone like me who is not in this, doesn’t work in this field, it’s a bit daunting.

What is your greatest need of resources?

At our hospital we have a very excellent surgical programme and we have pathology, full-time pathology, at the hospital, a good imaging department and we have medical oncology available. But to do comprehensive cancer treatment radiation therapy is a major component of that and especially in an area like where we’re working where patients come with advanced disease because it’s estimated that perhaps 90% of patients with solid tumours can benefit from radiation therapy. It’s a higher percentage than it is in the developed world.

Can you provide radiotherapy?

Radiation therapy is generally not available to the average patient all across sub-Saharan Africa. There’s an enormous deficit in this particular area because the technology is very sophisticated, it’s expensive to set it up and then it’s expensive to maintain. It takes very highly technically trained individuals, physicians and other people to actually operate the equipment safely. So it pushes the envelope about what’s possible, especially on a wide scale. On a limited basis there are centres that do radiation therapy but the need is enormous and generally is not being met in the sub-Saharan African countries.

So we have, at the level that we are at in our hospital, we’re receiving about a thousand new cancer patients each year. We try to refer some of those but it’s very difficult for patients from our area to go down to the cities, we’re eight hours away from the coast and from the capital. So for our people to go there, to find housing, to get through all of their… to meet the specialty people that they need to meet it’s complicated and difficult and quite discouraging to many of them. So many of our patients don’t succeed and we think that we can deliver much better care if we have our own unit and can provide the care for the people that are from our area.

It’s estimated that the need is to have one linear accelerator for each million patients in a population and the population of Cameroon is about 25 million. So it would be nice to have a lot of units and right now we have one cobalt machine that’s working and there’s a private clinic that has a linear accelerator now operating. So that’s the level that we’re at. But most patients can’t afford it or they don’t have access.

Would a cloud based service reduce the number of people needing to go abroad?

We have actually pretty good internet access at our hospital. We have a fibre optic cable that’s there so we do utilise it. We use it for information technology as our primary reference for medical information is all online now. And we do conferences of various kinds that are involved, especially with our postgraduate training programmes that we do live video conferencing with that. But it’s used as a supplement. Something that is as technical… so, for instance, having someone train in radiation oncology is very much a hands-on thing where you have to go to a place where they’re actually doing it.

So having information on the cloud, there are different tools that they are talking about here at the conference about how you might use this to help in planning the therapy for patients and it would speed things up, make it easier for people who are planning radiation therapy, for example. But medical training is done pretty much in a one on one setting where you have preceptors that oversee your work and help you to learn in a very close relationship. So it can be used as a supplement, for the information side of it it’s very helpful but it doesn’t replace the direct interaction between the patient and the trainee and his supervisor. That’s the key component in medical education.

How do you power the centre?

We are on the national grid at the hospital right now and we use diesel generators as our backup electrical source. But we are in the process, well down the road of the process, of building a hydroelectric plant at the hospital which will generate enough power to provide electricity to run the hospital indefinitely is what we hope. It will provide stable power. The quality of electricity is problematic in much of across sub-Saharan Africa with voltage fluctuations and it goes on and off, different things of that sort, and it’s very damaging to sophisticated medical equipment. So we hope that this hydroelectric project, when we complete that, will address that issue and we won’t have that problem.

Have you explored the use of solar panels?

Actually in our particular area there isn’t a lot of sun because we are in a mountainous area and we have a lot of rain. We have looked at that a bit but because we have a lot of rain we have a lot of water and so solar works well but only when the sun’s out, you have to store the energy. But the hydroelectric is, we think, an ideal solution because it runs continuously.

Have there been any cultural or religious barriers towards giving medical care?

I think that the primary problems that we get into are some of our patients, well many of our patients, most of our patients, visit traditional healers as part of therapy, either before they come to see us or even during the time they continue to take traditional treatments. They have a lot of confidence in that sort of thing. There are some patients who have a lot of confidence in their pastors and the ability of their pastors to help them with prayer and other things. So we have had examples where patients would actually be taken out of the hospital and taken to someone where they could receive that kind of support. There are patients in our area who will perhaps start with us, they get a diagnosis of their disease and for whatever reason they will decide to transfer and to try traditional treatment rather than continue.

When people are coming with very late, very advanced disease we are only able to offer palliation for them for their problem. Everyone hopes for a cure and if someone promises them that they have the ability to do that that’s attractive. So it’s in that light that many people decide to take that option. We try to be straightforward and honest with our patients about what we can accomplish for them and when they’re coming with advanced disease we don’t want them to be under the illusion that the treatments we offer are going to provide a cure, that it’s much more palliation. Many patients do come with very advanced disease in that setting because they don’t have access to care or there’s a delay in diagnosis.

What can people do to get earlier diagnosis?

It’s in the area of education and when people have good information they make better decisions. So we have our oncologist spends a lot of time working with women especially, talking about the early signs of breast cancer and if they find something abnormal that they need to seek treatment right away. We do that through our churches a lot of times, we talk to the men about prostate cancer. In children the most prevalent tumour that we see is Burkitt’s lymphoma and there’s quite a lot of that. That’s a very rapidly growing tumour so if there is any significant delay the disease progresses very quickly. So what we want is through education for people to realise that when there is something like that to try to take them to a facility where a diagnosis can be made quickly and we can initiate treatment. Especially some of these tumours that grow very rapidly it’s very important for that.

We see really tragic cases that come – women who come with far advanced cervical cancer or widely metastatic breast cancer and it’s very tragic. We have some palliative care that we can offer but it’s limited and it doesn’t help nearly as much as we would wish that we could. It would have been much better if we had gotten the patients earlier where we could have done more.