The Global Health Catalyst initiative

Wilfred Ngwa - Harvard Medical School. Boston, Massachusetts

The Global Health Catalyst programme is a programme at Dana Farber, Brigham and Harvard Medical School cross-institutional and the goal of that is really collaboration. Basically collaborating between low and middle income countries and also high income countries like the United States and Europe, European countries like Germany, and all of that. We started from the idea of cancer, so bridging cancer disparities, so collaborating to reduce cancer disparities. The concept comes from the fact that if you are born with cancer in Cameroon or Tanzania or some low or middle income country then what happens is that you don’t have access to treatment. But if you are born just down the street here you have multiple options so you can either go to Brigham, you can go to Dana Farber, you can go to Beth Israel, you can go to all these different institutions and you get world class care. So just this disparity where it’s no fault of your own where you’re just born somewhere and you don’t have access to treatment.

So how can we collaborate to eliminate this disparity? That’s the goal of the programme itself. Over the years, we started in 2015, it was mostly cancer health professionals that met: the President for the Union of International Cancer Control, the IAEA, some really big people, AORTIC – the African Organisation for Research and Training in Cancer. We thought about how can we reduce these disparities? How can we collaborate to make that better? So we started talking to each other. One outcome that came from that is that we can focus on information and communication technologies because they break these geographic barriers. People have time, a lot of people had time, they wanted to help. They want to help but they don’t have time to travel to those developing countries to do anything. So if you imagine you’re sitting here, you have to go 4,000 miles in order to do that. So what if you could pool that time, if these people just had 30 minutes a week or one hour in a month? If you can pool each person’s time you have one hour, I have one hour, the other person has one hour. You can create this infrastructure which allows them to do something cohesive to have an impact somewhere, that would be really powerful. All you need there is just to have this information and communication technology infrastructure.

Africa, for example, leapfrogged the landlines. I grew up in a village there where I didn’t have a land phone but now my mum uses WhatsApp and they have mobile phones, it’s deep penetration. So is there an opportunity there where you can use that kind of connectivity and actually close the disparities?

We’ve started doing a number of things and two things resulted from that. The focus recommendation from that meeting, the first summit that we had, was that we should focus on information and communication technologies. So that’s one thing. The second thing we decided to focus on was engaging the diaspora. Diaspora is literally people like me who were born in some village in Cameroon or some other African country and who are now in the United States contributing to the healthcare of the country here. You would say that’s a problem, it’s a brain drain – I’m not helping the country in which I was born. But we, these diaspora people, have a good appreciation of the problems on the ground and an appreciation of the problems here in the United States. We understand both cultures. Then, secondly, I really got inspired, partly because you have a lot of people here from Europe and from America coming to Africa to help administer healthcare. And it’s great but they inspire the people like me – I cannot just sit here and just watch those people doing it. Actually the people they are helping, those are my brothers and sisters. So engaging the diaspora to give back.

So we decided that we were going to turn the brain drain into global health gain which means that we create an infrastructure, an ICT infrastructure, information and communication technology infrastructure, engage the diaspora so we can sit here and have an impact there. I can tell you three things that we’ve done that resulted from that. One is this idea, and we talked about ideas today, the Dana Farber President talked about the fact that you can take the Dana Farber Harvard cancer centre and put it in the cloud. So it means that it doesn’t matter where you are, if you have a smartphone, you have a tablet, you have a computer, you can just log on, you can have access. Which means that you can upload patient data, sex, if you have the diagnosis you can upload a pdf, whatever, the doctor can sit here and can look at that and say, ‘Here’s my recommendation for you.’ So e-consultation, we started doing that.

Tumour boards, so we have the diaspora groups actually in Germany, Campo Medics [?], one of the leading partners that we have that hold these regular tumour boards with their countries making sure that the doctors there are giving the best care to their patients. They look at also education and training. So we actually won an award last year for this after launching the project, last year at this summit. What we have started implementing, we have trained, subsequently trained, over 200 professional oncologists in Africa in very specific things that are making an impact. For example, most of the doctors they are moving from 2D to 3D which means that they are getting 3D datasets. Now they have to use that to find where the cancer is in those images. So you have to contour them, draw and they didn’t have that knowledge. So just training them allows them to deliver their care more effectively.

What we saw was good and bad. The good part was that we saw a significant jump in the skill level. Take prostate cancer, around your prostate you have the bladder, you have the rectum, so if you are going to shoot radiation therapy to the prostate that has cancer you want to also not have the bladder and the rectum having radiation. So what a doctor would do is he has to go in there and contour, so basically draw circles around in the CT dataset what is your prostate, what is your rectum and then plan a treatment delivery where you shoot the x-rays such that they only maximise the dose to the prostate. If you don’t know what the rectum and the prostate is on the CT dataset you cannot even begin the treatment planning. So what that really means then is that we trained people just to recognise that there was a jump in skillset. We realised people went to get the test before and then after the training were able to actually identify and do all that contouring much, much better.

So the good part was there was a jump in skill level, the other part that was shocking for me personally was it means that all the patients that had been seen until then, what was happening to them? Some patients have been suffering because they didn’t have that skill level. I can’t really blame them because that’s the education they had.
But that training actually happened very collaboratively so you had the best professors here at Harvard, from UPenn, from MD Anderson, from Heidelberg, from Oxford University, David Kerr and all those people, they gave lectures. So if you do that collaboratively for them it’s just one hour apart from their busy schedule but they are training somebody there that’s having a really big impact. So that’s the cloud, what limits the cloud is you don’t have to travel, just using information and communication technologies you can do that.

So now we actually had this past week a partnership, we just had the session today, with IBM. They’re doing a lot with the cloud, how we can partner in this. So we’re very excited about the potential impact of this. Yesterday Professor Elzawawy talked about launching the Global Oncology University where we can actually give these courses, all the specialists can give the courses, pooling their time together. Then we credential local sites in these different low and middle income countries where we go there, see what infrastructure they have and say, ‘This is where you’re going to do your practical training. You can take the classes online but this centre has enough infrastructure where if you go through the different components, this number of hours of training, we can certify that you’ve completed those degree requirements.’ So you can have residents getting their residency, you can have people getting their Masters degrees and PhDs.

There’s a lot of short-term training that’s useful, like what we did last year, but now we are making that longer term where you can actually get a degree. You can get residency training. So we’re very excited and that’s going to be collaborative teaching. So you’re still going to be getting the best experts, Professor Kerr from Oxford, you’re going to have Professor Starmer [?] from Heidelberg, you’re going to have Professor Elzawawy from Egypt, you’re going to have somebody in MD Anderson and we’re very excited about this. So we actually mentioned that yesterday, so many people already signed up on the platform. I didn’t even realise that, I was just sharing that today. When I looked at that I saw that so many people had already signed, just to show you how many people resonate with the concept. Obviously we are looking to see how we can partner with ecancer as well because you have tonnes of really great videos that can actually be used. You actually are the pioneers of this kind of education and training. So we really look forward to seeing how we can collaborate in this area. So that’s one thing we’re excited about.

How is your own research linked to GHC?

I’ve talked a little bit about the education component but the cancer centre in the cloud, comprehensive cancer centre in the cloud, is really comprehensive because we have both education, research and care. The research part is what I also do, all of my research falls under that. The reason for that is this. We have a lot of possibilities here where you can actually do research in a low or middle income country that is beneficial also for high income countries.

So in 2015 I won the Bright Futures prize here at Harvard which is really based on developing tiny drones that you can use to target cancer. It precisely delivers the drugs to the cancer cells without the side effects that you get from chemo. When you see somebody with chemo obviously there are those side effects. But what was really cool about it is that it can train your immune system to actually recognise the cancer. Part of my talk yesterday was showing how you can actually take that technology and bring it to a low resource setting where you can give. The title of the talk was ‘Curative cancer treatment for less than $300.’ If you think about that, that’s a big access issue. Remember I talked about global health disparities? One of the things, even here in the United States, is that when you are diagnosed with cancer you have to ask yourself should I see a cancer specialist first or should I see my financial specialist because the money, the cost, is really high -  average $150,000, I was reading somewhere. So many populations, even here in the United States, have to go to Mexico, they have to go to India to get access to treatment if they don’t have health insurance and that’s a difficult issue. That’s even worse in developing countries. Cameroon, where I was born, I grew up in a village walking barefooted so even talking to you here is a miracle. So if you don’t bring the cost down to those people…

The Bright Futures prize was really interesting in the sense that Harvard set it up in three levels. One, you have a great idea that they like. So it was peer reviewed, reviewers selected it and then select the top six projects and they do kind of a shark tank. So they get the best, the deans and all those people that sit here and then you present your project and they look at it and question you. Then they take the three best projects and then they put it out to the public and they say, ‘Okay, which of these projects that are equally worthy of winning this prize, which of these projects do you want to…’ there are similar models today, ‘… do you want to support?’ So a lot of people voted, not only in all fifty states in the United States, from Europe, but also a lot of them from Africa. The people who voted from Africa said, ‘Is this one of those technologies that you’re going to develop that’s only going to benefit the United States? Why should I vote for this if it’s never going to come to me?’ At that point we made a commitment that it doesn’t matter what, we’re going to make sure that it’s accessible.

So actually it’s a partnered technology by Dana Farber and Brigham but we have options to license that. But we decided that instead of licensing it we are going to make sure that we develop it ourselves and we just got funding from the NIH, $4 million, to do some of this. So you do that so that people can have access to you. Because you can give that to a company, they may decide to do whatever they like with it. So we’re very excited about that because that really fits into the global health thing. So we are planning on a clinical trial and one of them probably would be with Professor Kerr in Oxford. He’s talking about the idea yesterday about AfrOxH. He already has AfrOx which is Africa-Oxford, and now he wants to add an H to it which is Africa-Oxford-Harvard. We will make this more [?? 13:33] clinical trials so people in different regions in these countries can have access to the same clinical trials that we are having here at Harvard. That’s one of the clinical trials we’re very excited about, my colleague Paul Nguyen talked about it yesterday, he’s driving that for prostate cancer. We also have some really good data already for pancreatic and lung cancer. So that’s a technology that really falls under the Global Health Catalyst kind of thing.

Some other people have talked about it here today, they have AI that can contour, things like that. Those are things we want to include in the platform of global health – it’s ICT based, it’s something that can bridge disparities, that kind of thing. So overall the research, really, I’m excited about that, the fact that what we are doing can actually be made accessible to developing countries.

What would your final message be?

The final message is just that the Global Health Catalyst summit, we really thank you guys for being here. It’s really about collaborations and obviously Professor Eduardo Cazap is one of the luminaries in global health. I don’t even know what title is best to fit him – Editor in Chief now for you guys and also Danny [?] and you guys are doing great. But the idea of collaboration is really the essence of this summit so we actually opened it up yesterday. The idea was that if you had just one word you are taking out of here it’s how can we collaborate? Not trying to take away what you are doing, so you are really good at what you are doing but let’s find areas where we can synergise our efforts and go further. Because if you go by yourself you may go fast, that’s what they say in Africa, if you go together you go further. You can still do what you are doing but find areas where we can collaborate. For me, it’s really looking forward to working with ecancer to see how with these partnerships already built we can collaborate to go forward.