I graduated from Northwestern in 2014 and moved to the Bay Area where I currently work in health tech at a company called Collective Health. I recently reached out to the global health blog to see if I could cover some of what is going on in the Bay Area global health scene to stay connected to the Northwestern community. I attended an event a few weeks ago where the UCSF Helen Diller Family Comprehensive Cancer Center, the UCSF Institute for Global Health Sciences, and Global Oncology hosted Mrs. Kim Simplis Barrow, the First Lady of Belize, for a talk on global cancer prevention and thought it would be a great opportunity to share what I learned.
The talk began with an introduction by Franklin W. Huang, Assistant Professor of Medicine in Hematology and Oncology at UCSF and founder of Global Oncology, a non-profit comprised of physicians, scientists, and other professionals with a goal to bring the best in cancer care to underserved populations throughout the world. Dr. Huang spoke about some of the projects Global Oncology has worked on, ranging from an educational comic book on HPV and cervical cancer to thegomap.org, an online network of cancer-related projects. Earlier this year, Global Oncology opened the first public oncology unit in Belize, which is how Dr. Huang originally became connected with Mrs. Barrow.
A lot of global health and non-profit work focuses on communicable diseases. While those are important issues worldwide, I was surprised to learn that cancer actually kills more people in low and middle income countries than HIV/AIDS, tuberculosis, and malaria combined. In those countries, cancers that are usually easily diagnosed and treated are often deadly. According to Dr. Huang, there are many reasons why cancer is such a big issue, ranging from lack of awareness to limited resources that make it difficult to prioritize preventive or diagnostic care. Belize, with a population of about 375,000 people, shares many criteria with other low and middle income countries that makes cancer a widespread issue. 41% of Belizeans are below the poverty line and may not have access to primary care or other ways to detect cancer. Because of this, 44% of patients who receive cancer diagnoses at Karl Heusner Memorial Hospital (KHMH), the main public hospital in Belize, are at a stage IV diagnoses, meaning cancer has spread to other organs or parts of the body. Cancer that is treatable at stage I is much more difficult to cure at stage IV.
Due to the prevalence of late-stage cancer in Belize, the issue is close to Mrs. Barrow’s heart. She has spent a large portion of her career advocating for women and children through her role as the Special Envoy for Women and Children and as the founder and director of the Lifeline Foundation, a charity trust relief organization which “collects funds from the community and manages these funds, using the income to deliver food, medicine, clothing and other necessities to children who lack these essentials due to hunger, poverty or natural disaster.” While cancer does not solely impact women and children, the cultural climate can make it more difficult for women and children to get diagnosed or receive care.
Mrs. Barrow began her presentation by telling us the story of Maria, a mother of four who was diagnosed with cancer at the age of 45. Maria’s story highlights some of cultural stigma associated with the disease. Due to her diagnosis, Maria’s husband left her and she struggled to make ends meet and take care of her children, let alone pay for treatment. Maria passed away from a preventable and treatable form of cancer. Mrs. Barrow was extremely touched by this story, and it is has helped her come to understand both the magnitude of cancer in Belize and the vast number of undiagnosed or unreported cases that likely exist, making the number even higher. Not only is cancer already the leading cause of death in Belize, the number of cancer diagnoses is predicted to double by 2030.
Mrs. Barrow is a cancer survivor herself. In 2011 she was diagnosed with stage III breast cancer. As she went through the emotionally and physically challenging treatment process, she realized the degree to which her privilege and position gave her access to the care she needed. She was seen right away at KHMH and was also able to fly to Miami to get better care than she could have received in Belize. While Mrs. Barrow was thankful for her treatment and care, she was frustrated by the understanding that without her privilege it would be extremely difficult to access.
I imagine it would be easiest to privately focus on your health while going through treatment, but Mrs. Barrow realized she had a unique opportunity to put cancer care and prevention in the public discourse. She recognized there was misinformation and shame associated with cancer in Belize, which was one of the reasons cancer was taking so many lives. As she went through chemotherapy and lost her hair, she made a conscious decision to not wear a wig. She turned her cancer treatment into a message to the people of Belize: cancer is not something to be embarrassed about, as it could even affect the most important people in their country.
It was inspiring to hear about Mrs. Barrow’s personal journey and how she used her story to fight cancer’s stigma, but her work with cancer didn’t end with her recovery. She realized that while part of the problem is the lack of awareness she fought by making her cancer public, there is also a resource issue. Most people in Belize do not have health insurance, presenting a major barrier to care. Through a partnership with Global Oncology, she has worked on increasing access to cancer care in Belize, including opening the first oncology unit at a public hospital, KHMH. This new outpatient cancer treatment facility is making mammography and ultrasound services available to many people who were not able to go to a private hospital.
While the new oncology unit will increase access to care, it also highlights some of the economic inequalities of cancer screening. Not only can it be difficult to afford something like a mammogram, it can also be extremely challenging to travel to get to the one public imaging location. Furthermore, a lot of women in Belize are economically dependent on men. As highlighted in the story Mrs. Barrow shared about Maria, some men even leave their wives when they learn of a cancer diagnosis, putting them into a situation where they may have very little or no resources at their disposal. Even if that is not the case, a woman may have to decide whether to spend her limited resources on her children or herself. If she does not have a lot of awareness about the importance of cancer prevention and early diagnoses, it may seem relatively unimportant for her to spend the time and money to get a mammogram when she could instead spend the money on food or education for her children.
After Mrs. Barrow told her story, the room opened up for discussion. It was filled with UCSF students, medical professionals, and faculty who had interesting questions and ideas about how to increase cancer prevention and awareness in Belize. There was a woman who worked with Spanish speaking populations in San Francisco who mentioned she faced some similar issues in trying to spread cancer awareness in that group. There was also a radiologist who specialized in mammography who wondered if a mobile mammography van could help more women access mammograms without having to travel to KHMH. I’m excited to continue to follow Mrs. Barrow and Global Oncology’s work in Belize and see if any of the suggestions from the talk become implemented in their collaborative work.