Cancer care in post-genocide Rwanda

When thinking of diseases that affect sub-Saharan Africa, HIV/AIDS is perhaps the health crisis most immediately associated with the region. But in many countries in sub-Saharan Africa such as Rwanda, health experts are seeing a shift in the way disease manifests itself.

In many global health classes at Northwestern, we learn that a model of how disease often repeats a similar pattern. In developed countries, where vaccines against many infectious diseases are common, the heaviest burden of disease comes from chronic or non-communicable diseases that require long-term care over time, such as cancer and diabetes. Developing countries, in contrast, tend to have fewer vaccines and the largest burden of disease from infectious diseases.

In Rwanda, this traditional notion of how disease impacts a country is shifting. Along with the burden of disease from HIV/AIDS, Rwanda has seen a drastic rise in the number of patients suffering from cancer. Just last year, Partners in Health and the Dana-Farber Cancer finished building the Butaro Cancer Center in northern Rwanda. When the center celebrated its birthday in July, it had treated over 1,000 patients, according to Partners in Health.

When Dr. Agnes Binagwaho, Rwanda’s Minister of Health, traveled to the United States earlier this year, she spoke with a small group of students at Harvard Medical School about the new challenge of treating cancer in her home country.

“Most people don’t believe that cancer exists in Africa,” she said, explaining that a principal challenge is getting people around the world to understand that the projected burden of disease from cancer is higher than they might expect. In Rwanda, “its also a new group of diseases that we need to convince people that exist.”

Outside of educating Rwandan citizens about the prevalence of and treatment for cancer, Dr. Binagwaho also says that getting attention from the international community, particularly the World Health Organization, has been difficult. A challenge that the Ministry will take on this coming year is petitioning the World Health Organization to add cancer drugs to their influential list of essential medicines, which can have a drastic impact on the price of a drug on the global market. The goal is to make these medications as widely available to Rwandan citizens as antiretrovirals to treat HIV—which are available to nearly all Rwandans.

“HIV was the first collaborative movement,” said Dr. Binagwaho, about treating diseases on a large scale in sub-Saharan Africa. “I think we should build on this approach.”

And a critical way of building on this approach will be through collecting data. The Minister and her team publish regularly, and constantly assess their work in order to see where they are succeeding and where they can improve. “Collecting data is a responsibility,” she said. “How do we know if our planning was successful? We only know with data.” It is with this data, as well, that Rwandans have been able to show concrete proof of their successes around the globe, and will be able to demonstrate the need for more attention to cancer treatment in developing countries.

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