04 December 2012

Rwanda's Butaro Cancer Center: Realizing Francine's Wish

The following post is written in conjunction with PRI The World's series on cancer and builds on yesterday's post covering Rwanda's efforts to take on cervical cancer.

When Nicole first arrived at the Butaro Cancer Center of Excellence she could no longer stand because she was so sick from leukemia. She received intense treatment for acute lymphoblastic leukemia at the center over a two month period. Over the course of her treatment, Nicole regained her strength and was speaking to health staff in her native Kinyarwandan and English. 

Five weeks ago, Nicole was discharged from the center with oral chemotherapy to return home to her mother and sister. Her family will have to return to the center once a month for the next 30 months to continue the treatment. They will travel the roughly 77 kilometers North towards the border with Uganda to the only center capable of treating Nicole’s cancer in Rwanda. 

Butaro Cancer Center of Excellence, Credit: PIH
One year ago, Nicole never would have accessed the treatment that could save her life. The Butaro Cancer Center of Excellence was inaugurated this past July as the first cancer ward in rural East Africa. The establishment of the hospital represents a step forward towards turning cancer from a death sentence into a treatable illness. 

“Some childhood cancers have cure rates of 80 percent in the US, but in most parts of Africa cancer is a death sentence because treatment simply isn't available. We want to change that paradigm and bring world class cancer care to the world's poorest children, using a replicable and sustainable model,” said Peter Drobac, Rwanda PIH/IMB Country Director, in marking the inauguration of the center. 

Equity in Stone 

“There are tremendous barriers to patients in the rural setting to access specialty care services including for cancer,” explained Dr. Neo Tapela, Partners in Health's (PIH) Director of the NCD Program in Rwanda. Rwanda’s four referral centers exist in urban settings, but 80% of the population lives in rural parts of the country. The center will provide comprehensive cancer services including screening, diagnosis, chemotherapy, surgery, patient follow-up, and palliative care. 

Building the center is a step by the government to reduce the barriers to treatment and ensuring equitable care. Equity is central to the Ministry of health. “Equity is written in stone in our hearts,” said Minister of Health Dr. Agnes Bingawaho with pride. “It is in our constitution.” Achieving equitable health care means taking steps to put skilled doctors in each district and bring cancer services to rural parts of the country. 

Paul Farmer, co-founder of PIH, addressed concerns about investments in cancer by recalling early opposition to funding for AIDS. “Just a few years ago we had no system or financing mechanism to diagnose and treat AIDS in Africa,” said Dr Farmer. “People said it was too expensive or too complicated. But today nearly 7 million people in developing countries are receiving treatment for HIV. We can do the same with cancer.” 

Global Effort 

The establishment of the center in Butaro is the result of a multi-stakeholder partnership between Rwanda’s Ministry of Health, PIH, the Jeff Gordon Children’s Foundation and the Dana-Farber/Brigham and Women's Cancer Center. A $1.5 million donation from the Jeff Gordon Children’s Foundation and comprehensive support from PIH led to the building of the center. The land was provided by the Rwandan army, Dana-Farber/Brigham will provide testing support, and the government will pay the staff. 

Specialty cancer nurses from Dana-Farber Cancer Institute serve as mentors for the nurses in the center to support their work with the patients. PIH will support the government efforts to implement a comprehensive cancer plan that will serve to inform and shape all of the country’s health systems. Not only will rural Rwandan’s have improved access to care, but the proximity to neighboring Burundi and Uganda means that the center will serve as a regional hub that extends beyond borders. PIH will support patients from other countries who do not have health insurance, explained Dr. Tapela. 

Anne Elperin , an oncology nurse from Boston who already participated in the program as a Dana-Farber fellow was struck by how eager the nurses were to learn. "The Rwandan nurses were very engaged and would come to my chemotherapy classes on their days off or after they had worked a full night shift," Elperin told nurse.com. "They took a lot of pride in the fact that they were doing something new for Rwanda." 

One example is the implementation of national cancer trainings for doctors and nurses beginning March 2012. Doing so, “provides baseline knowledge for doctors and nurses at all levels in cancer diagnosis, treatment and care,” said Dr Tapela. The work goes further to include curriculum development and training community health workers in chronic diseases. “We need to create a community of care providers to accelerate science and the transfer of skills,” said Dr Bingawaho. 

Francine’s Wish

The story of Nicole is illustrative of the center’s transformational power. Francine Tuyishime, only fifteen years old, was the first patient to receive chemotherapy in PIH-supported hospital in Rwinkwavu, Rwanda. Like Nicole, Francine arrived at the hospital when her family thought that she would likely die. When traditional healers failed, Francine’s father brought her to the hospital in Rwinkavu for treatment. 

“There was a time when I thought I would never make it, when they started the medications,” said Francine. “I wish others in this part of the world could be cured just like I was cured by the medicines I was given.” Enrollment at both centers in Butaro and Rwinkwavu has grown this year, especially in Butaro following its opening. The establishment of the Butaro Cancer Center of Excellence and the story of Nicole are realizations of Francine’s wish.