A Conversation with Dr. Patrick Loehrer about Improving Cancer Care in Kenya
A number of U.S. cancer centers have programs and initiatives to help improve cancer control and care in developing countries. For more than 20 years, the Indiana University (IU) School of Medicine, in collaboration with the Moi University School of Medicine in Eldoret in western Kenya, has led an initiative called AMPATH (Academic Model for Providing Access to Healthcare) to improve access to and the quality of health care in Kenya.
Leaders from Indiana University’s Melvin and Bren Simon Cancer Center have built upon those efforts and are establishing a cancer program and treatment center at Moi. Dr. Patrick Loehrer, director of the Simon Cancer Center, talked with the NCI Cancer Bulletin about the effort and the center’s future plans in Kenya.
How did this effort begin and where do things stand?
The model for what we’ve done is the work under AMPATH to stem the tide of the HIV epidemic in Kenya. As progress has been made in that area, other chronic diseases have emerged as priorities. Of these, cancer is one of the leading causes of concern. So we’ve been trying to build a cancer program there for the last 8 years.
Initially, we needed to build a platform for training, build the workforce, and provide the essential tools to treat patients. We received a grant from the Frank Levinson Family Foundation, which provided initial funding to treat patients with chemotherapy, and we have received generous help from the Walther Foundation, the Indiana Hemophilia and Thrombosis Center, Celgene, Lilly, and Pfizer to expand the workforce, as well as to help cover the cost of treatment for those who can’t afford it.
Over the last 2 years, we’ve been focused on building an outpatient facility capable of housing a radiation program and infusion therapy. We have received generous support from IU, its Department of Radiation Oncology, and others to initiate this process and now have an architect on the ground [in Eldoret]. We plan to build a chronic care facility, with much of the first floor used for providing chemotherapy and radiation treatments. We hope to have help from the International Atomic Energy Agency to secure a cobalt unit [for radiation therapy].
Additionally, we have partnered with the University of Toronto, Brown University, Vreie University (Amsterdam), and the University of Massachusetts, which have been very helpful in education and training, particularly with gynecology-oncology and medical and pediatric oncology.
What is access to cancer care like in that region of Kenya?
By some estimates there are 20 million people in western Kenya. Before we arrived, there were no formally trained medical oncologists, with radiation therapy only available in Nairobi, four and a half hours away. When we first started in Eldoret, there were two internists—neither of whom was formally trained in oncology—taking care of cancer patients. They would use whatever chemotherapy drugs they could find to treat patients. Often there was uncertainty about patients’ diagnoses and inadequate supplies, which made for some very poor outcomes.
We now have a Kenyan care team led by Dr. Naftali Busakhala, director of oncology at [the Moi Teaching and Referral Hospital (MTRH)], and Drs. Festus Njuguna and Evangeline Njiru. Three years ago, Dr. Matthew Strother joined the faculty at Indiana University, and he spent the first 2 years on the ground in Eldoret with his wife and four children. He really helped to build the program and provide structure.
In January of this year, another fellow joined the IU faculty in Eldoret, Dr. Chite Aswira. Dr. Asirwa was born and raised in Kenya but completed his Internal Medicine residency and Hematology-Oncology fellowship at IU. He’s arguably one of the best trained oncologists in the country, and he is now back in his hometown, leading the program with Dr. Busakhala. He is also joined by one of our new Pediatric Oncology staff, Jodi Skiles, who spends six months a year at the AMPATH-Oncology Program.
The IU and Toronto Obstetrics-Gynecology programs have similarly invested in full-time faculty at MTRH, which has lead to a remarkable growth in capacity for treatment and screening for gynecologic malignancies through their Kenyan partners.
Are you starting to see progress?
We’re up to 9,000 patient visits a year now in Medical Oncology clinics. Three years ago, virtually no women in that part of the country were screened for cervical cancer. Now we’re screening over 8,000 women annually for cervical cancer, and between 8,000 and 9,000 women for breast cancer. We also have a palliative care team that sees 6,000 patients a year.
We see a much wider variety of patients now than we originally did. Because of the HIV/AIDS epidemic, people with Kaposi sarcoma still make up a substantial proportion of the patients we treat. But we also see many women with cervical cancer, which is the number one cause of cancer death among women in Kenya, as well as breast cancer, lymphoma, and head and neck cancer…. Many of the cancers we see are viral-induced malignancies, so vaccines could have a huge impact.
Transportation is a serious issue in Kenya, so AMPATH has a number of satellite sites. There are more than 50 outreach clinics in rural Kenya, and the cancer program uses about four of them. Eldoret is the third-largest city in Kenya. Because we’ve been providing medical care for needy patients, some patients have been coming up from Nairobi to get care, so our reputation is growing around the country.
So this is clearly a long-term commitment?
It’s been an extraordinary journey, but there’s a lot of work still to be done. We’re working with the Kenyan government to expand insurance coverage for cancer treatment. And the Kenyan Minister of Health sent us a memo recently saying that the government is very proud of the program and asking us to submit a budget [that would detail the cost of] running the cancer care program for a year.
What we are trying to build is a sustainable program, not just a research project. Still, we recognize that research is the academic glue that keeps this multi-institutional alliance together. AMPATH’s mantra is to “lead with care,” so our primary goal is to build a generation of Kenyan physician-scientists and health care workers who can adequately care for cancer patients and address the issues unique to sub-Saharan Africa. All the while, remembering that this is a Kenya-led program of which we are privileged to be a part.
—Interviewed by Carmen Phillips