Notable progress has been made in Rwanda in the healthcare, which can mostly be seen by the sustained reduction in the incidence and prevalence rates of infectious diseases such as malaria, tuberculosis and HIV among others.
But the health sector is not resting on its laurels and focus is now shifting as the improvement of healthcare and increase of life expectancy bring about another risk: development of non-communicable diseases including diabetes and cancer.
According to a world cancer report by the World Health Organization (WHO) provided in 2003, cancer rates were set to increase by 50% to 15 million new cases globally in the year 2020 from 10 million in 2000. And recently the WHO even increased its estimation for 2020 to 16 million new cancer cases, with 70% of those cases in developing countries like Rwanda.
The increase would mainly be due to steadily ageing populations in both developed and developing countries and also trends in smoking prevalence and the growing adoption of unhealthy lifestyles. However, the report also provided clear evidence that healthy lifestyles and public health action by governments and health practitioners could contain this trend, and prevent as many as one third of cancers worldwide.
It showed that action on smoking, diet and infections can prevent one third of cancers while another third can be cured, and there will be provision of good, palliative care to the remaining third that need it.
But for the care of patients and eventual cure of some to be possible, there are a number of things that are needed: equipment that allows accurate diagnosis and early detection, facilities where the patients can be cared for, drugs and, most importantly, healthcare providers who know what they are doing and have the skills, namely oncologists, skilled surgeons and specialized nurses.
As for Rwanda, there are nearly 11 million people, yet the country does not have a single Rwandan oncologist. "The only recognized oncologist we have is an Indian doctor who usually operates from Kampala," explains Dr. Leonard Kayonde, the director of the cancer diseases unit in the department of non-communicable diseases at the Rwanda Biomedical Center (RBC), pointing out that the oncologist only comes to treat people once every two weeks at King Faisal Hospital.
This complicates things as for example childhood cancers like acute lymphoblastic leukemia, which has an 80% cure rate in the United States, are a virtual death sentence for children in Rwanda, according to the ministry of health.
"Just a few years ago we had no system to treat AIDS in Africa. Today nearly 7 million people in developing countries are receiving treatment for HIV. We can do the same with cancer."
There is a number of testing equipment that allows the detection of cancer, but they are mostly in referral hospitals including CHUK and Faisal. This makes access to cancer detection and care difficult for those who need it and are in rural areas, leading to late detection when cases have reached advanced stages.
Full spectrum of services
It's in this context that the ministry of health, together with Partners In Health, the Jeff Gordon Children's Foundation and the Dana-Farber/Brigham and Women's Cancer Center will inaugurate the Butaro Cancer Center of Excellence on July 18, which will serve as the first national cancer referral facility in rural Rwanda.
"The new Butaro Cancer Centre of Excellence not only comes at an appropriate time, but also fits well into our vision," remarks Health Minister Agnes Binagwaho. "As Rwanda makes significant strides in combating major infectious diseases like HIV/AIDS, TB and Malaria, efforts are now put into the diagnosis and treatment of the most frequently occurring non-communicable diseases."
The minister points out that this adds value to the interventions designed in combating non-communicable diseases.
The Cancer Center of Excellence aims to address both existing resource limitations and the growing global cancer burden. The Butaro Cancer Center of Excellence will provide a full spectrum of cancer care including screening, diagnosis, chemotherapy, surgery, patient follow-up, and palliative care. It will also serve as the first facility to implement standardized cancer training and protocols that align with Rwanda's new national guidelines.
Paul Farmer, co-founder of Partners In Health and chair of Harvard's Department of Global Health and Social Medicine, expressed optimism that access to cancer treatment by all is possible. "Just a few years ago we had no system or financing mechanism to diagnose and treat AIDS in Africa. People said it was too expensive or too complicated," he points out. "But today nearly 7 million people in developing countries are receiving treatment for HIV. We can do the same with cancer."
The Center, located within Butaro Hospital in Burera district, Northern Province, is a critical element of the country's ambitious five-year plan to introduce cancer prevention, screening and treatment on a national level. The facility's opening will mark a major milestone as the first center of its kind to bring comprehensive cancer care to rural East Africa.