Cancer patient outcomes improving in Kenya

primary_logo-compressedToday's guest blog comes to us from F. Chite Asirwa, MD, Medical Co-director of the AMPATH Oncology and Hematology Program and Visiting Assistant Professor of Clinical Medicine at the Indiana University School of Medicine. A hematologist and medical oncologist, Dr. Asirwa is charged with helping to build the AMPATH Oncology Institute in Eldoret, Kenya. AMPATH, the Academic Model Providing Access to Healthcare, is a partnership between Moi University School of Medicine, Moi Teaching and Referral Hospital in Eldoret, Kenya, and a consortium of 11 academic health centers led by Indiana University. Together with Kenya's Ministry of Health and the U.S. government, AMPATH delivers health services, conducts health research and develops leaders in health care for both North America and sub-Saharan Africa.

As I walked through the basement clinic, where a few rooms were kept aside for the cancer outpatient clinic on Mondays and Wednesdays, I could not help but feel inadequate and some sense of hopelessness. The year was 2011, I had just completed my medical residency and fellowship training at Indiana University. Now, back home in Kenya, I was working at AMPATH to help build the cancer care programs, education, and research.

In the cancer clinic, the number of patients can be overwhelming. Many days, I can easily count about 100 people squeezed into a narrow space between six clinic examination rooms and the chemotherapy tent outside.

One of my first patients, I will never forget. She was a 42-year-old woman we will call "Naomi." When Naomi walked into the examination room, she was limping and took a considerable time to make it to her seat. She was a mother of four, her youngest only two years old. Naomi presented with advanced stage IV breast cancer. By the time she had come to us in the AMPATH clinic, she had metastasis in her bones, lungs and liver.

In the two and a half years prior to coming to the AMPATH clinic, Naomi's symptoms were ignored, misdiagnosed, or treated with traditional herbs from a medicine man. I discussed with her exactly what cancer was, how it is evaluated, how it is staged and treated, how different cancers have different treatments, and what we needed to do now. We got the palliative team involved and I continued to see her routinely in clinic. She had a partial response after first-line of treatment; however, the cancer started to grow again. When she died 14 months after our initial contact, I attended her funeral service. The family was there, which I had prepared them for this. Even then, it was such a hard blow.

In the past 4 years, I have seen many Naomis and Johns and Peters and Marys with similar stories. But what keeps me going is the fact that the scenario in western Kenya is slowly but surely changing. We are now seeing at least 15% of breast cancer presentation in early stage disease. This is in part due to the collaborative partnership of AMPATH that brings together an amazing selfless group of people dedicated to the betterment of the world we live in and the future of the generations to come. Included in that group of amazing selfless people are the many philanthropists and organizations, like Lilly, for their belief and support to our program.