FEATURED: Cancer: No longer a death sentence in Rwanda

Monday February 4th is World Cancer Day. Rwandans will join the rest of the world in commemorating the day, having an opportunity to honor cancer patients, survivors and cancer care-providers in Rwanda and across the globe. Special recognition goes to our generous supporters, without whom Rwanda’s efforts to curb this growing challenge would not be possible. This year, Partners In Health/Inshuti Mu Buzima, in conjunction with Rwanda’s Ministry of Health, celebrates brave women, men and children who have passed through the doors of the Butaro Hospital’s Cancer Center of Excellence, like this remarkable woman, Jessica Akimana (name changed to protect her identity). When Akimana’s second child birth triggered vaginal bleeding that culminated into a cervical cancer diagnosis in late 2017, not surprisingly, she got depressed. “I was devastated, especially since I was sure that there was no way I was going to afford cancer treatment!” she says. However, she quickly discovered that her assumptions were very wrong! “I received treatment which included a year of treatment and chemotherapy in Rwanda at Butaro Hospital, and a referral to Nairobi, Kenya for radiation therapy. All the costswere covered by Partners In Health: transport to my village, flight, accommodation while in Nairobi, food and even a nurse to follow us and help us navigate the systems. Everything!” she exclaims. Now, 36-year-old Akimana has completely recovered and has a new lease to life, and is a happy, healthy mother of 5, who is delighted to embrace life to the fullest, work hard and contribute to her community! Akimana’s story is not isolated. Thousands of cancer patients who come from Rwanda and all across Africa – from the neighboring countries of Burundi, Uganda and Congo and further, like Nigeria, Liberia and Somalia, have received care at Butaro Cancer Center of Excellence (BCCOE), a first of its kind, a cancer treatment facility in a rural setting that serves as a beacon of hope for many. Cancer Care: Located in Burera district, Butaro Cancer Center of Excellence (BCCOE) is nestled snugly inside the sprawling Butaro district hospital grounds. The hospital itself is situated at the top of the lush green hills that characterize the northern province of Rwanda. The vision of a comprehensive cancer care center sprouted from the presence of Partners In Health in Rwanda, which was invited by the Government of Rwanda to help strengthen health systems making it feasible to achieve health care for all, specifically the most vulnerable communities. Partners In Health was already supporting a full health strategy in the districts of Kayonza, Kirehe and Burera. Subsequently, the Ministry of Health approached Partners In Health to collaborate on a systematic, inclusive and scalable national adult and pediatric cancer program. This led to the birth of BCCOE which officially opened in July 2012, becoming the only rural cancer center in East Africa. There is no treatment too complex or too expensive to justify its access for only some people and not for others, especially the poor. Partners In Health by its very mission is determined to prove this, and particularly with cancer care. Our partnership with the leadership of the Ministry of Health is setting an exceptional environment for Rwanda to succeed in providing cancer care for all and be an example for the rest of the world,” asserted Dr. Joel Mubiligi, Partners In Health’s Executive Director. Today, BCCOE is in its 7th year of operations, and it offers a range of cancer services which include basic imaging, pathology-based diagnosis, outpatient screening and consultation, selective surgery, chemotherapy, and fully covered referral of selected cases for radiotherapy and palliative care. This support is provided to people like Akimana and other patients in the first, second and some in the third category of Ubudehe, a classification of Rwandans based on economic status initiated by the Government of Rwanda to ensure social protection of Rwanda’s poorest families. “Since opening, the Center has taken in over 7,500 patients from all over Rwanda, as well as from neighboring countries, seeking treatment in Rwanda. We could not have imagined this outcome when we started in 2012,” Dr. Cyprien Shyirambere, the Oncology Program Director at Partners In Health, says. The most common cancer treated at Butaro Cancer Center of Excellence among adults is breast cancer, with 87% of the diagnoses being women, while acute lymphoblastic leukemia is the most common pediatric cancer. BCCOE has made significant inroads to addressing the growing global cancer burden and Partners In Health has been supporting its growth. This support is two-fold, both medical and socio-economic support. Notably, when BCCOE refers patients for radiotherapy, which is soon to be offered in Rwanda, Partners In Health would take over the responsibility of covering the treatment itself as well as their expenses during the duration of the stay. Patients are sent to Nairobi, Kenya, which is where the bulk of cancer patients from BCCOE are referred for radiotherapy. This will be changing as of 2019. Rwanda Military Hospital is gearing up to open Rwanda’s first Radiotherapy Center. The second type of support is socio-economic: “During his inaugural address at the UGHE ribbon cutting in Butaro, President Kagame noted something important about Partners In Health’s approach to healthcare - which is that we treat people, not diseases. We consider the condition of the person and address it all together. When a woman comes to Butaro Cancer Center of Excellence for breast cancer, we see her in the clinics, we learn of her socio-economic status, and based on her categorization in socio-economic cluster (ubudehe category), we provide her support in food, transport, and in the long run work with her to improve her livelihood. This has been the corner stone in reducing lack of follow up for cancer patients, this improves their health outcomes,” Antoinette Habinshuti, the Deputy Executive Director at Partners In Health, elaborates. As BCCOE grows to accommodate the growing need for comprehensive cancer care in Africa, and globally, it calls into question the need for sustainability. The Ministry of Health and Partners In Health have been taking steps to address this question, by organizing intensive capacity training of Rwandan clinicians, with a result that over 40 trained oncology nurses have been deployed to different health centers across the country. Dr. Fredrick Kateera, the Chief Medical Officer, attributes this dedication to revolutionary cancer care and treatment as part of the core tenets of Partners In Health; “At Partners In Health, we number ourselves alongside all institutions and individuals across the world committed to taking action against cancer. We avail ourselves to proactively engaging with governments, health systems and local communities to mitigate the injustice of cancer and the effects.” “The Butaro Cancer Center of Excellence was founded by the Rwandan government, as a response to an urgent need for comprehensive services that would address and help to reduce the increased cancer incidence in Rwanda. The leaps and bounds that cancer care has taken since 2012 is so impressive that it far exceeded any of our expectations. This has only been made possible because of the progressive nature of the Rwandan government and its policies towards Rwanda’s health system as a whole. Going forward, we hope to see an increase in trained oncology and cancer care clinicians in Rwanda. Given the current trajectory of cancer care in Rwanda, I am in no doubt that in years to come, the country will be Africa’s premier cancer care and research destination,” Dr.Mubiligi remarks. This World Cancer Day, Partners In Health is proud to commit to this year’s theme - “I am and I Will,” – where we recommit ourselves to bring cancer prevention and care to Rwandans as well as fighting to mitigate the impact for cancer patients, their families and communities. Partners In Health (PIH), known locally as Inshuti Mu Buzima (IMB), is an international nonprofit organization that helps build and sustain public health systems in poor and underserved communities around the world. Grace Gatera Communications Officer, Partners In Health - Inshuti Mu Buzima GHC Fellow 2018/2019

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FEATURED: Cancer: No longer a death sentence in Rwanda