At Partners In Health, a non-profit organization working in Rwanda and other 11 countries across the world, we recall a tale of a young patient called Sibo. In 2007, in the remote community of Mahama in Kirehe District, cancer was still shrouded in fear and misconceptions about witchcraft. However, for young Sibo, a 14-year-old boy, a cancer diagnosis marked the beginning of a long and challenging journey. Sibo, the eldest son of his family, was a cheerful young man when he was diagnosed with cancer after months of searching for answers about an illness that remained a mystery. His family, lacking awareness of the disease and struggling financially, had little hope that their son would recover. But when Sibo arrived at one of the Partners In Health-supported hospitals, a new chapter began. With the organization's support, he started treatment at Rwinkwavu District Hospital, underwent multiple rounds of chemotherapy and radiation therapy in neighboring Uganda. Unfortunately, the cancer returned a few years later. Partners In Health then arranged for Sibo to be transferred to Boston Children's Hospital in the United States, where he underwent a grueling bone marrow transplant. After years of treatment, Sibo's cancer was cured. Sibo returned home to continue his education and later received a scholarship to study in the United States. Today, he has graduated from high school and works at the Partners In Health warehouse in the Pharmacy section at Rwinkwavu, where his treatment journey began. He aspires to become a doctor one day and help patients in need. Sibo's story is a testament to the progress of cancer care in Rwanda. Cancer is a complex disease that requires one or a combination of treatments, as well as infrastructure, qualified healthcare providers, and an efficient system to ensure that patients have timely access to quality care. For low-income countries like Rwanda, access to life-saving cancer care remains a challenge. The growing burden of cancer in the developing world is similar to the HIV epidemic of the 1990s, when some public health experts claimed that treating HIV in low-income countries was a waste of resources and too costly and complex for these countries. However, as we later learned, they were proven wrong. Rwanda, in partnership with organizations like Partners In Health, is determined to change the narrative around cancer care as well. Before 2011, cancer care was virtually nonexistent in Rwanda. Today, variable treatment modalities can be found at five Hospitals. In 2012, the government of Rwanda in partnership with Partners In Health inaugurated Butaro Cancer Center of Excellence, hosted at Butaro Hospital. In its first six months, the center received 543 patients. In the following year, that number increased to 1,147. As of this writing, the center has enrolled over 14,000 total patients from Rwanda and across the continent. More than twenty different types of cancer can be treated at Butaro Hospital in collaboration with other local hospitals like the Rwanda Military Hospital. Partners In Health subsidizes chemotherapy and other ancillary medications to ensure that all patients receive treatment. Targeted therapies that increase survival rate with less side effects on patients are being added to the treatment regimens. In addition to medical care, most patients receive comprehensive care without necessarily having to travel abroad like Sibo. However, the type of cancers that can receive such comprehensive care in the country are still few compared to the need. At the backdrop of World Cancer Day marked in February, other milestones are also worth celebrating. An HPV vaccination rate of 93% among school-going girls in the country has been achieved. Radiation therapy is available at the Rwanda Military Hospital. Cancer has been demystified through awareness campaigns and great testimonies of cancer survivors like Sibo and others. Partners In Health, Rwanda Biomedical Centre and other partners work together to promote healthy lifestyles and educating the public about the importance of early detection through various campaigns and programs. Cancer screening programs have been decentralized to health centers across the country, where nurses have been trained to detect symptoms of cancers like breast and cervical cancers at an early stage when it is most treatable. While there are many wins in our cancer treatment journey, cancer remains a growing burden in Rwanda and the African continent with about 70% of deaths from cancer reported from low- and middle-income countries, coupled with a number of roadblocks. One of those challenges is the supply chain and cost of cancer drugs. The chain of cancer drugs is a complex and multi-faceted process that involves a variety of stakeholders, including manufacturers, distributors, wholesalers, and pharmacies. Cancer drugs are imported from outside the continent at a high price. However, even when an order is made, it takes a long time for these drugs to arrive due to lack of local retailers, putting the lives of thousands of patients at risk. But most importantly, the price of the drugs – set by manufacturers – is not affordable by the large majority of people in developing countries and often pushes families to financial ruin. As seen with the HIV pandemic and COVID-19 vaccine distribution, even those in resource-limited countries have the right to and can receive the highest attainable level of health care. With its limitations, the cancer care service in Butaro Hospital is thriving to prove the same. Where you live should not determine whether you live or die. Alongside all the efforts for prevention, the next challenge is to build on the existing foundation and allow our patients to access the latest advances in cancer care without flying across the world. This will require a global collaboration to reduce the cost of cancer drugs and facilitate the supply across the world. Dr Joel M. Mubiligi is the interim Vice Chancellor of University of Global health Equity (UGHE) & Executive Director of Partners In Health/Inshuti Mu Buzima.
