When a cervical cancer patient is done with treatment, they usually go back for check-ups for a period of five years.

This is done to see whether the patient has not developed complications from treatment and that there is no recurrence of the disease, according to medics.

Check-ups are done every three months for the first two years, every six months for the third year, and six to twelve months for the fourth and fifth year, though this varies, sometimes depending on how the oncologist sees the patient. And that’s what is termed as ‘survivorship care.’

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According to Dr. Fidel Rubagumya, Consultant Clinical and Radiation Oncologist at Rwanda Military Hospital and a senior lecturer at University of Rwanda, caring for any cancer patient after treatment is important in offering them any necessary support which includes medical, emotional, social, and of course inspection for any cancer recurrence as well as detecting any new cancers.

Dr. Rubagumya however says offering this form of care in Rwanda is impeded with challenges such as limited cancer centres and the number of oncologists.

Currently, there is only one centre with capacity to treat cervical cancer, yet there are still a number of cervical cancer patients coming in at our cancer centre for treatment and the numbers are really increasing, he says.

"Almost 50 per cent of the patients we see are cervical cancer patients. And as numbers increase, not only with cervical but other types of cancers, they put pressure on the system and you find that cancer specialists are overwhelmed.

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"And in addition to treating new patients, cervical cancer patients still have to come back to the centre for post treatment care. You can imagine that if 300 patients have been treated a year and they have to come back every three months, plus the new patients, this puts a lot of pressure on the system,” he says.

He therefore plans to decentralise survivorship care, with a goal for every district hospital to be able to avail these services to cancer patients.

Earlier this year, Dr. Rubagumya was awarded a grant by American Society of Clinical Oncology (ASCO)-that is aimed at supporting his research project on decentralising cervical cancer survivorship care in Rwanda.

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Patients who finish their treatment will not always need to come back to the centre unless there is a need that cannot be solved by gynaecologist or general practitioners at the nearest district hospital, that’s his goal.

"We plan for survivors to be seen by doctors near where they live, so that they don’t travel a lot. Usually they come to Kigali for this yet some don’t have relatives to accommodate them, they spend a lot of time and money on transport and accommodation.”

Piloting the project with cervical cancer will involve training general practitioners and gynaecologists at district hospitals, to be able to take care of those patients. They will also be availed with materials and resources to be used while attending to patients.

"We will create channels where there will be communication with the oncologist at the centre in case of need for support. We are piloting this in a few district hospitals in three years, and we hope to advocate with the Ministry of Health so that this can be scaled up in the whole country,” he explains.

Putting survivors at the front

With this award, Dr. Rubagumya notes that they have support and a team that they are building to help implement this.

"We hope that by the end of this project, which is a three year project, we will be able to minimise the number of patients seeking this particular service. We want to put survivors at the front. We don’t want to again jeopardise their quality of life or their survival. By doing this, we will ensure quality care.”

The oncologist commends the country’s efforts in eliminating cervical cancer, noting that vaccination and screening efforts are all yielding positive results.

"In Rwanda, we have achieved one of the targets whereby 15-year-olds are now vaccinated with the coverage of 90%. So the target is that even older women, those who are eligible to be screened, to be at the rate of 70% and 90 per cent of those who have the disease be treated.”

"With this in mind, there are going to be a lot of cervical cancer survivors and that means they are going to need a lot of care. This means that in the next 10 to 15 years, we are going to see a reduction in numbers of cervical cancer in Rwanda, it will be a relief.”

He emphasises the need for patients to do their follow up, because without that, complications could arise and doctors may fail to detect cancers, which can come back, or be caught at an early stage.

"What matters is the quality of life of the patient. Complications can cause a lot of issues. Follow up is important. Just like patients, survivors need to get full attention. We don’t want them to feel like they are discarded from the system once they finish their treatment, but rather supported and cared for.”