On December 1, Rwanda, like the rest of the world, marked the World Aids Day and the country hosted the 2014 International HIV Research Conference in the same week. Clearly, there has been a great success in HIV/Aids prevention and reduction in mortality and morbidity rate in Rwanda. But one would ask what can be done to leverage the existing infrastructure for HIV and Aids to address the cancer burden in Rwanda. Twenty years ago, at least more than 50 per cent of hospital beds in the country were occupied by HIV/Aids patients. This number has dramatically gone down. Today, at least you will find a cancer patient or one that is suspected in each hospital and to, a great extent, at Butaro Hospital, which has a cancer centre of excellence. For the past two decades, there has been a dramatic increase in resources sunk into fighting HIV/Aids in the country and this was made possible by the government with the support of development partners. This greatly contributed to the provision of different HIV/Aids services throughout the country. From 1997 programmes like Voluntary Counseling and Testing (VCT) and prevention of mother to child transmission (PMTCT) revolutionised HIV/Aids prevention campaigns without forgetting the free access to HIV/Aids drugs (anti-retroviral drugs and treatment). During that period, the general perception was that a person diagnosed with HIV would not live long due to lack of treatment, or would even succumb to depression mainly because the disease was conceived a death sentence. However, despite the gains made in fighting HIV prevalence, on the other side cancer is killing more people than AIDS, tuberculosis, and malaria combined, with 70 per cent of cancer deaths occurring in developing countries. Screening programmes Despite this huge burden, cancers have been receiving a fraction of global and national attention while more resources have been invested in the fight against infectious diseases. More alarming is that most low- and middle-income countries have limited comprehensive cancer prevention, care and control efforts on their health agendas in the broader context of health system. I believe that with the available resources, infrastructure, and experience in combating HIV/Aids much can be learned and applied to address the cancer burden in Rwanda. It should be noted that most cancers, when detected early, can be cured. These include breast cancers, cervical cancers and different childhood cancers. In the fight against HIV/Aids, many VCT sites were created, while different campaigns, seminars and conferences were conducted in different parts of the country with the aim of zero HIV infection. The same approach should be used to motivate people to seek early cancer screening and this would work best if there was an increase in screening capacities nationwide. Easy access to treatment The country so far does not have more than five mammography machines (for breast cancer), not more than ten colono/endoscopies (to screen for esophagus, gastric, intestine, and rectum cancers) while specialised blood-cancer screening tests are carried out in few centre. The free access to HIV/Aids drugs dramatically led to a decline in HIV/Aids mortality rate which was initially believed to be unachievable. Similarly, cancer drugs should be readily availed in order to motivate people to go to hospitals for screening tests and treatment. Decentralising cancer care In many developing countries, Cancer Care is rare due to different reasons and where it is available it’s only in urban areas. It has been proved in Rwanda that HIV/Aids Care can be integrated in other health services. So far, HIV/Aids patients are efficiently treated and followed up at health centres. The same approach should be used to tackle cancer and we need to identify what can be done at each level from the community level up to referral hospitals in screening, detecting, and raising awareness of cancer, at the same time ensuring standard quality of care. Awareness, advocacy, education It remains essential that the general public be educated about the early signs of different types of cancer and informed that there is a good prognosis when detected early. Different NGOs, activists and advocates are needed to mobilise funds and raise awareness of the disease across the country. The success in treating HIV/Aids is proof that cancer can be approached in the same way and decisively dealt with. This will be achieved with the help of different groups, organisations, development partners, media and individuals. The writer is Founder & Director, Rwanda Children’s Cancer Relief and a medical doctor, Butaro Hospital, Oncology Department idel.rubagumya@yahoo.com
